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National Institute for Health and Care Excellence

NICE will not recommend medical cannabis for epilepsy and chronic pain

Draft guidance says patients with chronic pain should not be offered tetrahydrocannabinol (THC) or mixtures of cannabidiol and THC unless the treatment is part of a clinical trial.

The National Institute for Health and Care Excellence (NICE) has said it is currently unable to recommend cannabis-based medical products (CBMPs) for severe treatment-resistant epilepsy.

In draft guidance on the use of CBMPs, NICE said that more research into the use of CBMP for the treatment of a number of conditions was needed because “current research is limited and of low quality”, adding that clinical trials had shown a high level of adverse events. 

However, the committee that drew up the guidance did not make any recommendations against the use of CBMPs, because this might restrict further research in the area and “prevent people who are currently apparently benefiting from continuing with their treatment”, NICE said.

The guidance said that patients with chronic pain should not be offered tetrahydrocannabinol (THC) or mixtures of cannabidiol (CBD) and THC unless the treatment is part of a clinical trial.

NICE also said there is no evidence that CBD in isolation is effective for chronic pain and that the potential benefits of CBPMs in all cases “were small compared with the high and ongoing costs, and the products were not an effective use of NHS resources”.

In line with existing NICE guidance, the draft recommendations say that Sativex (nabiximols; GW Pharmaceuticals) — the first cannabis-based medicine to be licensed in the UK — should not be offered to patients with spasticity because “it is not a cost-effective treatment at its list price”. 

However, nabilone, a synthetic cannabinoid, can be recommended as an add-on treatment for adults with chemotherapy-induced nausea and vomiting who have not responded to conventional anti-emetics.

The guidance says that initial prescriptions for CBMPs should only be issued by clinicians on the General Medical Council’s specialist register, but subsequent prescriptions may be issued by another prescriber as part of a shared care agreement.

Then health minister, Seema Kennedy, said in May 2019 that just six NHS prescriptions for CBPMs had been issued in the community since medical cannabis was legalised in the UK on 1 November 2018.

The consultation on the draft guidance is open until 5 September 2019.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2019.20206928

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