New regulations

NHS England has issued new guidance on prescribing cannabis-based products for medicinal use, as new regulations came into force yesterday.

The regulations are drafted in such a way that cannabis-based products for medicinal use can now be supplied under the prescription or direction of a specialist doctor.

NHS England says it is “exploring” how this may work under shared care arrangements. In the first instance, however, it expects specialist prescribing only. Trusts will meet the costs of this, where necessary.

In guidance issued earlier this week, the organisation said it expects that cannabis-based products, “should only be prescribed for indications where there is clear published evidence of benefit or UK guidelines and in patients where there is a clinical need which cannot be met by a licensed medicine and where established treatment options have been exhausted.”

In addition, the NHS advises that it is “good practice to discuss use of cannabis-based products for medicinal use with a peer clinician in the same Specialist Register of the General Medical Council” and “any such discussions should be appropriately documented.”

“If cannabis-based products for medicinal use are prescribed then treating clinicians should maintain a detailed assessment of clinical and patient outcome measures to support patient safety and longer term understanding of the effectiveness of cannabis-based products for medicinal use,” according to the guidance.

Helping Crohn’s Disease

In the first study of its kind, cannabis oil has been shown to significantly improve the symptoms of Crohn’s disease (CD) and the quality of life of patients.

In the double-blind, placebo-controlled trial, 46 patients with active CD were randomised to receive either cannabis oil with 15 per cent cannabidiol (CBD) and 4 per cent tetrahydrocannabinol (THC) or placebo for eight weeks.

A remission rate, defined as Crohn´s disease activity index (CDAI) of less than 150, was achieved in 65 per cent of patients in the cannabis group and 35 per cent of those in the placebo group (P<.05). The cannabis group also had significant improvements in quality of life compared with the placebo group. However, contrary to previous medical thinking, cannabis oil had no effect on gut inflammation.

Commenting on the findings, lead researcher Dr Timna Naftali said there are “good grounds” to believe that the endocannabinoid system is a potential therapeutic target in Crohn’s disease and other gastrointestinal diseases. “For now, however, we can only consider medicinal cannabis as an alternative or additional intervention that provides temporary symptom relief for some people with Crohn’s disease,” Dr Naftali said.

The findings were presented at the United European Gastroenterology week.

References

Cannabis-based products for medicinal use. UK Department of Health and Social Care. 2018 October 31. https://www.england.nhs.uk/wp-content/uploads/2018/10/letter-guidance-on-cannabis-based-products-for-medicinal-use..pdf

Naftali T, Bar-Lev Schlieder L, Konikoff F, Benjaminov F, Lish I, Sergeev I, Ringel Y. Cannabis induces clinical response but not endoscopic response in Crohn’s Disease patients. Abstract OP 196. United European Gastroenterology Week. 20-24 October 2018. Vienna, Austria.