In November 2018 when the UK made cannabis-based products for medicinal use (CBPMs) legal most people assumed these would immediately be made available to patients, but they were wrong. In the year since almost no National Health Service (NHS) prescriptions have been issued and less than a hundred have been made available from private providers at a cost of at least £1000 a month. For these reasons, some parents of children with severe epilepsy continue to go overseas to get their children access to the only treatment which has proven to be effective for their condition, that is, a cannabinoid medication. Moreover, the vast majority of the estimated 1.4million medical cannabis users source from the black market with its problems of illegality, unknown quality, content and provenance. Given the substantial evidence of the utility of CBPMs in many disorders as identified in the US National Academy of Sciences review in 2017 this failure of delivery in the UK seems odd and, to many, inexcusable.
Although cannabis-based products for medicinal use are now legal in the UK, it is still challenging for patients to gain access, and only very few National Health Service prescriptions have been written to date. This paper attempts to make sense of why the UK lags behind so many other countries which also have legalised medical cannabis. From consulting with parents and patients, prescribers, pharmacists and decision-makers it seems that there are a series of distinct barriers to prescribing that need to be overcome in order to improve patient access to medical cannabis in the UK. These include concerns about the perceived lack of scientific evidence. To alleviate these concerns, we highlight the importance of patient-centred approaches including patient-reported outcomes, pharmacoepidemiology and n=1 trials, which can contribute to the development of the evidence base for medical cannabis. We hope that this paper will help policymakers and prescribers understand the challenges to prescribing and so help them develop approaches to overcome the current situation which is detrimental to patients.
The many thousands of UK patients self-medicating with non-regulated CBPMs and the international database evidence suggest these new medical products offer a significant advance in treatment for many in whom current medicines are either ineffective or poorly tolerated. They also offer the potential of significant cost savings to the NHS in terms of reduced hospital stays and less prescribing of other medicines particularly opioids for chronic pain. The failure of the medical and pharmacy professions to embrace CBPMs despite their being made ‘legal’ over 18 months ago is a great worry to patients and will already likely have led to preventable deaths from conditions such as epilepsy. We hope that this paper will help policymakers and prescribers understand the challenges to prescribing and so help them develop approaches to overcome the current highly unsatisfactory situation.
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