DORSET MEDICINES ADVISORY GROUP COMMISSIONING STATEMENT ON THE USE OF CANNABIS BASED PRODUCTS SUMMARY NHS Dorset Clinical Commissioning Group (CCG) has noted the change in legal status for cannabis-based products that came into effect in November 2018. Prescribing of unlicensed cannabis-based medicinal preparations is restricted to clinicians listed on the Specialist Register of the General Medical Council. Prescribing by General Practitioners (GPs) is not permitted. Cannabis-based products are categorised as non-formulary in Dorset as specialists within Dorset are not included in the list of specialists or managing the indications for which the products are listed. Ongoing prescribing is expected to be managed by the initiating specialist. Patients requesting prescriptions who are not currently under the care of a listed specialist should only be referred to specialist services where clinically appropriate and in line with current pathways. From 1st November 2018, cannabis-based medicinal products were reclassified under the Misuse of Drugs Regulations (MDR) to schedule 2. There will be no change to the status of cannabis as a class B drug under the Misuse of Drugs Act so punishments for illicit use are unchanged. BACKGROUND
Under the new legislation, all cannabis-based products for medicinal use apart from Sativex® (listed in Schedule 4 of the MDR and which has a marketing authorisation) would be unlicensed medicines. NICE does not recommend the use of Sativex® for its licensed indication (spasticity due to multiple sclerosis). It is non-formulary in Dorset and is only considered through the individual funding request process for any off-label indications.
RELEVANT NICE GUIDANCE
The National Institute for Health and Care Excellence (NICE) has been asked by the Department of Health and Social Care to produce a clinical guideline on the prescribing of cannabis-based products for medicinal use in humans. This guideline is expected by October 2019 at the latest.
FORMULARY STATUS
Non-formulary.
PBR STATUS
Not currently relevant.
COMMISSIONING IMPLICATIONS
Not currently relevant.
RELEVANT CLINICAL WORKING GROUP
Not currently relevant.
PATIENT PATHWAY IMPLICATIONS
Not currently relevant.
SUMMARY OF EVIDENCE TO SUPPORT FORMULARY STATUS
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. The indications for which this might be considered are included in the commissioned activity from NHS England generally (e.g. specific types of epilepsy in children or for chemotherapy induced nausea and vomiting). In the light of this and the lack of licensed product availability currently, the Dorset Medicines Advisory Group has agreed that use of cannabis-derived products for pain management will remain non-formulary. ASSESSMENT OF COST IMPLICATIONS
Not currently relevant.
INFORMATION FOR PATIENTS
Information for patients on the availability of cannabis-based medicinal products is available on the NHS website here: https://www.nhs.uk/conditions/medicalcannabis/ 1. NICE CG186: Multiple sclerosis: management of multiple sclerosis in primary and secondary care (October 2014) 2. Government announces definition for cannabis-based products for medicinal use (21 September 2018)
REFERENCES
3. Home Office: Government announces that medicinal cannabis is legal (11 October 2018) 4. Cannabis-based products for medicinal use (letter to GPs from Department of Health and Social Care, 31st October 2018. Gateway Reference, 08539) 5. Supplementary information on cannabis-based products for medicinal use (20 November 2018, Gateway Reference 08652) 6. Cannabis-based medicines: an interim desktop guide (RCGP, Nov 2018)
DATE
December 2018
REVIEW DATE
November 2019 or before in the light of new information
CONTACT FOR THIS POLICY
Michelle Trevett, Senior Pharmacist, NHS Dorset CCG
