REMEDY : BNSSG referral pathways

Cannabis prescribing

Checked: 21-11-2018 by Rob.Adams Next Review: 21-11-2019

Overview

The following advice has been provided by the BNSSG Medicines Optimisation Team regarding medical cannabis:

Purpose

To highlight the changes in legislation and clarify the prescribing responsibility of cannabis-based products for medicinal use issued from NHS England to all prescribers.

Recommendation

  1. GPs are not permitted to prescribe cannabis-based products for medicinal use.
  2. Only those clinicians listed on the Specialist Register of the General Medical Council may prescribe cannabis-based products for medicinal use. The decision to prescribe within their own area of practice and training (e.g. physicians for adults should not be prescribing for children) and the decision to prescribe should be agreed by the multidisciplinary team.
  3. Products containing CBD oil continue to be available to purchase legally from a range of retailers however it is important to note these are classed as food products rather than medicinal products therefore the quality cannot be guaranteed and the proportions of cannabinoid compounds may vary from batch to batch.

Background

Background

From 1st November 2018 certain cannabis-based products have been rescheduled for medicinal use to Schedule 2 will mean they can be prescribed medicinally where there is an unmet clinical need.

Due to the limited evidence base and their unlicensed nature, the Government has chosen to restrict the decision to prescribe cannabis-based products for medicinal use to only those clinicians listed on the Specialist Register of the General Medical Council. The decision to prescribe within their own area of practice and training (e.g. physicians for adults should not be prescribing for children) and the decision to prescribe should be agreed by the multidisciplinary team.

Any decision to prescribe must take into account the relevant GMC guidance and the relevant NHS Trust governance procedures for unlicensed medicines in the normal way. As a minimum, NHS England expect that approval for use is granted on a named patient basis by the Drug and Therapeutics Committee Chair or Trust Medical Director. It is also good practice to discuss use of cannabis- based products for medicinal use with a peer clinician in the same Specialist Register of the General Medical Council.  Any such discussions should be appropriately documented.

National Institute for Health and Care Excellence (NICE) has been asked by the Department of Health and Social Care to produce a clinical guideline on the prescribing of cannabis-based products for medicinal use in humans. This guideline is expected by October 2019 at the latest.

Interim clinical guidance is based on the best available clinical evidence by the following bodies:

  1. British Paediatric Neurology Association (BPNA) on the use of cannabis-based products for medicinal use in children and young people with epilepsy.
  2. Royal College of Physicians (RCP) guidance around prescribing of cannabis-based products for medicinal use  in chemotherapy induced nausea and vomiting, chronic pain and pain in palliative care patients.
  3. NHS England have also asked the Association of British Neurologists (ABN) to provide interim guidance on the use of cannabis-based products for medicinal use in adult neurological conditions, including Multiple Sclerosis (MS).

References:

  1. Guidance to clinicians: Cannabis-based products for medicinal use. Department of Health and Social Care. NHS England. October 2018
  2. Additional guidance to clinicians: Cannabis-based products for medicinal use. Department of Health and Social Care. NHS England. November 2018

 

Referral

Referral to secondary care

Patients should not be referred to any specialty for a specific medication, including cannabis-based products. These can only be considered by a Specialist when a patient has an unmet special clinical need that cannot be met by licensed products. Local treatment guidelines and referral pathways should be followed.

Medical cannabis and pain

Please note that at present local pain clinicians have advised that they will not prescribe medical cannabis in their clinics.