Guidance issued by Nice today (November 11) recommends the prescribing of oromucosal spray Sativex for the treatment of moderate-to-severe spasticity in adults with multiple sclerosis (MS), and Epidyolex oral solution for children with two forms of severe epilepsy.

Sativex contains cannabis extract nabiximols and Epidyolex contains cannabidiol. Neither have been recommended for the treatment of chronic pain – a condition with which cannabis-based medicines are often associated in the media.

Read the full Nice recommendations.

Rescheduled

Cannabis-derived medicinal products were rescheduled from schedule 1 to schedule 2 under the Misuse of Drugs Regulations 2001 last year.

Doctors on the General Medical Council’s specialist register – such as paediatricians and neurologists – are able to issue prescriptions for cannabis-based medicines, home secretary Sajid Javid confirmed at the time.

In its guidance published today, Nice recommends that “after the initial prescription, subsequent prescriptions of cannabis-based medicinal products may be issued by another prescriber as part of a shared care agreement”.

This could include “other healthcare professionals, such as GPs and non-medical prescribers if they were confident to take on the responsibility of prescribing”, it added.

RPS welcomes recommendation

Royal Pharmaceutical Society (RPS) chief scientist Professor Gino Martini welcomed the Nice guidance and said: “Pharmacists will be on the frontline of supplying cannabis-based medicinal products and can give advice to patients on them as part of their treatment plan.”

The guidelines around the shared care agreement are “encouraging”, he added, as it recognises that “some non-specialist clinicians might not be comfortable prescribing”.

It is “essential” that there is “robust governance” around prescribing and dispensing, and pharmacists have a “key role to play” in ensuring this is in place, Professor Martini stressed.

The RPS agrees that national registers of treatment with cannabis medicinal products should be set up to “record evidence on clinical outcomes and adverse effects”, he added.

Manufacturer: “A momentous occasion”

GW Pharmaceuticals, the UK-based manufacturer of both Epidyolex and Sativex, said the Nice recommendation is a “momentous occasion for UK patients and families”.

“This is proof that cannabis-based medicines can successfully go through extensive, randomised, placebo-controlled trials and a rigorous Nice evaluation process to reach patients,” the company’s chief operating officer Chris Tovey said.