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Official advice on reclassification of medicinal cannabis expected before end of July

In a report published on 3 July, Dame Sally Davies summarised the recent evidence specifically for medicinal use of cannabis on prescription.

Medicinal cannabis

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Dame Sally Davies, the chief medical officer for England, reached the conclusion that there is evidence for therapeutic benefits of cannabis-based medicinal products for certain conditions. Therefore, these products will be moved out of Schedule 1 of the Misuse of Drugs Regulations 2001

Official advice on the rescheduling of cannabis-related medicinal products can be expected within three weeks, the government has said, as part two of a review into medicinal cannabis begins.

The announcement comes after Dame Sally Davies, the chief medical officer for England, concluded that cannabis-based medicinal products should be moved out of Schedule 1 of the Misuse of Drugs Regulations 2001, on the basis that there is sufficient evidence for their therapeutic benefit for certain conditions.

In a report published on 3 July 2018, Davies, who is also chief medical adviser to the UK government, said that it “may be pragmatic” for these products to be moved to Schedule 2 pending a fuller review by the Advisory Council on the Misuse of Drugs (ACMD) to differentiate different products into the appropriate schedules.

Once the ACMD has completed its review the Home Secretary, Sajid Javid, has said he will then “consider the next steps”.

In her report, Davies summarised the recent evidence specifically for medicinal use of cannabis on prescription, and not recreational use. This forms part of a series of measures looking at the scheduling of cannabis, announced by Javid on 19 June 2018.

In the report, Davies said that there was “conclusive evidence of the therapeutic benefit of cannabis-based medicinal products for certain medical conditions and reasonable evidence of therapeutic benefit in several other medical conditions”, and for this reason, keeping cannabis based medicinal products in Schedule 1 was “very difficult to defend” as, by definition, Schedule 1 drugs have little or no therapeutic potential.

“Moving these drugs out of Schedule 1 would allow them to be prescribed under controlled conditions by registered practitioners for medical benefit,” she wrote.

“In addition, moving the whole class of cannabis based medicinal products out of Schedule 1, will allow the evidence base on the therapeutic benefits associated with using this class of drugs to be improved through research, maximising benefits to patients.”

Displaying the evidence, Davies highlighted that there was conclusive or substantial evidence that cannabis or cannabinoids were effective for the treatment of chronic pain in adults; as a treatment of chemotherapy-induced nausea and vomiting; and for improving symptoms in patients with multiple sclerosis.

The evidence also highlighted that there is “limited but high-quality evidence” for the use of medical cannabis products in epilepsy.

However, Davies added that there are well-known harms from cannabis and its derivatives including addiction and mental health disorders, and that, as with all other medicines, when taking prescribing decisions, doctors must balance the potential for harm against the potential for benefit.

“Recent cases involving sick children made it clear to me that we needed to take a fresh look at the scheduling of cannabis-related medicinal products,” said Javid.

“I would like to thank the chief medical advisor for her initial review and have now asked my independent advisory committee to commence the second stage of this process.

“When I have received its advice, I will consider what next steps need to be taken.”

Ash Soni, president of the Royal Pharmaeutical Society, said the RPS welcomed the position taken by Davies and the opportunity for research into potential new medicines.

“We are pleased there is an alignment of policy between us, and [we] look forward to working with her in this work,” he said. 

Rescheduling cannabis under Schedule 2 would allow for cannabis to be prescribed and legally supplied by pharmacists.

Citation: The Pharmaceutical Journal DOI: 10.1211/PJ.2018.20205124

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