As of the 1st of November 2018, it will be legal to prescribe medicinal cannabis products for patients in the UK. Prior to this date medicinal cannabis could be prescribed but required the prescribing doctor to hold a Home Office Licence allowing them to do so.
Under new guidance for doctors, published by the Department of Health, the only change is a rescheduling of cannabis products from schedule 1 to schedule 2 as an amendment to the Misuse of Drugs Regulations of 2001. As a schedule 1 product, a home office license was required. With the products now in schedule 2 that has been removed, however it remains under tight control. The exception to this are synthetic cannabis products such as Sativex which is currently in schedule 4.
The only doctors eligible to prescribe the schedule 2 preparations will be those on the specialist register and this is set in regulation and must be adhered to. This excludes all junior doctors, doctors on the GP register and importantly all non-medical prescribers. The mandate from the Department of Health also categorises these as unlicensed medicines and all the additional accountability that goes with that for the prescriber.
The rational for this appears to be based around the limited evidence base for the effectiveness and safety of cannabis products in medicinal use. The recommendations are that these should only be prescribed for conductions where some evidence base exists, and these have been outlined, and where all other treatment options have been exhausted. It must also be done on a named patient basis and with full support from the multidisciplinary team. These factors in themselves are likely to dramatically limit prescribing to a small group of patients.
There will be a requirement for robust monitoring of the patients and increased pharmacovigilance with an emphasis on Yellow Card reporting. This is an increased workload burden, even though the numbers of patients are likely to be small.
It is likely that many patients will see this legal change as a herald to prescribing of medicinal cannabis in the UK and approach their GPs in large numbers. The reality will mean that GPs cannot prescribe this and will only refer if the condition of the patient meets locally agreed criteria.Another potential issue is cost and supply of these medications and the potential for diversion and misuse. It has been stated that it will be down to individual trusts to decide on how and if they fund these treatments. Many may decide not to do so, and this could lead to a variation in prescribing patterns across the UK and perceived inequality of access to healthcare.
It is going to be difficult for doctors in the early stages of this change in legislation, as they are so used to prescribing medicines with a robust evidence base and an understanding of the safety profile of established drugs. Access to treatments will still be very limited and many patients and patient groups are disappointed with this outcome. It will be a considerable time I fear before we have the robust evidence base to modify legislation and guidance further.
Deborah Robertson is a lecturer in adult nursing at the University of Salford, and the consultant editor of Nurse Prescribing