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expert reaction to draft NICE recommendations on the use of cannabis-based medicinal products and the NHS England review ‘Barriers to accessing cannabis-based products for medicinal use on NHS prescription’

NHS England have published a review called ‘Barriers to accessing cannabis-based products for medicinal use on NHS prescription’± , and NICE have published their draft recommendations on the use of cannabis-based medicinal products*. 

 

Prof David Nutt, The Edmond J Safra Chair and Head of the Centre for Neuropsychopharmacology, Division of Brain Sciences,  Dept of Medicine, Imperial College London, Imperial College London, said:

“The NICE consultation is very disappointing for those tens of thousands of patients and carers having to break the law every day to obtain black-market medical cannabis. The total reliance on placebo controlled RCT  trial data by NICE reveals a deep lack of appreciation of the complex and varied nature of medical evidence.  

“I would argue that patient experience and effectiveness trials are vital for a proper understanding of the real world value of medical cannabis and that NICE should have taken these into account, as the Health Minister Mr Hancock said to the Health Select Committee only last month.  This failure of mature and balanced leadership from the Department of Health is very distressing and is why I am working with the charity DrugScience to set up programme Twenty21 which aims to provide treatment for 20,000 patients by the end of 2021.”

 

Ian Hamilton, Lecturer in Mental Health, University of York, said:

“This report tries to address some of the concerns that many patients and clinicians have been expressing since the policy change on medicinal cannabis products was introduced in November last year. The main concern patients have is the very limited access they have to these products, in part this is due to the reluctance of many clinicians to prescribe cannabis products due to the lack of evidence supporting their efficacy. The report recommends that research into their efficacy is prioritised and suggests that evidence is collected beyond the usual gold standard Randomised Control trials, this is a welcome recommendation as it recognises that RCT’s are not the only method that should be used in evaluating these products.

“The report also addresses the other pragmatic problem, namely knowing who is able to supply pharmaceutical cannabis products that can be used in medicine, this is clearly important if both patients and clinicians are to have confidence in the quality of the product that is to be used in treatment.

“The report makes clear that the policy change in November in effect raised expectations of patients but systems were not in place to meet these expectations, in effect it is only in recent months that the information that clinicians need to make decisions on whether to prescribe a product or not are being put in place.

“Although the report recognises that the cost of these products is a barrier to some patients and their health trusts there are no potential solutions offered to mitigate this concern.”

 

Dr Michael Bloomfield, Excellence Fellow, Head of Translational Psychiatry Research Group and Consultant Psychiatrist, University College London (UCL) and British Association for Psychopharmacology (BAP) Secretary for External Clinical Affairs, said:

“I welcome NICE fast-tracking guidance on cannabis-based medicinal products.  Cannabis-based medicines are a vastly under-researched area and we need much more research investment, including from industry, to build-up a clear evidence base of which cannabis-based medicine may work for whom.  The British Association for Psychopharmacology will be providing NICE with expert feedback on the draft guidelines in due course.” 

“The biggest change will come when we have more scientific evidence about these drugs. That is why we need further investment in understanding how the effects of these drugs to increase the medical evidence for their use.  Beyond the guidance, we need medical research in psychiatric conditions for which people report self-medicating with cannabinoids.”

 

*https://www.nice.org.uk/guidance/indevelopment/gid-ng10124/consultation/html-content-2

± https://www.england.nhs.uk/publication/barriers-to-accessing-cannabis-based-products-for-medicinal-use-on-nhs-prescription/

 

Declared interests

Prof David Nutt: Not personally  – but DrugScience does get support in the form of educational grants from some producers of medical cannabis.

Ian Hamilton: No conflicts of interest

Dr Michael Bloomfield: No conflicts of interest

None others received.

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