As we reported at the time, on 1 November 2018, cannabis-derived medical products were placed in Schedule 2 of the Misuse of Drugs Regulations 2001. On the face of it, that provided official recognition in the UK that these products have a therapeutic value, enabling doctors to prescribe them. However, we cautioned that this re-categorisation was not going to result in ‘open season’ for the prescribing of medical cannabis. And how true that turned out to be.
The day before, on 31 October 2018, the NHS in the guise of the Department for Health and Social Care, issued a letter providing interim guidance to the medical profession on prescribing cannabis-based products for medical use. Hugely restrictive, these have been in place pending publication of longer term guidelines by the National Institute for Health and Care Excellence (NICE). As of November 2019, those are now available.
While the new guidelines do provide for a very limited use of cannabis-related products; specifically for:
- intractable chemotherapy-induced nausea and vomiting (with Nabilone);
- moderate to severe spasticity in multiple sclerosis (with THC:CBD spray); and
- drug resistant paediatric epilepsy – Dravet and Lennox-Gastaut syndromes (with CBD),
they say that people with chronic pain should not be prescribed drugs containing THC (delta-9-tetrahydrocannabinol), the main psychoactive ingredient in cannabis. In essence, this amounts to a blanket ban on NHS-prescribed medical cannabis for chronic pain.
The reason for this is that NICE says there is no evidence to show that cannabis is of benefit for people suffering chronic pain.
However, among many others, the campaign group, End Our Pain, said the new guidelines were a “massive missed opportunity” to prescribe medical cannabis for a range of conditions. Spokesperson Millie Hinton said “This restrictive guidance is condemning many patients to having to pay for life-transforming medicine privately, to go without or to consider accessing illegal and unregulated sources.”
Of course, in terms of funding, NICE only regulates NHS prescribing. In an earlier article we explained that people with extremely deep-pockets have the option of seeking a private prescription. However, as the Evening Standard have reported, private prescriptions could set you back an eye-watering £600 to £700 per month!
Arguably, there are also wider socioeconomic factors. Dr Daniel Couch, medical lead at industry body, the Center for Medicinal Cannabis, said “Cannabis as a medicine is unlike any other novel agent, in that it is already in widespread use outside the NHS. Up to 7% of NHS patients may already be using cannabis solely as a medicine, albeit without a prescription, and obtaining symptomatic relief through street vendors who are not subject to the good manufacturing processes and standards present amongst pharmaceutical suppliers. The tried and tested drug evaluation process may not take these non-clinical and wider-societal risks into account. An adaptive approach should be debated.”
Despite its increasing availability overseas, including in the majority of states of the US, for the foreseeable future, affordable, legitimately-sourced medical cannabis remains out of reach in the UK for those suffering chronic pain.