Medicinal Cannabis Legalised in the UK
New legislation for prescribing on a case-by-case basis
The UK government has decided that medicinal cannabis will become a legal drug, and can be prescribed by specialist doctors from 1st November 2018 to patients who have been appropriately medically assessed.
This new legislation will not limit the types of conditions that can be considered for treatment with cannabis-based medicines, but there is anecdotal evidence to support its use for patients, including children, with treatment-resistant seizures, and other conditions (see below).
The decision to prescribe cannabis-based medicines must be made by a specialist doctor, a consultant, and not a GP. Consultants focus on one field of medicine such as neurology or paediatrics and are listed on the General Medical Council’s specialist register. They must make decisions on prescribing cannabis-based products for medicinal use on a case-by-case basis.
Cannabis-based medicines are currently unlicensed and so they should only be used when the patient has a special clinical need that cannot be met by licensed products. The clinician would be expected to take full responsibility of risks and liability for treatment.
Clinical conditions indicated for using medical cannabis
There is some evidence for cannabis being useful in the following ways:
- Assisting with intractable seizures in Dravet and Lennox-Gastaut syndromes
- Improving short-term sleep associated with obstructive sleep apnoea syndrome, fibromyalgia, chronic pain and multiple sclerosis
- Improving symptoms of Tourette’s syndrome
- Improving anxiety symptoms for patients with social anxiety disorders
- Improving symptoms associated with post-traumatic stress disorder
- Better outcomes after traumatic brain injury or intracranial haemorrhage
- Easing chemotherapy-induced nausea and vomiting
- Increasing appetite and decreasing weight loss associated with HIV/AIDS
- Improving patient-reported multiple sclerosis spasticity symptoms
- Assisting with chronic pain in adults
Potential adverse effects
- Decreased short-term memory, dry mouth and impaired perception and motor skills
- Impairment of driving skills
- Panic attacks, paranoid thoughts and hallucinations (with higher doses)
- Schizophrenia and other psychosis
- Social anxiety disorder
- Chronic cough and production of phlegm
- Unintentional cannabis overdose injuries with children
- Lower birth weight babies, if smoked during pregnancy
- Impairment in academic achievement and education, employment, income and social relationships
- Suicidal thoughts (with higher doses)
- Developing problem cannabis use and dependence
Prescribing and legal information
The National Institute for Health and Care Excellence (NICE) has been commissioned to develop clinical guidelines for clinicians to follow.
Cannabis plants contain more than 100 cannabinoids, as well as other compounds including flavonoids and terpenoids. This is a possible reason why some people respond better to herbal cannabis than the pure cannabis derivatives.
There are no established uniform dosing regimens for herbal cannabis, smoked or vaporised cannabis, or cannabis oil. Patients should titrate the dose slowly until the desired effect is obtained.
Medicinal cannabis is currently available in other countries including:
- The Netherlands (legalised in 2003)
- Germany (legalised in 2017)
- Croatia (legalised in 2015)
So there are precedents for its use which the UK clinicians can follow.
In the UK, cannabis-derived medicines will become Schedule 2 Controlled Drugs, which will require the associated special prescription requirements, and they must be stored in a controlled drugs cabinet in healthcare facilities.
Unlawful possession or supply of cannabis, which is a Class B Controlled Drug, will still carry an unlimited fine and up to 14 years in prison for dealers.
Ashtons has prepared a slide presentation on cannabis for medicinal use. Please contact your visiting pharmacist for further details.
- The Pharmaceutical Journal, July 2018, Vol 301, No 7915, online | DOI: 10.1211/PJ.2018.20205224