Cannabis prescriptions in the UK: What you need to know

In November 2018, legislative changes in the United Kingdom opened the door to the prescription of medicinal cannabis-based products (CBPMs) across the nation. In his latest online article, Dr Rajesh Menon delves into the conditions for which medical cannabis is prescribed, the underlying mechanisms of its prescription, eligibility criteria for patients, and the professionals authorised to prescribe it.

What conditions is medical cannabis prescribed for in the UK?

In light of legislative amendments, starting November 1, 2018, medicinal cannabis-based products (CBPMs) are eligible for prescription throughout the United Kingdom. These products are primarily recommended for three key conditions in accordance with NICE guidelines:

• Persistent and uncontrollable nausea and vomiting
• Spasticity associated with Multiple Sclerosis
• Severe treatment-resistant epilepsy in children, such as Lennox-Gastaut syndrome.

How does medical cannabis work as a prescription?

It works by interacting with the body's endocannabinoid (ECS) receptors, specifically CBD1 and CBD2, which play a crucial role in transmitting messages to the brain. The ECS regulates a broad spectrum of biological and physiological processes, such as pain management, inflammation, sleep, mood, digestion, and various others.

Who is eligible for a cannabis prescription in the UK

Patients experiencing the three conditions—chronic pain, severe anxiety, and sleep disturbances—who have undergone unsuccessful conventional treatments (more than two attempts) may explore the option of using cannabis, following consultation and verification by a Multi-Disciplinary Team (MDT).

Numerous cannabis-based medicines in the UK lack licensing, signifying that they haven't met rigorous safety and quality standards. Prescribing CBPMs in such cases should be grounded in an evaluation of the specific patient, and it may be warranted when no licensed medicine adequately addresses the patient's requirements.

Who can prescribe medical cannabis?

Legislation in the UK confines the authority to prescribe cannabis-based products for medicinal use (CBPMs) to doctors listed on the Specialist Register. Specialist doctors are obliged to acknowledge and adhere to the limits of their expertise, as emphasised in Good Medical Practice (paragraph 14) (https://www.gmcuk.org/professionalstandards/professional-standards-for-doctors/good-medical-practice/domain-1---knowledge-skillsand-performance).

According to guidance from NHS England (https://www.england.nhs.uk/medicines-2/support-forprescribers/cannabis-based-products-for-medicinal-use/), a specialist doctor on the General Medical Council Specialist Register should exclusively make prescribing decisions within their designated area of practice and training. The decision to prescribe should also be a collaborative one, endorsed by the multidisciplinary team.

To summarise, any doctor listed on the GMC Specialist Register, typically a hospital consultant, can prescribe CBPMs. General Practitioners (GPs) have the authority to prescribe under shared care arrangements with specialist direction. Notably, doctors affiliated with medical cannabis clinics are more likely to have received training in cannabis medicine, increasing the likelihood of prescribing medical cannabis.

How long does a medical cannabis prescription last for?

Typically, it is prescribed on a monthly basis and subject to regular reviews, with initiation at a low dose and gradual titration over weeks to achieve optimal effectiveness. The duration of CBD's effects is commonly thought to span between 2 to 8 hours. The persistence of CBD in an individual's system is contingent on the dosage and administration method employed.

Dr Rajesh Menon is a respected pain management specialist. You can schedule an appointment with Dr Menon on his Top Doctors profile.