The recommendations have disappointed those who hoped that the NICE guidelines would significantly increase patient access to CBMPs - instead, the report largely echoes the limited recommendations in place since medical cannabis was legalised last year. In particular, the recommendation against CBMPs for the treatment of chronic pain is a bitter blow for the 13 percent of the UK adult population with the condition, many of whom may benefit from medical cannabis in some form. And while it is positive that the proposed guidelines allow epilepsy specialists to make CBMP prescribing decisions on a case-by-case basis, rather than recommending outright against their use, it is disappointing that such flexibility is not extended to additional conditions.

One notable and positive departure from previous advice is the recommendation to trial Sativex for adults with MS spasticity. Sativex treatment for MS patients was previously recommended against on the grounds that it was not cost-effective, and NICE’s revised position reflects the fact that the drug’s list price has since been reduced from £375 to £300 per pack.

Despite this, the prescribing recommendations confirm a frustrating reality - that until either sufficient clinical data on cannabis’ efficacy is produced, or the UK adopts an alternative framework for CBMP access - medical cannabis will remain largely an option only for those who can afford up to £800 a month for a private prescription.



Shared-care arrangements

NICE acknowledges that the requirement to see a specialist doctor for each CBMP prescription places an unfair burden on patients and carers. In response, they now allow for repeat prescriptions to be issued by a non-specialist prescriber (such as a GP) as part of a shared care agreement.



That NICE recognises the ‘clear need’ to streamline CBMP access is a good step in the right direction. Allowing greater involvement by non-specialist healthcare providers should reduce tertiary healthcare costs, increase the healthcare profession’s exposure and comfort with medical cannabis, and hopefully pave the way towards regulation granting greater autonomy (such as dose adjustment) for non-specialist healthcare providers as the scheme develops.

Research recommendations