Ministers have rejected a call from MPs to increase NHS access to cannabis-based medical products – a decision which is a blow to tens of thousands of people having to buy them on private prescription or on the black market.
The Home Office has told the all-party Home Affairs select committee that prescribing medical cannabis “is a clinical decision and not a matter for Government policy”.
Cannabis-based products for medical use (CBPMs) were legalised in 2018 after high-profile campaigns led by mothers whose sons suffered extreme and rare forms of epilepsy. They included Hannah Deacon, from Kenilworth, South Warwickshire, whose petition attracted more than 700,000 signatures.
Specialist clinicians working in either the NHS or privately were authorised to prescribe CBPMs in certain circumstances: to treat severe and rare forms of epilepsy, vomiting or nausea caused by chemotherapy and spasticity caused by multiple sclerosis.
Conclusive evidence medical cannabis works
The decision followed a recommendation by the then Chief Medical Officer for England, Professor Dame Sally Davies, who said there was “conclusive evidence of the therapeutic benefit of cannabis-based medicinal products for certain medical conditions, and reasonable evidence of therapeutic benefit in several other medical conditions”.
However, in January 2023 the then health minister Will Quince told parliament that fewer than five patients had been prescribed unlicensed CBPMs on the NHS in England and that a breakdown of the number of items prescribed would not be disclosed to protect those patients’ privacy. In stark contrast, 89,239 private prescriptions were issued between November 2018 and July 2022.
NHS England accepts that very few people are likely to be prescribed medical cannabis and that this would only be done when other treatments have failed or were unsuitable.
Huge number of users
Around 20,000 people were using medical cannabis in March 2023, and perhaps another 1.8 million self-medicate using the black market. Private prescriptions can cost between £250 and £1,800 a month. One family had difficulties with the NHS, and had no option but to go private, costing them £17,500 a year.
The select committee voiced concern that “there is currently a lack of access on the NHS for patients with a genuine need” and “access continues to be a problem”. It recommended that the government “widens the accessibility of unlicensed CBPMs on the NHS before the end of this parliament”.
Rejecting the recommendation, the Home Office said that cannabis-based medicines were “routinely available and funded on the NHS. However, for unlicensed cannabis-based medicines, clinical guidelines from NICE demonstrate a clear need for more evidence to support routine prescribing and funding decisions”.
Doctors are “reticent”
“Until that evidence base is built, clinicians will remain reticent to prescribe and no decision can be made by the NHS on routine funding. Clinicians can apply for NHS funding in exceptional clinical circumstances; these requests are assessed by an independent panel made up of doctors, nurses, public health experts, pharmacists, NHS England representatives and lay members.”
The government, it said, remained committed to taking an “evidence-based” approach to unlicensed cannabis-based medicines and would continue to encourage manufacturers of unlicensed products to conduct research. It was also working with regulatory and research bodies and the NHS to establish clinical trials to test the safety and efficacy of these products.
NHS England and the National Institute for Health and Care Research are working to develop two randomised control trials on medical cannabis to treat epilepsy and the Institute is open to research proposals in these areas as a priority.
“Manufacturers have a responsibility”
However, the government insists that as with “other medicines, it is the responsibility of manufacturers to produce evidence on safety, quality and efficacy and to put forward their products for scrutiny by the Medicines and Healthcare Products Regulatory Agency before a marketing authorisation (licence) is granted. The industry has largely failed to invest in clinical trials to establish the safety, quality and efficacy of their products”.
The Home Office says that “the law does not restrict which conditions CBPMs may be prescribed for and there is no legal impediment to specialist doctors prescribing CBPMs where clinically appropriate and in the best interests of patients”.
Reasons for the low take-up of NHS prescriptions include firstly, a lack of awareness of the legality of medical cannabis (in part due to advertising restrictions). In addition, while most CBPMs are allowed legally, some are not yet licensed, and doctors are worried that for this reason they could be sued by patients in the case of serious side effects.
In 2022, a medical cannabis access bill was introduced in parliament by Jeff Smith, a Labour MP. It proposed that GPs should be allowed to prescribe CBPM, a commission on cannabis-based medicines be set up and more CBPMs should be licensed. The bill was killed when it ran out of time.
