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UK's Health Service Urged to Consider New Medical Cannabis Guidance

By Alexander Beadle

Published: Mar 10, 2020   
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Medical cannabis is being unfairly denied to British patients, according to the Medical Cannabis Clinicians Society (MCCS), a UK expert group that provides a confidential, independent network for clinicians working with medical cannabis.

The comments come following the re-issuing of the society’s guidelines on medical cannabis prescribing.

The new MCCS guidance is a direct response to the recent publication of long-awaited medical cannabis prescription advice from the National Institute for Health and Care Excellence (NICE), which the MCCS says is too conservative.

The MCCS is urging the National Health Service (NHS), NICE, and government bodies such as the Medicines and Healthcare Products Regulatory Agency (MHRA) to follow its example in giving serious consideration to ‘real world’ data when considering the available evidence base on medical cannabis.

Addressing evidence outside of the clinical model

In its new publication, the MCCS provides information on the history, evidence, and prescribing information related to medical cannabis treatments for a wealth of different health conditions. The main difference between the MCCS prescribing guidelines and its NICE equivalent, the society says, is that the MCCS has considered the results of observational trials and valid case studies in addition to the randomized controlled trials that are considered the gold standard of clinical evidence.

“Medical cannabis is being unfairly denied to patients in the NHS because the regulators do not understand the treatment,” said Professor Mike Barnes, chair of the MCCS, in a statement.

“People in the UK are being left to suffer because NICE, the Department for Health and Social Care, and the NHS have thus far failed to provide doctors with fair and balanced guidelines when it comes to prescribing medical cannabis.”

“Medical cannabis does not fit into the pharmaceutical model which depends on randomized controlled trials and it is disappointing that NICE does not acknowledge this in their guidelines. They simply reject the wealth of other global evidence,” Barnes continued.

“The MCCS guidance, updated, and reissued today, goes beyond this inadequate view and considers the extensive evidence available across a wide range of conditions. We hope this is welcomed by medical bodies and urge them to consider these expert recommendations.”

Medical cannabis access in the UK

Medical cannabis has been legal in the United Kingdom for over 16 months, and yet so far access to the drug has been incredibly restricted – and not by design.

Theoretically, medical cannabis prescriptions can be given and filled for free through the NHS. The process is designed so that patients can speak to their normal family doctor or general practitioner (GP) about medical cannabis treatment, who can then refer the patient onto a specialist doctor. This specialist can make decisions on a case-by-case basis as to the best course of treatment; they can write the patient a prescription for medical cannabis and provide an individual treatment plan if the specialist believes medical cannabis would be helpful.

In practice, only a handful of prospective patients have actually been able to access medical cannabis in this way. Many NHS doctors are hesitant to refer patients for cannabis treatment, leaving patients choosing between the option of expensive private clinics or using illicit cannabis. Recent estimates indicate around 1.4 million British adults are already using ‘street’ cannabis to self-medicate for professionally diagnosed medical conditions.

The movement to improve patient access in Britain

While they may have focused on a more conservative evidence base, the publication of the NICE guidelines represented a significant step forward in the pursuit of improved patient access to cannabis medicines.

The recommendations resulted in two cannabis-based medicines – Sativex and Epidiolex, both produced by the British company GW Pharmaceuticals – being approved for use by NHS England as treatment for spasticity in people with multiple sclerosis and seizures in two rare forms of epilepsy, respectively. Sativex was previously given approval by the All Wales Medicines Strategy Group and has been available on the NHS in Wales since 2014.

In recent months, the UK has also seen the establishment of the first British medical cannabis charity, which exists to provide financial support to medical cannabis patients pursuing treatment at private clinics, and the reform of medical cannabis import rules, which should improve the nation’s medical cannabis supply chain.

The import rules reform, which was announced earlier this month, is expected to make a dramatic, immediate difference to British patients.

The United Kingdom is the world’s largest producer of medical cannabis products and yet most of the cannabis-based medicines used in the UK are imported from abroad. The latest reform measure will allow licensed wholesalers to begin importing larger quantities of cannabis-based products and to hold supplies for future use. It’s hoped that these changes will address the problems previously caused by the large timeframe it takes to obtain an export certificate, and the need for continuous prescription review.

“The changes made today are a tremendous step towards improving the supply of cannabis-based medicinal products by helping to ensure quicker and more reliable access for patients,” said the health and social care secretary, Matt Hancock, in a statement.

“But we still have a long way to go. We need more research into the quality and safety of these medicines, and to do all we can to cut down the costs and remove barriers so that, when appropriate, patients can access it, including on the NHS.”

Alexander Beadle

Science Writer

Alexander Beadle has been working as a freelance science writer since 2017 and has covered the cannabis industry for Analytical Cannabis since 2018. He has also written for our sister publication, Technology Networks, and the cannabis industry consultant firm Prohibition Partners, among others. Alexander holds a Master's in Materials Chemistry from the University of St. Andrews, where he won a Chemistry Purdie scholarship, and conducted research into zeolite crystal growth mechanisms and the action of single-molecule transistors.


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