Project Twenty21: Europe's largest medical cannabis program opens to UK patients

The Twenty21 project opens up to British patients. Unveiled in November 2019, Twenty21 is a registry that will track the health data of 20,000 patients using cannabis-based medicines (CBMPs), creating the largest body of evidence in Europe on the safety and efficacy of CBMPs.

The registry system has been developed by scientific experts and will collect patient data from medical consultations to finally answer the main questions about medical cannabis, namely whether the benefits of treatment are proven and outweigh the potential risks. The project will produce scientific information for doctors, patients and decision-makers in the NHS and the UK government.

Limited access to medical cannabis

On November 1, 2018, the medical cannabis legalized in the UK, authorizing doctors to prescribe cannabis-based medicines. No public prescriptions has been issued to date., The only way to access medical cannabis is through private prescriptions, at costs too high for most patients.

Medical cannabis is only authorized in the UK for a few conditions (epilepsy, spasticity, nausea or vomiting resulting from chemotherapy) which may be covered by the NHS. Patients must also find a doctor trained to prescribe medical cannabis, a course of training that has not been undertaken by the state.

Another obstacle is the lack of data or evidence. Until recently, unless a company obtained a special license from the government, it was not allowed to research cannabis. For the NHS to authorize the use of this medicine, it requires solid scientific evidence showing that the treatment works and is cost-effective. Since November 2018, the Department of Health and Social Care has called for more research into medical cannabis, so that it can be evaluated and approved for use in the NHS. This is why Project Twenty21 was created.

Project Twenty21

Over a 2-year period, the Twenty21 project will provide 20,000 patients with cannabis for the following diseases:

• Anxiety disorder
• Chronic pain
• Multiple sclerosis (MS)
• Post-traumatic stress disorder (PTSD)
• Substance use disorder (as a harm reduction strategy)
• Tourette's syndrome

In June 2020, the Twenty21 Project team began beta-testing the patient pathway and opened access to a clinic (Medical Cannabis Clinics) for 100 patients. It is now open to the remaining 19,990 patients, who can now register for the project and be prescribed medical marijuana.

To join the register, the patient must choose a clinic among those participating in the project and provide them with a diagnosis of their illness and a history of two «classic» medications that were previously prescribed but have proved ineffective in treating their disease. The first consultation at the clinic will determine whether the patient can be prescribed medical cannabis products based on his or her medical history and clinical needs. The cost of the consultation is borne by the patient, between £110 and £150 depending on the clinic.

Projet Twenty21 then teamed up with medical cannabis producers to limit the cost to £150 per product per month, with the remainder covered by Twenty21. This fee gives access to:

• up to 20 mg THC / day alone - 600 mg THC oil per month
• up to 100 mg CBD / day alone - 3000 mg CBD oil per month
• up to 1g of cannabis flower / day alone - 30g of dried flower per month

Various CBD and THC ratios will be available. For the time being, Project Twenty21 is working with Khiron Life Sciences (Latin America), Bod Australia, Cellen Therapeutics and Senzer Pharamceuticals (UK) and the Jamaican Medical Cannabis Corporation to source the cannabis.

To remain in the registry, patients will have to report the effects of cannabis on their symptoms, as well as any side effects, at quarterly clinic consultations. Analysis of the project data is scheduled to begin at the end of 2022.

A quick video explains how the British can become part of the Twenty21 Project.