Cannabis-based products were made available for specialist doctors to prescribe legally from 1 November 2018. This was partly as a result of the government having been made aware of patients, particularly children, who are likely to benefit from the use of these products.
Who can prescribe cannabis?
- GPs are not able to make the initial prescription of cannabis products, but can refer patients to a clinician on the GMC's specialist register if it is felt that cannabis products may benefit the patient.
There are strict controls in place, but the government has recognised these products are effective in certain circumstances and can be used where there is an unmet clinical need.
A specialist should only prescribe within their own specialism and any decision to prescribe should be made by the multidisciplinary team. The Royal College of Physicians and the Royal College of Radiologists have published joint recommendations on the medicinal use of cannabis-based products.
- In November 2019, NICE produced clinical guidance on prescribing cannabis-based medicinal products. The guidance is focused on advice in relation to prescribing for patients with intractable nausea and vomiting, chronic pain, spasticity and severe treatment resistant epilepsy. Once a specialist medical practitioner has made the decision to prescribe, subsequent prescriptions can be made by another prescriber as part of a shared care agreement - providing certain criteria are met.
- The British Paediatric Neurology Association has also published guidance on the medicinal use of CBD products in children and young people with epilepsy, which highlights the key questions clinicians need to address before prescribing, as well as guidance on appropriate treatment regimes and dosage.
- The Department of Health and Social Care has also published its expectations of what this regulatory change will mean for doctors. As well as local guidelines, the relevant GMC guidance also needs to be taken into account. Any approval for use should be made by the drug and therapeutics committee or the trust medical director, on a 'named patient' basis only.
- Although GPs will not be prescribing cannabis-based products, they may be asked about the treatment by patients, parents or carers. The government acknowledges the products are unlicensed medicines and that further research is needed, so it's important to make sure doctors in this situation are familiar with the GMC's guidance on prescribing.
Although the drug is available to certain patients under specific circumstances, it is still for the specialist doctor to decide if it is appropriate to prescribe a cannabis-based product. The doctor remains responsible for prescribing the drug and the decisions they make.
It is also essential that patients or their carers have enough information about the medicine to allow them to make an informed choice about taking cannabis-based products. Any decision made by the specialist and patient, and the reason for it, must be clearly documented in the clinical records.
Only those doctors on the specialist register can prescribe cannabis-based products, but they must work within the limits of their competence. Patients need to be aware of the benefits the drug can offer, but also of any side effects and what to do if they experience them. The specialist would be expected to accept full responsibility for any risks or liability, according to the government's review.
- Cannabis-based products are unlicensed and special consideration needs to be made where unlicensed medications are prescribed.
The GMC recognises there are circumstances where unlicensed medicines are necessary to meet the specific needs of the patient. Specific auditable safeguards must be followed, as well as pre-existing controlled drug protocols.
Doctors must be satisfied there is sufficient evidence or experience in using the medicine, and follow-up and monitoring of the patient must be arranged. As with any patient consultation, it is important to keep clear, accurate and legible records, noting the reason for prescribing an unlicensed medicine.
These new provisions apply to England, Wales and Scotland, and the government will continue to monitor the new policy's impact as the evidence base develops.
This guidance was correct at publication 09/12/2019. It is intended as general guidance for members only. If you are a member and need specific advice relating to your own circumstances, please contact one of our advisers.