Cannabis-based products were moved to Schedule 2 of the 2001 Misuse of Drugs Regulations and in October, doctors in England, Wales and Scotland were given the green light to prescribe medical cannabis by Home Secretary Sajid Javid. (Drugs under Schedule 1 are deemed to not have any therapeutic value and are only available for research purposes through a Home Office licence.) From 1st November, it became law that registered specialist doctors are now able to prescribe medical cannabis to some patients in need.
5 key conditions – more to follow
Although medical cannabis could be used to treat over 52 conditions, in the short-term, doctors and clinicians will focus on the five conditions set out in the government’s review:
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Multiple sclerosis (specifically pain or muscle spasticity)
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Chemotherapy-induced nausea and vomiting
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Severe treatment-resistant epilepsy in children (specifically Dravet Syndrome and Lennox-Gastaut Syndrome)
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Chronic pain in adults
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Appetite and weight loss associated with HIV/AIDS
Data from the British Medical Journal shows that over 4 million people in the UK suffer from ailments that could be eased with cannabis therapies (including Crohn’s disease, anxiety and depression, spinal cord injuries, Alzheimer’s, rheumatoid arthritis and fibromyalgia, among others). However, only a fraction of patients are expected to apply for treatments. A potential patient base of 4 million would represent 6% of the UK population and most mature medical cannabis programs only penetrate between 0.5% (The Netherlands) and 3.6% (California) of the population.
Legal doesn’t mean accessible
Although medical cannabis is now officially legal, that does not mean it will be easily accessible. The government has restricted access to medical cannabis products due to “limited evidence base and their unlicensed nature”. With the exception of Sativex, all other medical cannabis products are currently unlicensed in the UK. Furthermore, according to NHS guidelines, only clinicians on the Specialist Register of the General Medical Council will be allowed to prescribe medical cannabis and only in certain conditions:
“As with any unlicensed medicines or “specials”, the prescribing of such products must be on a “named patient” basis. It is therefore expected that rigorous and auditable safeguards around prescribing of an unlicensed product will be followed, alongside existing protocols on controlled drugs […] NHS England expects that cannabis-based products for medicinal use should only be prescribed for indications where there is clear published evidence of benefit or UK Guidelines and in patients where there is a clinical need which cannot be met by a licensed medicine and where established treatment options have been exhausted.
The NICE is set to produce clinical guidelines for prescription by October 2019. In the meantime, the British Paediatric Neurology Association will issue clinical advice for using medical cannabis to treat some forms of severe epilepsy.There will be three access routes for patients to access medical cannabis:
1. A special medicinal product for use in accordance with a prescription or direction of a doctor on the Specialist Register of the General Medical Council;
2. An investigational medicinal product without marketing authorisation for use in a clinical trial or;
3. A medicinal product with a marketing authorisation.
Doctors and healthcare professionals currently lack the knowledge and experience to implement the new system but online platforms are already being produced by medical cannabis experts. As the medical cannabis program develops in the UK, education will be instrumental in creating safe and accessible treatments for patients across the region.
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