Information for doctors on Cannabis-based products for medicinal use (CBPMs)
Following legislative changes, from 1 November 2018, cannabis-based products for medicinal use (CBPMs) can be prescribed across the UK. This change of law followed a review of CBPMs, and recommendations from the Advisory Council on the Misuse of Drugs.
Find out more about our prescribing guidance and how it applies to the prescription of CBPMs.
Links to the available clinical guidance are below.
Who can prescribe CBPMs?
- The legislation in the UK has restricted the decision to prescribe CBPMs to doctors on our Specialist Register.
- As with all areas of clinical care, specialist doctors must recognise and work within the limits of their competence. (Good medical practice, para 14)
- Guidance from NHS England states ‘a Specialist doctor on the General Medical Council Specialist Register should only make the decision to prescribe within their own area of practice and training (e.g. physicians for adults should not be prescribing for children) and the decision to prescribe should be agreed by the multidisciplinary team’.
Is it ok to prescribe CBPMs?
- Many cannabis-based medicines in the UK are unlicensed which means that they have not yet met strict safety and quality standards.
- As with all unlicensed medications, the decision to prescribe CBPMs should be based on an assessment of the individual patient, and may be necessary where there is no suitable licensed medicine that will meet the patient’s need.
- For adults who lack capacity and children, doctors will need to consider if the proposed treatment is in the patient’s best interests.
- Doctors must be satisfied there is sufficient evidence or experience to support an unlicensed medicine’s safety and efficacy. Where there’s a limited evidence base for an unlicensed treatment, there are additional risks to prescribing it. Doctors must give patients (or their parents or carers) sufficient information about the medicine(s) they propose to prescribe, to allow them to make an informed decision..
- All adverse reactions should be reported to the Medicines and Healthcare Products Regulatory Agency‘s Yellow Card scheme.
What do doctors need to consider when prescribing CBPMs?
- Doctors should follow the principles we set out on prescribing unlicensed medicines, and take account of the clinical guidance available.
- Doctors must make decisions in collaboration with patients, exploring the options available and taking account of the patient’s individual needs, wishes, and preferences.
- Doctors should
- consult experienced colleagues with relevant specialist expertise and clinical knowledge.
- follow any local procedures in place such as Local Area Prescribing and Medicines Management Committees (or equivalent Drug and Therapeutics Committees).
- If, in their professional judgement, a doctor decides that prescribing a CBPM is not appropriate for the needs of the patient, they should not be pressured into prescribing the treatment.
- Doctors need to make a clear record of their discussions with a patient (or the patient‘s family and carers), and the decisions made about treatment and care.
Where to get more information
- The National Institute of Clinical Excellence (NICE) guidance on prescribing CBPMs for people with intractable nausea and vomiting, chronic pain, spasticity and severe treatment-resistant epilepsy November 2019
- Barriers to accessing cannabis based products for medicinal use on NHS prescription (NHS England and NHS improvement) August 2019.
- The Home Office circular on the re-scheduling of CBPMs