ITEND to avoid overly medical topics when considering what to write about in my column each month – I worry that getting too technical might put readers off.

However, this month I’ve decided to put that aside, to talk about two drugs that have both featured in the Island’s political discussions of late – lisdexamfetamine and tetrahydrocannabinol.

At first glance you might think you haven’t heard of either of these drugs, but I’m sure you are probably aware of them in one way or another. That’s because tetrahydrocannabinol, or THC for short, is one of the main active components in cannabis. And lisdexamfetamine is a form of amphtetamine commonly used in the treatment of Attention Deficit Hyperactivity Disorder, or ADHD.

With both hitting the headlines, I thought it might be interesting to carry out a “compare and contrast” exercise.

Firstly the similarities. Well, both cannabis and lisdexamfetamine are prohibited under the Misuse of Drugs (Jersey) Law 1978, listed under class B.

This means that both substances are illegal to possess, supply or consume without the appropriate authority. And as I’m sure you will be aware, both amphetamines and cannabis have been used for many years for recreational purposes (in the case of cannabis for several millennia).

Both drugs are also listed under Schedule 2 of the Misuse of Drugs (General Provisions) (Jersey) Order 2009, which outlines the process by which these controlled substances can be prescribed for medical reasons.

Actually, that’s probably it for the similarities – the drugs work in very different ways, produce very different effects and are used for different medical reasons.So now onto the contrasts, initially from a UK perspective.

Lisdexamfetamine (with the brand name Elvanse) was licensed in the UK for the treatment of ADHD in 2013. It is one of a handful of amphetamine-type drugs prescribed, and is particularly useful due to its long-acting effects – the body needs to turn it into active amphetamine, which occurs over a period of time, so the effect is gradual and avoids the on-off effects of some other medications.

Receiving a medical licence means that the product went through several rounds of safety and effectiveness testing beforebeing authorised for prescription. In the UK, lisdexamfetamine, like most similar ADHD medications, is usually started by a specialist before prescribing is taken over by the patient’s GP under what’s known as a “shared care” arrangement.

Cannabis, on the other hand, is not generally a licensed medication. There are a few licensed cannabis-containing products available for specific and limited use, and all cannabis prescribing in the UK is limited to doctors on the General Medical Council’s Specialist Register only. NHS use is restricted to specific conditions – namely intractable nausea and vomiting, multiple sclerosis-related spasticity, and severe treatment-resistant epilepsy.

If you’ve read this far, you will probably have the impression that lisdexamfetamine and similar ADHD medications are relatively straightforward, have been well tested, and would mostly be prescribed by a GP. And in the UK you would be right.

Cannabis, on the other hand, is generally unlicensed, with more restrictions on who can prescribe and a far more limited range of patients likely to benefit (at least, according to current licensed indications). Which brings me on to the situation in Jersey.

According to recent press coverage on ADHD treatment, currently in Jersey’s adult service there are around 300 monthly prescriptions, all supervised by a single specialist consultant. Patients are only able to access a prescription once they have gone through the local diagnostic process, for which the waiting list is many years long.

There isn’t a shared-care pathway in place, and if GPs were given the authority to prescribe ADHD medication it was estimated that this would cost an additional £800,000 annually to the Health Insurance Fund, to treat an estimated 1,500 adults with ADHD.

So what about cannabis? Data presented earlier this year suggested that up to mid-2023 approximately 6% of the adult population in Jersey were being prescribed cannabis (compared to 0.05% in the UK).

Recent FoI data shows a continuing steady increase in imports since then – from approximately 47kg of cannabis flower imported per month in the first half of 2023, to 76kg per month in the first half of 2024. So it’s reasonable to assume that the prescription numbers have also continued on an upward trend.

It’s certainly interesting to note that, when Jersey legislated for the prescribing of medicinal cannabis in 2018, no limits were placed on which doctors couldprescribe, or for what purpose.

You might be thinking at this point, why the difference? We have discussed two controlled drugs – one which is relatively freely available via GPs in the UK and the other limited to specific indications under the care of a registered specialist. In Jersey, we have things exactly the opposite – the welltested, licensed and mostly safe ADHD medication being strictly rationed and cannabis being a relative “free-for-all”.

It’s certainly not my place to say what was going through the minds of the States Members who legislated for cannabis prescribing, but what they certainly did do was open up commercial opportunities for local clinics to grow the business of private prescribing with relatively few restrictions.

I am not commenting here about the medical benefits of either drug – both have their uses in the right circumstances. But what I am commenting on is the issue of health equity. Due to commercial imperatives, it is now relatively easy to access cannabis on prescription in Jersey, if you have the funds to do so. On the other hand, accessing ADHD medication is somewhat of a lottery, even if you can afford private care.

The Health and Social Security Scrutiny Panel are currently looking into the issues patients are having accessing medication for ADHD, including the reluctance of non-specialist prescribers to take on shared-care protocols in the community. I would ask the panel, and others involved, to reflect on why it’s so easy to access one controlled drug but not the other?

•Dr Chris Edmond is the founder and medical director of WorkHealth (CI) Ltd, a dedicated Jersey-based occupational health provider. He is also a director at Jersey Sport and Lifestyle Medicine Jersey, and adviser to the Jersey Community Foundation. He writes in a personal capacity.

‘‘There isn’t a shared-care pathway in place, and if GPs were given the authority to prescribe ADHD medication it was estimated that this would cost an additional £800,000 annually to the Health Insurance Fund

What do you think?

•Are you on the waiting list for ADHD diagnosis? How long have you been waiting?

•What is your experience of getting access to these medications?

•What would be your comments to the Health and Social Security Scrutiny Panel?

Send your thoughts to editorial@ jerseyeveningpost.com or #jointhedebate on social media