BY NOEL WARDLE
The National Institute for Health and Care Excellence (NICE) has opened a consultation on the prescribing of cannabis-based medicinal products. By way of a reminder, NICE’s role is to “improve outcomes for people using the NHS and other public health and social care services”.
This includes providing guidance to NHS commissioners and prescribers on the effectiveness – including the cost-effectiveness – of prescribing certain medicines. NHS prescribers and commissioners will usually follow NICE guidance when making decisions about healthcare provision, so what NICE says is important.
The draft guidance which forms the basis of the current consultation sets out the circumstances in which it may, or may not, be appropriate to prescribe cannabis-based products for certain medical conditions.
The draft guidance runs through four medical conditions (intractable nausea and vomiting, chronic pain, spasticity and severe treatment-resistant epilepsy) and makes certain recommendations.
It is always difficult to summarise detailed clinical guidance in a few short words but it is probably fair to say that the draft NICE guidance does not recommend the prescribing of cannabis-based products for any conditions except for the use of nabilone for chemotherapy-induced nausea.
Most significantly, the draft guidance does not recommend the use of cannabis-based products for severe treatment-resistant epilepsy due to the lack of “good quality evidence in this population”. This may surprise some, because it is the treatment of this condition in children which caused the partial relaxation of the law around the supply of cannabis-related products last year following significant press coverage.
The draft does, however, note that there will be some appraisal guidance on the use of CBD for seizures associated with certain syndromes later this year.
The draft guidance then makes some recommendations for research. This includes research into the use of CBD as a treatment for fibromyalgia and certain neuropathic pain and for severe treatment-resistant epilepsy.
On the face of it, the draft guidance is unlikely to have any immediate impact on community pharmacies, because few pharmacies would see NHS prescriptions for cannabis-related products anyway.
However, the draft guidance is a reminder to pharmacists who supply cannabis-derived products (such as CBD oil), that there is limited clinical data regarding the safety and efficacy of those products to treat specific medical conditions, and that care needs to be taken where they are sold in pharmacies to ensure that patients have sufficient information to make an informed decision about the use of CBD oil if they ask the pharmacist for advice.
The consultation closes on 5 September, and NICE has said that it expects to publish the new guidance on 4 November 2019.
Pharmacy law expert Noel Wardle is Partner at Charles Russell Speechlys LLP.