Patients have joined calls for cannabis-based medicines to be added to the NHS drug dictionary, saying their exclusion could lead to potentially “dangerous” contraindications.
Patient organisation PLEA (Patient-Led Engagement for Access) has joined clinics in the sector and MPs, calling for cannabis-based products to be added to the NHS dictionary of medicines and devices.
As most cannabis medicines are unlicensed in the UK, they are not listed in the database, with only the licensed cannabis-based medicines Nabilone, Epidyolex and Sativex currently included.
This means that those who have legal prescriptions for medical cannabis currently have no record of this in their GP notes, other than any letters which have been sent from their private clinic.
Experts have highlighted the “danger” this poses, with patients at risk of being prescribed medications with known contraindications if their doctors are not aware they are taking cannabis.
Scottish National Party MP, Alyn Smith, raised the issue in a parliamentary debate on Thursday 4 November.
Smith, whose Stirling constituency is home to Scotland’s first medical cannabis clinic, also highlighted that bringing all cannabis prescriptions into the NHS drug dictionary would allow for “better assessment of the scale of prescriptions already in existence, along with “better analysis”.
Smith, who was himself diagnosed with arthritis nine years ago, said: “What it has given me is a really keen awareness that pain management and chronic medical conditions are life-defining for millions and millions of the people that we serve. Medical cannabis, anything that can help and alleviate those conditions surely needs to be properly worked through for the benefit of those millions of people… it shouldn’t be held back by outdated thinking.”
The UK Government has a chance to treat drugs as a public health issue opposed to a criminal justice one.
Medical cannabis prescriptions have the ability to change millions of lives across the country. A fresh approach and further research is needed on this topic. pic.twitter.com/SaGZEYjLRk
— Alyn Smith MP
(@AlynSmith) November 4, 2021
Smith has been working closely with Sapphire Medical Clinics, which opened its Stirling clinic earlier this year.
Speaking at the summary event of Medical Cannabis Awareness Week on Sunday 7 November, Sapphire’s head of communications, Beth Sweet-Escott said: “One thing that we can push for immediately is for NHS Digital to add cannabis-based medicines – all the different types of medicines – to the NHS drugs dictionary.
“At the moment they’re not included and that is actually really dangerous and has impacts for things like contraindications. This is something that needs to happen very quickly… so that it’s transparent and on the record.”
Sweet-Escott, also highlighted that this would help with clinician education around medical cannabis.
She continued: “One of the main focuses is to increase education awareness. The Primary Care Cannabis Network carried out research on GPs earlier this year, and found that there’s still a huge kind of lack of awareness, even though GPs asked on a daily basis about CBD and cannabis by patients.
“All healthcare professionals have so much to learn when they are starting out, but this is a vastly growing patient community who are being helped and there’s no other option but to provide education and support conditions, on safety data, on efficacy data, on adverse events. Cannabis is a very complex medicine.”
Also on the panel, medical cannabis patient Lex Wolfe, revealed that they were almost prescribed an antidepressant with known contraindications with cannabis, due to their prescription not being in their medical records.
“Nowhere on my health records – other than a couple of letters from my cannabis clinic – does it state that I’m a medical cannabis patient,” said Lex.
“I’ve had GPs try to prescribe me tricyclic antidepressants, which have known contraindications with cannabis products. They can cause tachycardia and as a patient that already has tachycardia issues that can be really dangerous.”
A spokesperson for NHS Business Services Authority, which manages the NHS dictionary of medicines and devices, told Cannabis Health that products would be added once they received regulatory approval from the Medicines and Healthcare Products Regulatory Agency (MHRA).
They added that the “lack of standardised information” creates challenges when authoring in the dictionary of medicines and devices.
“The NHS dictionary of medicines and devices (dm+d) aims to include any regulatory approved licensed medicine that has undergone robust assessment by the Medicines and Healthcare Products Regulatory Agency (MHRA) to support prescribing and dispensing purposes. Regulatory approved documentation is aligned with credible standards (e.g., Pharmaceutical form) that helps support inclusion of product profiles in dm+d,” they said.
“Many cannabis-based products are not licensed in this country and in the absence of more products not being approved by the national regulatory agency, the lack of reputable and standardised information creates challenges for authoring on dm+d.
“We’ll continue to review products and as soon as any achieve a reputable regulatory approved status they will be added to the NHS dictionary.”
The Department of Health said that “the majority” of products containing THC and CBD products, are unlicensed and have not demonstrated “clear evidence of their safety, clinical and cost effectiveness”.
They added that they continue to back further research and look at how to minimise the costs of these medicines.
A spokesperson said: “Three cannabis-based medicines have been made available for prescribing on the NHS for patients with multiple sclerosis or hard to treat epilepsies, where clinically appropriate.
“The NHS dictionary of medicines and devices aims to include information on licensed medicines approved by the UK’s independent regulator, the MHRA, to support both prescribing and dispensing – including Nabilone, Epidyolex and Sativex.
“Currently, many cannabis-based products are not licensed. This means there is a lack of standardised information on these products, which creates challenges for adding them to the dictionary. We are working closely with the NHS and the National Institute of Health Research to establish clinical trials to develop the evidence base to support further commissioning decisions.”
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