There seems to be some understandable confusion about the implications of the overly cautious interim prescribing guidelines from the Royal College of Physicians and British Paediatric Neurology Association published yesterday by the NHS so I will try to clarify as best I can, but please understand that things are evolving so quickly, that even the media are struggling to keep up! The situation may have changed by the time I finish writing this blog!
The Home Office, MHRA and the Department of Health have stated categorically that there will be NO policy restrictions on medical conditions for which cannabis based medicinal products (CBMPs) can be prescribed by a specialist registered on the General Medical Council. These specialists retain the authority to prescribe CBMPs for anything they feel there is a clinical benefit for.
THAT'S POLICY - and with no restrictions on product types or strengths, the UK, potentially, has one of the most open and accessible medical cannabis policies in the whole of the EU!
Yesterday the Royal College of Physicians, produced interim guidelines, which stated that they felt there was not enough evidence and they do not recommend (not forbid - recommend) CBPMs for Chronic Pain - This is disappointing and serves to illustrate the serious lack of education around the real risks associated with cannabis along with the lack of awareness of good existing clinical evidence of efficacy.
Whilst it is true that very few specialists will have the confidence to prescribe outside of the guidelines published by their professional body, ultimately, these are guidelines, not rules and only constitute a somewhat uninformed and current opinion. This opinion will change over time as the profession familiarises itself with the efficacy of cannabis. As the current Minister for Health, Matt Hancock, confirmed yesterday, live on ITV News, the guidelines are helpful but ultimately these are clinical decisions. Our medical profession have been given the room to be flexible.
Now we have to bring medical profession on board.
As we stated in previous posts, reflecting the words of the Department of Health, the UK medical cannabis implementation will start cautiously and will evolve significantly over time, and that is precisely what we are now seeing.
Our Medical Professional bodies, quite rightly, put their trust in evidence, data and clinical trials which why one of the access routes to these medicines for patients proposed by the Department of Health and the MHRA are through clinical trials. This will also be the most effective and efficient way of quickly building up evidence and confidence.
As you will be aware, current clinical trials for approved medicines can take 2 or 3 years to complete which would be inappropriately lengthy and detailed given the relative risks of medicinal cannabis products, so these will need to be small, short, observational trials which have been very successful in other countries, such as Israel and Canada. These will need to be designed and agreed by the MHRA who are listening and have expressed a desire to work this through. These trials would be funded by medical cannabis producers seeking to supply their products to the UK market.
As patients advocates, not only will Families 4 Access and United Patients Alliance be representing the voice of families and patients throughout the NICE process for creating full and proper prescribing guidelines, due for delivery on or before October 2019, we will also be working very closely with The Centre for Medical Cannabis and other partners on a proposal for trials and we hope, design and implementation along with helping to facilitate patients onto the trials once in place.
November 1st was a huge day, in terms of the legalisation of medical cannabis, but we have a little way to go yet before patients in large numbers can properly benefit from the changes. This situation is evolving and we will have good news days and bad news days, but we will always be moving forwards and we are confident that once things settle down between now and October 2019 when full and proper (not interim) guidelines, which will have had the benefit of those trials, are published, the UK will have a world leading medical cannabis policy which is more accessible that any implementation across Europe.
Jon Liebling - Political Director