Prescribing Cannabis-Based Medicines to Start in November: 5 Questions

Siobhan Harris

Disclosures

October 12, 2018

The Home Secretary Sajid Javid has announced that doctors will be able to prescribe cannabis products to patients from November 1st.

The new rules apply to England, Wales, Scotland, and Northern Ireland  and follow several high-profile cases, including those of young epilepsy patients Alfie Dingley and Billy Caldwell, whose conditions appeared to be helped by cannabis oil.

There is evidence cannabis-based medicines may help with nausea related to cancer treatment and multiple sclerosis symptoms as well as with epileptic seizures.

"This is a landmark moment as the UK comes closer to joining countries around the world to offer access to cannabis for medicinal use. MS is often painful and exhausting, and this change in the law could have a huge impact for up to 10,000 people with the condition to relieve their pain and muscle spasms," said Genevieve Edwards, director of external affairs at the MS Society. 

So who can prescribe medicinal cannabis and who will?

Q&A

Medscape UK spoke to Professor Mike Barnes, consultant neurologist and one of Europe's most learned experts in medical cannabis and medical cannabis policy. He secured the first long term license for Alfie Dingley.

Medscape UK: What's your reaction to the Home Secretary's announcement that doctors will be able to prescribe cannabis-based medicine from November 1st?

Prof Barnes: It’s a very exciting day. We've known this has been coming but it's been put through quickly and efficiently. There are some limitations which will need ironing out over the course of the first few months but overall this is very promising and very pleasing.

Medscape UK: What sort of limitations?

Professor Barnes: The main one, and I understand why they have done it, is that prescriptions will only be done by doctors on the specialist register, in other words hospital consultants.

The problem with that is, first of all it cuts down the number of people being able to prescribe as GPs are excluded. And secondly there is very little expertise on cannabis and the great majority of hospital doctors won't prescribe it, not because they are against it but because they simply don't know enough about it.

It's fair enough you shouldn't ask doctors to prescribe something they aren't sure about, don’t know the side effects and what dose to give. So the limitation factor will be the doctors' knowledge in the first year or so until educational programmes come along and doctors feel more comfortable about prescribing.

In reality though. limiting the doctors to just the specialists is a disadvantage. I can't see really why GPs should not be allowed to prescribe as well.

Medscape UK: How can doctors find out more about the potential benefits of medical cannabis?

Professor Barnes: Healthcare professionals can now sign up for access to the Academy of Medical Cannabis. Europe's first ever medical cannabis online education platform. The online learning system has 12 modules of 15 or 20 minutes each, teaching people about cannabis. It consists of simple questions that gives doctors a basic knowledge, enough to offer a sound opinion to a patient. It'll be up and running on November 5th.

Medscape UK: Is there any resistance to the use of medical cannabis from the medical profession?

I don't think there's much resistance in terms of the principle. I think people appreciate that the drug can help many people. I think the resistance is out of ignorance, by that I mean doctors in general don't know much about it.

There are doctors who fear for significant mental health risks of street cannabis. I think some of them get confused by the fact we are not talking about street cannabis we are effectively talking about a different product. This is a medical product and one that has, relatively speaking, low THC levels. It's the THC that makes you high and it's the THC in high levels in the street cannabis that causes mental health issues. With medical cannabis, with lower TCH levels, there's really very little in the way of significant risk. It's a very safe drug. I think there will be some doctors, particularly in the mental health arena who will be against it as they've seen the effects of that high THC street cannabis.

Medscape UK: How will it be regulated?

Professor Barnes: The Government has said the products need to comply to good manufacturing practice. This ensures quality and safety and consistency. There will need to be some monitoring. It's being prescribed through the specials system where doctors will take responsibility for prescribing a drug for which there is no license.

The vast majority of cannabis drugs have not been through a pharmaceutical route so there will need to be some monitoring of the specials system. There'll also need to be monitoring generally about how the whole thing goes, whether or not patients are accessing it adequately, and whether doctors are actually being unhelpful in terms of obstruction through that lack of knowledge.

They haven't said so but I think the Government is looking at it as a sort of 1 year trial period, before NICE report in October 2019. By then we will have a lot more experience of what the problems have been.

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