NICE guidelines on cannabis-based medicinal products - Twenty21

[Smokey]

The National Institute for Health and Care Excellence (NICE) published their guidance to clinicians on the 11th of November 2019 regarding the prescribing of Cannabis-Based Medicinal Products (CBMPs).

Drug Science welcomes this news from NICE as it shows the start of a more rational approach to medical cannabis. However, it must be emphasised that this is just the start of a long process and not the answer to the needs of the hundreds of thousands of patients who use illegal cannabis for medicinal purposes every day. The reason that these guidelines are inadequate is two-fold:

Firstly, the NICE decision relates to just two illnesses – MS and severe childhood epilepsy – a small fraction of the total number of patients. The Drug Science Twenty21 initiative has already had requests from over 3500 patients. The majority have chronic pain syndromes and many others have disorders such as PTSD for which neither Sativex nor Epidiolex has an indication.

Secondly, both Sativex and Epidiolex are fixed doses – a Sativex dose is a roughly equal mixture of about 3mg each of Delta-9-Tetrahydrocannabinol and Cannabidiol whereas Epidiolex is purely a strong dose of Cannabidiol. Many of the patients we have spoken to have tried these already and found them ineffective or they have not tolerated them and prefer the flexibility of dosing that other forms of medical cannabis offers. Twenty21 will attempt to deliver this more flexible dosing approach and allow titration to optimise each patient’s case.

Furthermore, the guidance did allude to two promising recommendations:

"The committee discussed the importance of collecting data on the treatment, clinical outcomes and adverse events experienced by people prescribed cannabis-based medicinal products, to inform future guidance and use. They noted the ambition to develop a UK register outlined in NHS England and NHS Improvement's barriers to accessing cannabis-based products for medicinal use on NHS prescription." This registry is something that the Drug Science team are creating right now to bolster NHS clinicians confidence in prescribing CBMP's through the NHS.

"Some evidence identified the need for training and further education for prescribers". This recommendation is something that Drug Science are very aware of. The roll-out of medicinal cannabis in the UK is dependant on prescriber confidence. Drug Science is creating a set of educational materials for current medical students, an online space for prescribers to ask questions to cannabis experts and a series of seminars devoted to cannabis education.

Using this information, the Drug Science team are continuing to fight for patients that need access to medicinal cannabis. As you might imagine, this is not a speedy process, however, we urge all of you that have signed up to be a part of this registry to stay tuned as we expect to have some exciting updates coming soon!

Best wishes

The Drug Science team