A lack of clinical evidence is preventing clinicians from being able to prescribe cannabis-based medicines, an NHS review has found.
CBD
Last year, the law was changed so specialist doctors could prescribe cannabis-based medicines if they deemed it clinically appropriate for their patients.
It was hoped that this change to the law would help build up a body of clinical evidence, but this very lack of data into the safety and efficacy of cannabis-based medicines is what’s stopped doctors prescribing these medications.
The National Institute for Health and Care Excellence (NICE) has called for two clinical trials to be set up. Additionally, NICE has issued draft guidance into the use of cannabis-based medicinal products for a number of conditions where the therapies could be effective.
A major point of contention comes from the watchdog’s recommendation into the use of cannabis-based medicines for severe-treatment resistant epilepsy.
Of the 600,000 people in the UK, it’s estimated that 30% of these are resistant to current treatments. NICE state that a lack of clear evidence into the benefits of cannabis-based medicinal products means it can’t recommend treatments be used to treat epilepsy.
Parents in the NHS review have said that they understand the evidence is limited, but clinicians are failing to take into account observational data from around the world.
Concern has also been raised into the parents feeling that they have to break the law in order to obtain medical cannabis for their children.
Professor David Nutt from Imperial College London said:“The NICE consultation is very disappointing for those tens of thousands of patients and carers having to break the law every day to obtain black-market medical cannabis.”
Professor Nutt also warned that NICE’s reliance on placebo controlled RCT trial data “reveals a deep lack of appreciation of the complex and varied nature of medical evidence.”
There’s also an argument to be made for the change in law last year that resulted in raised expectations from patients regarding access to cannabis-based medicines.
Ian Hamilton, lecturer in Mental Health, University of York, said: “The report makes clear that the policy change in November in effect raised expectations of patients but systems were not in place to meet these expectations, in effect it is only in recent months that the information that clinicians need to make decisions on whether to prescribe a product or not are being put in place.”
Issues into the cost effectiveness for cannabis-based medicines were also raised in regard to the drug Sativex – used to treat spasticity in people with multiple sclerosis (MS) and nausea and vomiting in chemotherapy patients. NICE is unable to recommend the drug due to it not being cost-effective at its current price.
In response to the draft guidance by NICE, Genevieve Edwards, director of External Affairs for the MS Soceity, said: “We’re bitterly disappointed by these guidelines. NICE’s refusal to recommend cannabis for pain and muscles spasms, or to fund Sativex on the NHS, means thousands of people with MS will continue to be denied an effective treatment.
“MS is relentless and painful, yet not a single person with MS has benefited from medicinal cannabis being legalised nine months ago.”
Paul Chrisp, director of the Centre for Guidelines at NICE, said: “We 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.”
Responses to the NHS review have been more positive, welcoming the fact that the organisation is willing to recognise different models of evidence for cannabis-based medicines.
Professor Mike Barnes, chair of the Medical Cannabis Clinicians Society said: “This is a positive review that recognises the need for accepting different but valid evidence for the efficacy of cannabis as a medicine.
It’s sad to compare this forward-looking and positive review of cannabis medicine by the NHS with sadly outdated draft Nice guidelines into Cannabis-based medicinal products also released today. Nice has surely reached its sell-by date.
I hope that Matt Hancock takes advice from his own review and rejects the outmoded and outdated draft Nice guidelines.”
The NHS is now recommending that a UK-wide specialist clinical network for children be set up in order to provide expertise and support to clinicians in generating evidence.
More so, the NHS and the Department of Health and Social Care (DHSC) will develop clear information for patient groups on cannabis-based medicine prescriptions.