Information for doctors on Cannabis-based products for medicinal use (CBPMs)

Since 2018, it has been legal to prescribe cannabis-based products for medicinal use (CBPMs) across the UK.

This change of law followed a review of CBPMs, and recommendations from the Advisory Council on the Misuse of Drugs. Cannabis-based medicinal products are controlled drugs and many are unlicensed. There are a range of factors that you need to consider before prescribing them.

This page contains links to relevant clinical guidance and explains how our guidance on Good practice in proposing, prescribing, providing and managing medicines and devices applies to the prescribing of CBPMs.

Who can prescribe CBPMs?

The law requires that the supply of an unlicensed CBPM is for use in accordance with a prescription or direction of a doctor 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, paragraph 2)

Guidance from NHS England states ‘a Specialist on the GMC specialist register should only prescribe within their own area of practice and training, and the decision to prescribe should generally be agreed by the multidisciplinary team’. This guidance also includes information on shared care agreements for the prescription of CBPMs.

If sharing care, doctors must follow our guidance on shared care. If you are a specialist proposing a shared care arrangement, you may advise your patient’s GP which medicine to prescribe. If you are recommending a new or rarely prescribed medicine – like a CBPM – you should specify the dosage and means of administration, and agree a protocol for treatment. You should explain the use of unlicensed medicines and departures from authoritative guidance or recommended treatments. You should also provide both the GP and the patient with sufficient information to permit the safe management of the patient’s condition (Good practice in proposing, prescribing, providing and managing medicines and devices, paragraph 80).

In any scenario where a specialist doctor is delegating the assessment of a patient’s suitability for a medicine, the doctor must be satisfied that the person they delegate to has the qualifications, experience, knowledge and skills to make the assessment and must give them enough information about the patient to carry out the assessment. Following this, if the specialist doctor prescribes on the proposal or recommendation of another healthcare professional, they must be satisfied the prescription is needed, appropriate for the patient, within the limits of their competence and that they have enough information to safely proceed (paragraphs 75-76).

Is it ok to prescribe CBPMs?

A lot of cannabis-based medicines in the UK are unlicensed. Many of these products do not have a marketing authorisation in the UK and likely haven’t been assessed by the MHRA for safety, efficacy and quality.

As with other unlicensed medications, the prescription of CBPMs may be appropriate where, on the basis of an assessment of the individual patient, a specialist doctor concludes, for medical reasons, that it is necessary to do so to meet the specific needs of the patient (Good practice in proposing, prescribing, providing and managing medicines and devices, paragraph 103).

For adults who lack capacity, doctors will need to consider if the proposed treatment would be of overall benefit to the patient. Our standards on Decision making and consent provides detailed guidance at paragraphs 76-91. For patients under 18 this guidance should be read alongside our guidance on 0–18 years.

When prescribing unlicensed CBPMs, doctors need to follow paragraph 105 of the prescribing guidance, which sets out the steps and considerations that they must take.

All adverse reactions should be reported to the Medicines and Healthcare Regulators Agency’s Yellow Card scheme.

What do doctors need to consider when prescribing CBPMs?

Doctors must follow the principles we set out on prescribing unlicensed medicines, and keep up to date and follow relevant clinical guidelines.

Doctors must support patients to make informed decisions about their treatment and care, exploring the options available and taking account of the patient’s individual needs, wishes, and preferences.

If doctors are unsure about any aspects of prescribing and managing particular medicines, they should seek advice from experienced colleagues (Good practice in proposing, prescribing, providing and managing medicines and devices, paragraph 11). NHS England guidance makes clear that decisions to prescribe CBPMs should generally be agreed by the multidisciplinary team.

CBPMs are controlled drugs, meaning that if prescribers don’t have access to relevant information from the patient’s medical records, they must not prescribe controlled drugs or medicines that are liable to abuse, overuse or misuse or when there is a risk of addiction and monitoring is important.  Exceptions to this are when no other person with access to that information is available to prescribe without unsafe delay and it is necessary to:

  • avoid serious deterioration in health or avoid serious harm
  • ensure continuity of treatment where a patient is unexpectedly without access to medication for a limited period (paragraph 59).

In these exceptional circumstances, prescribe a limited quantity and dose and follow paragraph 60.

It’s also important that doctors keep up to date with – and follow – any relevant local procedures that may have been put in place by their Integrated Care Board or Drugs and Therapeutics Committee, for example.

If, in their professional judgement, a doctor thinks that prescribing a CBPM would not serve the needs of the patient, they should not prescribe the treatment. They should explain their reasons to the patient and explore other options that might be available, including their right to seek a second opinion (paragraph 51).

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.

The prescribing doctors should also ask for the patient’s consent to contact their GP (or other treating doctors) to share information when the episode of care is completed. If the patient refuses to consent, or does not have a GP, the doctor should explain to the patient the risks of not sharing this information. This should be documented in their medical records (paragraphs 28 and 30).

Where to get more information