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NICE on cannabidiol for childhood epilepsy

tall cannabis plants growing

At the end of last week, NICE released their initial appraisal on cannabidiol in the form of Epidiolex for childhood epilepsy.  As predicted by Drug Science experts they found against it on the grounds of cost-benefit. We don’t have the company submission regarding cost/benefit analysis, and consequently cannot comment on those, but we can reflect that this decision is the same as the one that NICE made for Sativex in Multiple Sclerosis. Getting pure extracts of plant cannabis products into the NHS now seems a lost cause.  We have repeatedly argued that medical cannabis isn’t suitable for traditional pharmaceutical development programmes in part because of their high costs and low likelihood of returns for investors.

Another significant issue in the case of these epilepsies is the fact that cannabidiol by itself isn’t particularly efficacious, most of the successful outcomes have come from the use of cannabis oil which contains other molecules such as d9THC and THCv that are also anti-epileptic (read more about THCv in a previous blog post here). Developing and testing the most effective combinations would be extremely challenging and expensive and, given none may ever be reimbursed by NICE, ultimately futile. This is why no mainstream pharmaceutical companies are in the field.

What we need to do now is learn from the parents who have gone overseas to find experts to treat their children and have seen remarkable outcomes. Their UK doctors are allowed to prescribe medical cannabis as this was made legal in November 2018, yet fewer than ten NHS prescriptions have been issued in the past ten months. At the very least all those children who were hoping for Epidiolex to become available to make their lives better should now have their specialists prescribe medical cannabis for them as a matter of urgency.

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