Is Cannabis available on prescription?

Cannabis-based medicinal products have been legal in the UK since November 2018, when they were re-classified from Schedule 1 controlled drugs to Schedule 2 controlled drugs. This change came about following prominent cases with children dealing with unmanageable epilepsy being denied the drug. Cannabis is available on prescription, but it is still challenging for patients to gain access. A very low number of National Health Service prescriptions have been written to date. Here is what you need to know about medicinal cannabis, how it works and how it is prescribed on the NHS.

What Is Cannabis?

Cannabis comes from a species of plant called Cannabis sativa, of which there are many varieties. Cannabis contains chemical compounds called cannabinoids. The most well-known are THC (tetrahydrocannabinol) and CBD (Cannabidiol), THC is the compound that gives users a high. CBD does not have that effect and is already available freely. The cannabis products used to treat medical symptoms normally contain both compounds.

• Cannabidiol (CBD) – its medicinal benefits include anxiety, pain, sleep and epilepsy management. It does not cause euphoria or sedation and can reduce the potential negative effects caused by THC
• Tetrahydrocannabinol (THC) – its medicinal benefits include pain, nausea and muscle spasm relief and sleep management. It is a psychoactive drug and can cause symptoms such as euphoria or sedation

What are Cannabis-based products for medicinal use (CBPMs)?

CBPMs are prescribed medicines that are derived from cannabis for medical use in humans. They are licensed drugs that have been manufactured under strict quality and control guidelines by a pharmaceutical company backed with clinical evidence. These drugs are obtained by an NHS prescription.

Unlicensed cannabis is CBPMs that are most frequently prescribed by doctors at private clinics via a private prescription. A wide range of products is available with varying cannabinoid concentrations and formulations, such as cannabis oils.

Over-the-counter CBD oil and illegal cannabis differ from prescribed cannabis. CBD can be bought in health food stores but the quality and quantity of CBD they contain are questionable. Illegal cannabis off the street is the most unsafe way to buy cannabis as you have no idea of the quality, ingredients and strength of the product. You can not be monitored by a doctor and you have zero knowledge of its pharmaceutical grade.

Who can be prescribed cannabis-based drugs?

The National Institute for Health and Care Excellence (NICE) has recommended that healthcare professionals can prescribe cannabis-based products for medicinal use (CBPMS) in the following circumstances:

• Adults and children with severe forms of epilepsy
• Adults with vomiting or nausea caused by chemotherapy
• Adults with muscle spasticity caused by Multiple Sclerosis

How is it prescribed?

The prescribing of medical cannabis must be made by specialist doctors, who are generally hospital doctors listed on the Specialist Register of the General Medical Council (GMC). This clinician must also have a special interest in the condition being treated and can only prescribe after all licensed treatment options have been considered. Other healthcare professionals such as GPs, do not have the authority to prescribe it, but a referral to a specialist can be made if they feel cannabis will aid the patient. NHS England states that any decision to prescribe should be made by a patient’s multidisciplinary team.

You can also be prescribed cannabis if you take part in clinical trials for cannabis medicinal products.

How does cannabis work in the body?

To understand how cannabis works in the body, we need to look into the endocannabinoid system. This is a complex system working on cell signalling in the body, experts are still trying to understand it. In short, this system helps achieve a balance between all the systems in the body (digestive, circulatory, and nervous to name a few).

The three parts of the endocannabinoid system are:

• Cannabinoid receptors (CB1 and CB2) which cannabinoids attach to
• Cannabinoids, made by our bodies
• Metabolic enzymes, which break down cannabinoids

The cannabinoids floating around in our bodies look very similar to the cannabinoids from the cannabis plant. The cannabinoids from the cannabis plant can therefore attach to the CB1 and CB2 receptors and boost the endocannabinoid system. For this reason, medicinal cannabis has a wide range of potential benefits and applications.

What cannabis-based medical products are licensed in the UK?

There are three products licensed by the Medicines and Healthcare products Regulatory Agency (MHRA) in the UK via an NHS prescription:

• Sativex (THC: CBD spray) – is used to treat muscle stiffness or muscle spasticity in patients with multiple sclerosis. Your specialist doctor will put you on a four-week trial and assess muscle spasticity. If significant improvements are seen you will continue on the treatment
• Epidyolex (CBD isolate) – is used as an add-on therapy for two types of epilepsy conditions called Dravet syndrome and Lennox-Gastaut syndrome
• Nabilone (synthetic THC) – is prescribed for sickness caused by cancer treatments

There are risks and side effects associated with these drugs. All three drugs need to be used with caution in people who have experienced mental health issues in the past including schizophrenia, a history of heart disease and high blood pressure. There is also a risk of dependency and misuse of drugs with these medicines, but under specialist doctor supervision, it is less likely.

Cannabis-based products for medicinal use are not approved for long-term use of chronic pain. There is no strong clinical trial data to justify its use for pain relief.

Cannabis FAQ’s

What are the side effects of cannabis?

Some common side effects are:

• Senses are altered
• Mood changes
• Memory loss
• Reduced appetite
• Sickness
• Hallucinations

Do CBD products work?

There is no robust evidence to support whether or not CBD products work or not. Patients who take CBD products speak highly of improvement in pain, muscle spasms, epilepsy, nausea and many other conditions. Currently, there is no evidence to support these claims.

Is it legal to have cannabis in my possession?

Possessing cannabis, unless it has been legally prescribed to you, remains to be a criminal offence which you can be prosecuted for.

Sources

• Cannabis-based medicinal products – NICE
• How does marijuana produce its effects? – NIH
• Cannabis-based products for medicinal use – NHS