As Richard Lowes wrote recently, as of 1 November 2018, medicinal cannabis will be available on prescription in the UK. The move was announced in a written statement by Home Secretary, Sajid Javid. It’s a move that has got many chronic pain patients excited, but what exactly does this mean for sufferers?
Who can get a prescription?
The legislation says anyone can; there’s no restriction on the type of illness you need to have to be eligible for a medicinal cannabis prescription. In real terms, it’s likely to be given at first to sufferers of these conditions:
- Nausea caused by chemotherapy
- Chronic pain
How do I get a prescription for medicinal cannabis?
Through a consultant. GPs will not yet be able to prescribe medicinal cannabis, but it looks likely that this will change in future.
Sounds great! What’s the catch?
Well, the Home Office statement is somewhat loose in its guidance. There’s no limit on the types of illness eligible for a prescription and no real guidance on the type of medicinal cannabis product that should be prescribed. We do know that prescribing cannabis for smoking is definitely not allowed, but oil may be given for vaping.
What that means is that every consultant will have to evaluate each patient individually and then decide what they think is best. The problem then is that whilst most consultants have a really good understanding of how, say, an opiate painkiller will affect a patient, they generally have almost no experience of the effects cannabis will cause. Doctors like to fully understand medicines before they prescribe them, and at the moment there’s hardly any out there with a real working knowledge of cannabis. Doctors have also been subjected to years of messaging portraying cannabis as a dangerous drug that ruins lives; you don’t overturn all that conditioning immediately.
There’s a good body of evidence out there to show cannabis’s efficacy for a range of conditions, but at the moment it’ll be up to each individual consultant to do their own research and I just don’t know how realistic that is.
So what will happen?
Realistically, therefore, I don’t think we’ll see thousands of these prescriptions being handed out by hundreds of consultants. The good news is that over the next few months, the professional organisations that approve medicines for use on the NHS will be conducting further research with the aim of giving stronger guidance to all doctors by October 2019. That could be the moment when medicinal cannabis genuinely goes mainstream in the UK.
Why is this happening now?
Cannabis has a higher profile now than ever before. Just this week, Canada has legalised it. More and more countries worldwide are decriminalising cannabis for personal medicinal use, including Australia, Belgium, Croatia, Germany, and Poland. In the past year there have been two very high-profile UK cases of young boys being granted permission to take cannabis oil for their epilepsy with stunning results. Don’t forget the impact of America’s opioid crisis either; the pressure to find alternative painkillers is possibly higher than it’s ever been.
Does this mean cannabis is likely to become legal in the UK?
The Home Secretary, Sajid Javid, has very emphatically said no: “I have been consistently clear that I have no intention of legalising the recreational use of cannabis”.
So what does it mean for chronic pain patients?
There’s no doubt that this is a great move forward. There’s good research out there showing that cannabis can help neuropathic pain, which will be music to the ears of desperate CRPS sufferers in particular.
It probably is only the first step towards medicinal cannabis on prescription for many of us, though; without specific recommendations for consultants it’s unlikely many of them will be willing to take the risk of prescribing medicinal cannabis. The government have promised that guidance is coming though, in the form of guidelines to be published next year and that may give prescribers the confidence they need to start prescribing it for their patients.
If you’re really keen to try medicinal cannabis on prescription now then I suggest doing your research and becoming an ‘expert patient’; this is something many pain sufferers are well used to doing. If you have a sympathetic consultant who you can present with a strong fact-based argument as to why you want to try medicinal cannabis right now then it could be enough to convince them.
Watch this space: more updates to come.