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The National Institute for Health and Care Excellence have published the FINAL scope for Cannabis-Based Medicinal Products Guidelines.

There have been a number of positive and significant changes since the DRAFT proposal was issued in November 2018. Whilst it is disappointing that only seizures pertaining to severe treatment-resistant epilepsy are included, it has been agreed that:

  • Chronic Pain is included

    • According to UPA’s recent Survey, around 65% of medical cannabis patients in the UK find cannabis to be effective in managing chronic pain and many of the first few prescriptions being written for CBMPs have been for symptoms of pain.

  • Intractable Nausea and Vomiting NOT limited to Chemotherapy

    • Shown to be an effective anti-emetic, there is no valid reason to restrict cannabis consumption to the side effects of Chemotherapy

  • Spasticity NOT limited to Multiple Sclerosis

    • Spasticity can be a symptom of many different conditions and cannabis has been shown to be effective whatever the underlying condition. There is no valid reason to restrict its use to only those suffering from Multiple Sclerosis

Other Changes of Note:

  • Sativex is no longer being treated as an exception and is to be included into the guideline in response to the question:

How can the committee make recommendations about information to patients and their families if you do not give information about the licensed alternative Sativex?
  • This guideline will consider unlicensed medicines and off-label use of cannabis-based medicinal products in line with the GMC's guidance, that is, when other licensed medicines haven't helped or have been discounted.

The wording change from “Exhausted” to “Discounted” here is very useful! And should help prescribing doctors to understand that other “licensed medicines” only have to be ruled out and DO NOT have to be tried by patients before CBMPs can be prescribed.

A word of caution, however, that we do still have a long way to go with a medical profession who remain very nervous about cannabis, demonstrated by a comment from an NHS In-house Pain Management Team:

We welcome the inclusion of chronic/persistent pain as one of the areas for the guideline.  There has been considerable public and press speculation about the use of cannabis for chronic pain and there is a need for a comprehensive appraisal of the evidence to guide clinicians and commissioners about the use of cannabis in this area. While we welcome this review, we urge caution in the light of experiences associated with the use of opioid medication in chronic pain and the potential for considerable harm to individuals and society.

We look forward to the critical and well timed report on The Use of Cannabis Based Medicinal Products in Pain from The Centre for Medicinal Cannabis which will detail the existing and strong evidence for efficacy due to be published in March 2019 which we hope will help to alleviate some of those fears.

All in all, whilst this scope does not go far enough for all patients and in some ways serves to illustrate just how far we have yet to go, it is reassuring that our voices are being heard and feedback is being taken on board. We must remember that It would normally take around 18 months to produce guidelines for a single medicine for a single condition so there really is only so much that can reasonably be accomplished and delivered in the 11 months given for these.

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The scope is just the very first stage in the Guidelines Writing Process taking place between now and October 2019. United Patients Alliance and Families4Access will be present at every meeting and we shall be representing the voice of patients and carers throughout.

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If you have any feedback on the “Scope” that you would like us to raise at the next meeting in a few weeks, please let us know by emailing us: info@upalliance.org

You can read all the comments and suggestions along with NICEs responses right here: NICE Consultation Comments and Responses

What can I do to help?

If you want to help us to continue to push for legal access to cannabis for patients here are some ways you can: