New guidance for prescription of medicinal cannabis but access is limited

Friday 2 November 2018

Yesterday, new guidance has been provided to clinicians by NHS England for the prescription of medicinal cannabis but access to the drug remains highly restricted

The regulatory change comes following the Government's decision to reschedule the drug following the high profile cases of two severely epileptic boys, Alfie Dingley and Billy Caldwell.

This guidance has been widely misconstrued by a number of media outlets claiming the widespread use of medicinal cannabis whereas, in reality, the guidance means medicinal cannabis will be available to very few patients.

What does the new guidance mean?

Due to the limited evidence base, the Government are only allowing prescription of cannabis products to be administered by those clinicians listed on the Specialist Register of the General Medical Council (GCM) and to patients where there is a clinical need which cannot be met by a licensed medicine and all other treatment options have been exhausted.

This is to ensure rigorous and auditable safeguards around prescription of these products is maintained as well as adhering to existing protocols on controlled drugs.

The specialist doctor should only make the decision to prescribe within their own area of practice and training and be agreed by a patient's multidisciplinary team.

Currently, these products are only likely to be prescribed for children with rare and severe forms of epilepsy, adults with chemotherapy-induced nausea and vomiting, adults with spasticity caused by multiple sclerosis (MS) and for conditions where other treatments are not suitable, available or haven't helped.

Highly restrictive guidance

NHS England announced very few patients will actually be eligible for a prescription and we're calling on the Government to urgently review the interim guidance for the prescription of cannabis-based medicinal products.

We also believe doctors are being actively discouraged from prescribing medicinal cannabis as guidance will standardise doctors to prescribe these products only when established treatment options have been exhausted as opposed to considering the best interests of the patient as the primary priority.

The scoping exercise and The Chief Medical Officer for England Review's findings, as well as those from patients, health professionals and charities, do not appear to have been adequately considered in the formulation of this guidance.

Clinical guidelines

Following the Government's announcement and NHS England guidelines, the National Institute for Health and Care Excellence (NICE) has been asked by the Department of Health and Social Care to produce a clinical guideline on the prescription of cannabis-based medicinal products which is not expected to be published until October 2019.

We will be feeding into this consultation outlining the highly restrictive measures of this interim guidance for patients wishing to access medicinal cannabis.

What next?

Whilst we welcome the regulatory change by the Government in legalising medicinal cannabis, we believe the guidance they are proposing is not in the best interests of patients for whom cannabis may help with their condition.

We will be speaking directly to clinicians and our community to identify how this new guidance will affect patients with a brain tumour, particularly for those suffering from chemotherapy-induced nausea and vomiting.

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