APPROVAL of cannabis-based drug Sativex is good news for people living with multiple sclerosis in Wales whose symptoms will be relieved by it - but its go-ahead highlights once again the issue of a postcode lottery for treatments.

LAST week's ministerial green light for the drug Sativex - to help ease muscle spasticity in some multiple sclerosis patients - attracted headlines as much for its cannabis-based components as for its symptom-relieving properties.

The drug, a spray taken through an oral inhaler, can now be prescribed to MS patients in Wales after an All Wales Medicines Strategy Group (AWMSG) recommendation of approval for use in the NHS in Wales was ratified by health minister Mark Drakeford.

MS charities hailed the decision as a big step forward, having sought to get Sativex approved across the NHS in the UK for some time.

But once again, the issue casts harsh light on postcode prescribing, Sativex being just the latest example of a treatment available on the NHS in one part of the UK, but not everywhere.

Barely a week goes by without the appearance of a story highlighting a treatment that might be, for instance, available in England but not in Wales or Scotland, or Northern Ireland.

There is also an issue with differing speeds of introduction for treatments into the NHS. In some cases, the process in one part of the UK can delay a treatment's availability for months.

It is an issue in which the term National Health Service can seem something of a misnomer for patients who, seemingly only due to an accident of geography, find themselves unable to access a treatment available to someone else in the UK.

On occasion, that someone else may only live a matter of miles away, over a border that devolution, in health terms, has made impassable.

The issue also spans the treatment range, taking in drug and non-drug treatments. Cancer drugs remain to the fore in the postcode prescribing debate, but MS treatments have a history too.

Nine years ago, Ian Williams, from Pontypool, was denied the opportunity to try chemotherapy drug mitoxantrone, to try to slow the progress of his MS, which had forced him to leave work and to use a wheelchair to get around.

After a protracted battle with health authorities, Mr Williams was successful in getting access to the treatment, which he says helped slow down the march of his MS.

A subsequent fundraiser for the MS Society, who has featured in awareness-raising campaigns and won awards for his efforts, Mr Williams, 41, who volunteers as a DJ at Able Radio, said Sativex was a drug he inquired about some time ago, discovering it was not available in his area, but was in other parts of Wales.

"I take pregabalin to ease muscle spasticity and it does that for me, but it is great that people now have the option to try Sativex," he said.

"Like a lot of other treatments, it will work well for some people, but won't work for others. But it is pleasing that Wales has stepped forward, and is sending out a message for the rest of the UK."

The National Institute for Health and care Excellence (NICE), which evaluates and decides what treatments should be available on the NHS, earlier this year rejected Sativex in its draft clinical guidelines for MS because it was not deemed cost effective.

The AWMSG assesses evidence on medications and provides recommendations and advice to the Welsh Government, to ensure effective treatments are available to people in Wales. It can recommend an alternative approach to NICE guidance, and its decision on Sativex overrules that guidance.

Not in England however, though NICE is reappraising Sativex. Another MS drug on its radar is fampyra, which can improve the walking ability of selected patients with the disease, the availability of which on the NHS in general is patchy.

The NICE draft guideline is that fampyra not be used to treat lack of mobility in MS patients, which charities such as the MS Society and the MS Trust are fighting.

Mr Williams said data on the efficicacy of fampyra, which costs around £190 a month, is very strong, with many people who have used it reporting at least a 25 per cent increase in their walking ability.

For Mr Williams, whose walking ability is now restricted to transferring to and from wheelchair and car, and "an

occasional trip up the stairs", fampyra could provide an option for future treatment should it become available on the NHS.

"It is annoying that a drug that has these potential benefits is being denied. Some of these treatments are potentially life-changing," he said.

As for Sativex, it is licensed to treat muscle spasms and stiffness in people with MS. A cannabis-based oral spray, it is a treatment option for people with moderate to severe MS-related spasticity which has not been adequately controlled by other anti-spasticity medication, and who demonstrate a measurable improvement in spasticity-related symptoms during an initial trial.

Previous research suggests not all recipients respond to Sativex. Its manufacturer Bayer has a scheme to help with the cost of identifying those who respond to Sativex by funding the first pack of treatment free of charge, after which the cost will be covered by NHS Wales for those people who find it effective.

Formulated from two chemical extracts derived from the cannabis plant, it contains delta-9 tetrahydrocannabinol (THC) and cannabidiol (CBD), and was the first cannabis-based medicine to be licensed in the UK.

It is a class B drug and can only be lawfully possessed under a prescription issued by a qualified health professional.

Passing Sativex to someone else, unless that person is lawfully entitled to possess the drug, is a criminal offence.