Twenty21 - Europe's Largest Medical Cannabis Trial

On Thursday 7th November 2019, Project Twenty21 officially launched at London’s Royal College of Psychiatrists. The Twenty21 trial is an endeavour to establish the largest body of evidence on medicinal cannabis in Europe, with the trial aiming to enrol 20,000 UK patients in the two-year project.

Project Twenty21 was developed by the leading independent scientific body on drugs in the UK, Drug Science, and has garnered support from medical cannabis campaigners, patients and several notable institutes, including; the Royal College of Psychiatrists, the British Pain Society and the United Patients Alliance.

It has been just over a year since medicinal cannabis was legalised in the UK, nonetheless only a small number of patients have been successful in accessing the medication through the National Health Service (NHS). This difficulty in accessing medicinal cannabis stems from doctors not fully understanding the drug and its efficacy and therefore being reluctant to prescribe it to their patients. When certain medical treatments have not worked for patients and they then find they are unable to access medicinal cannabis on the NHS, they are forced to choose between using the drug illegally or paying for expensive private prescriptions. The issues with access to medical cannabis and the prescribing of the drug are well-recognised, the director of Project Twenty21, Chloe Sakal, has said that ‘Medical cannabis has been legal to prescribe for a year now; one of the reasons we’re doing this is to help clinicians feel supported. We get requests from doctors every day saying they want to use it with their patients, but they don’t know how to write the prescription. We want them to feel like it’s OK [to prescribe medical cannabis] and that they’re supported [to do so].’

The cutting edge Twenty21 trial will primarily focus on how the drug affects patients who suffer from chronic pain, epilepsy, multiple sclerosis, post-traumatic stress disorder, Tourette’s syndrome, anxiety disorder, or who have a history of substance misuse. The trial will also concentrate on patients that have tried alternative treatments which have failed. It will not be a randomised control trial where some patients would receive a placebo, this trial will provide all of the 20,000 enrolled patients with medicinal cannabis, and the data will be collected every three months.

It is hoped that once the trial ends in 2021, the findings can then be used to convince policymakers of the need of affordable access to medicinal cannabis and to support and build confidence in UK health authorities and clinicians in prescribing the drug. The perception of medicinal cannabis is slowly evolving in the British medical industry, and this can be seen in early 2018 when the Royal College of Physicians united with the British Medical Journal, Faculty of Public Health, and the Royal Society of Public Health and called for UK drug law reforms. It is not only the medical community that the perception of cannabis is changing but throughout society, and this trial may just be the biggest pivotal point of that evolution in the UK cannabis industry.