We have considered previously both the legal status and availability of medical cannabis in the UK, particularly in the context of those suffering chronic pain.
The publication of that article shortly preceded the well-publicised cases of Alfie Dingley and Billy Caldwell, both young epilepsy sufferers denied access to cannabis oil which helps to control their seizures.
From a purely moral standpoint, on the basis of the past efficacy of the drug in both of these cases, the official prescribing position was unsustainable. Following the outcome of a review by the Government’s Chief Medical Officer, Dame Sally Davies, the matter was fast tracked to the Advisory Council on the Misuse of Drugs.
Now, following an announcement by the Home Secretary, Sajid Javid, from 1 November 2018, cannabis-derived medicinal products are to be placed in schedule 2 of the Misuse of Drugs Regulations 2001 (MDR). This provides recognition that they have a therapeutic value, which means that doctors are able to prescribe them. These products have to date been included in Schedule 1, indicating no therapeutic value and therefore available only with a Home Office licence, not on a doctor’s prescription.
However, Mr Javid was swift to stress that this move was not to be seen as a signal that the government were softening their stance on the recreational use of cannabis. “To take account of the particular risk of misuse of cannabis by smoking and the operational impacts on enforcement agencies, the 2018 regulations continue to prohibit smoking of cannabis, including of cannabis-based products for medicinal use in humans”, he said.
The incoming changes introduce a specific definition of “cannabis-based product for medicinal use in humans” and only products satisfying that definition will be included in Schedule 2 of the MDR.
To satisfy that definition, a product must fulfil three requirements:
- It needs to contain cannabis, cannabis resin, cannabinol or a cannabinol derivative;
- It must be produced for medicinal use in humans; and,
- It must be a medicinal product, or a substance or preparation for use as an ingredient of, or in the production of an ingredient of, a medicinal product.
The 2001 Regulations only allow three access routes for the order, supply and use of these products by patients. These are as follows:
- 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 – ie its use can only be prescribed or directed by consultants, not junior doctors or GPs;
- An investigational medicinal product without marketing authorisation for use in a clinical trial or;
- A medicinal product with a marketing authorisation.
Of course, the important one for most people is the first of those three.
Although the changes technically allow cannabis to be prescribed for any condition, do not expect ‘open season’ on prescriptions. Guidelines are due to be released before 1 November, providing advice for doctors on prescribing cannabis products for epilepsy, chronic pain and nausea caused by chemotherapy. They are expected to follow those guidelines strictly, which means that they are unlikely to prescribe it for conditions other than those stated.