The National Institute for Health and Care Excellence (NICE) has published its new draft recommendations on the use of cannabis-based medicinal products, following a comprehensive evaluation of their clinical and cost-effectiveness.
The organisation says that the fast-tracked guidance follows the re-classification of these products last year to allow specialist doctors to ‘prescribe them where the clinical needs of patients cannot be met by licensed medicines.’
The guidance is open for public consultation until 5 September 2019, and considers the use of these products for people with intractable nausea and vomiting as a result of chemotherapy, chronic pain, spasticity, and severe treatment-resistant epilepsy.
In the same vein, NHS England has published a review aimed at assessing the barriers to prescribing cannabis-based medicinal products where it is safe and clinically appropriate.
Medical cannabis supporting clinicians have said that the guidance is “welcome”, as they are “sensible, reasonable and set out clearly what steps we can and must take to seamlessly integrate medical cannabis into the patient treatment pathway”, according to Dr Michael Platt of Sapphire Medical.
The medical director went on to say that he is “encouraged” to know that “NICE have acknowledged the evidence supporting efficacy of medical cannabis in chronic pain”, and that he is “hopeful that the data generated at Sapphire on this and other conditions will help support the next stage of the review and NICE cost-effectiveness analysis to potentially allow access to medicinal cannabis for these patients on the NHS.”
The review also makes a point of highlighting that the lack of evidence about the long term safety and effectiveness of medicinal cannabis has weighed heavily on prescribing decisions and recommends two clinical trials be set up.
The draft guidance makes eight separate recommendations for further research across all the indications and cannabis-based medicinal products covered in the guidance, reflecting the overall lack of clinical and cost-effectiveness evidence for these products.
Paul Chrisp, director of the Centre for Guidelines at NICE, said that the organisation “recognise that some people will be disappointed that we have not been able to recommend the wider use of cannabis-based medicinal products. However, we were concerned when we began developing this guidance that a robust evidence base for these mostly unlicensed products was probably lacking. Having now considered all the available evidence it’s therefore not surprising that the committee has not been able to make many positive recommendations about their use.”
The NHS England review, which was “developed by listening to families and the specialist clinicians responsible for care,” makes clear that consistency is key and to ensure this, clinicians need the best information and support available to make decisions to prescribe medicinal cannabis for children with severe epilepsy which does not respond to regular treatment.
