The National Institute for Health and Care Excellence (NICE) has issued its draft guideline on cannabis-based medicinal products.
In November 2018 the UK Government changed the law to make it possible for ‘cannabis-based products for medicinal use in humans’ (or CBPMs) to be ordered and prescribed by specialist practitioners without a controlled drugs licence. NICE guidance has been keenly awaited by patients and carers, many of whom are finding that barriers to accessing CBPMs and other cannabis-based treatments remain in place despite the change in the law. While the guidance will not impose legally binding obligations, NHS bodies in particular will need to consider the guidance and any recommendations when considering whether to offer treatments involving CBPMs.
The draft guideline covers CBPMs, as well as Sativex, nabilone, CBD and synthetic cannabinoids, and their use in treating a number of conditions including intractable nausea and vomiting, chronic pain and severe epilepsy.
The draft guidance includes the following recommendations:
- Consider nabilone as an ‘add on’ treatment for chemotherapy-induced nausea and vomiting
- Do not offer cannabis-based medicines for chronic pain management in adults (and CBD only in a clinical trial)
- Prescriptions must be made by specialist doctors, and that the impact of prescribing for particular groups of patients must be considered
There is no recommendation on the use of cannabis-based medicines for severe epilepsy, and NICE instead makes recommendations aimed at promoting further research.
The guidance is open for public consultation until 5 September - view the consultation documents
The recommendations for further research into the use of cannabis-based medicines for severe epilepsy is consistent with the views expressed by the Chief Medical Officer and others, and will not be met with surprise. Nonetheless, there will be disappointment that the guidance does not offer immediate hope in particular to parents of children with severe treatment-resistant epilepsy.
NICE is also developing ‘technology appraisal guidance’ on the use of CBD in the treatment of Lennox-Gastaut syndrome and Dravet syndrome, two forms of severe epilepsy. Technology appraisal recommendations – which are binding on the NHS – are expected by the end of 2019.