Medicinal Cannabis – Limits on Prescribing

The Chief Medical Officer, National Medical Director and Chief Pharmaceutical Officer have written to GPs to explain changes to regulations covering medicinal use of cannabis-based products – and the anticipated effects on prescribing practice.

Prescribers may find the following extracts from the letter helpful:

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. This restriction has been set out in regulations. As with any unlicensed medicines or “specials”, the prescribing of such products must be on a “named patient” basis. It is therefore expected that rigorous and auditable safeguards around prescribing of an unlicensed product will be followed, alongside existing protocols on controlled drugs.

NHS England expects that cannabis-based products for medicinal use should only be prescribed for indications where there is clear published evidence of benefit or UK Guidelines and in patients where there is a clinical need which cannot be met by a licensed medicine and where established treatment options have been exhausted. In addition, a Specialist doctor on the General Medical Council Specialist Register should only make 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.

The regulations are drafted in such a way that cannabis-based products for medicinal use can be supplied under the prescription or direction of a specialist doctor. We are exploring how this may work under shared care arrangements, however in the first instance we expect specialist prescribing only. Trusts will meet the costs of this, where necessary. The current position is that no cannabis-based products for medicinal use are routinely commissioned by NHS England. When licensed they will become subject to normal NHS appraisal and commissioning processes.