Combating Medical Cannabis Confusion

In the UK, cannabis-based medicinal products (CBMPs) were legalized for prescription use in the UK in November 2018, when medical cannabis was rescheduled from a schedule 1 drug to a schedule 2 drug. Since then, however, medical cannabis has been largely only prescribed privately and dispensed through specialist distance-selling pharmacies.

While prescriptions for medical cannabis products are still relatively rare, there’s no reason not to develop your understanding of this emerging product area.

By Saša Jankovic

Medical cannabis is a broad term used to refer to any medical products derived from, or related to, cannabis ― often referred to as cannabis-based medicinal products (CBMPs). A number of products fall into this category, including whole cannabis flower ― which can be vaporized ― as well as capsules, oils, and sprays containing cannabinoids.

CBMPs were legalized for prescription use in the UK in November 2018, when medical cannabis was rescheduled from a schedule 1 drug to a schedule 2 drug. There are currently only a few licensed medical cannabis products in the UK despite the change in regulation, meaning that at present medical cannabis is largely only prescribed privately and dispensed through specialist distance-selling pharmacies.

What’s more, National Health Service (NHS) guidance says CBPMs are not considered as first-line treatments due to the majority of products being unlicensed. It also recommends that prescribers should first consider prescribing medicines that are licensed for the specific condition that the patient presents with.

However, medical cannabis may be useful in a number of conditions, including pain conditions and palliative care, psychiatric conditions, neurological conditions such as epilepsy, migraine and Parkinson’s disease, gastrointestinal conditions, and rare and unresponsive skin conditions such as psoriasis and acne.

Medical cannabis must be prescribed by a specialist clinician and supported by a multi-disciplinary team. It is only prescribed for diagnosed conditions where first-line therapies have failed. The Medical Cannabis Clinicians Society estimates that around 20,000 patients obtain private prescriptions each year, but says these numbers “pale in comparison to the 1.8 million people in the UK accessing the illicit cannabis market for medical reasons.”

“The current legal framework means that cannabis is not routinely prescribed in the NHS, and to my knowledge, there are only around five patients receiving CBPM treatment funded by the NHS,” says Matthew Rawding, medical cannabis specialist pharmacist at Medicines and Healthcare products Agency (MHRA)-approved specials manufacturer Rokshaw Laboratories. Rokshaw was cofounded by brothers Jonathan and Richard Hodgson in 2012 as the first company to manufacture medical cannabis in the UK, and is now part of the world’s largest cannabis company, Curaleaf.

“The unfortunate reality of this is that it pushes patients down the private medicine route, which has caused an influx of specialized medical cannabis clinics/pharmacies to form to try and service patients,” says Rawding.

“However, patients aren’t used to paying a premium for medicines in the UK and, with the current cost-of-living crisis, this further restricts access to medical cannabis.” The solution to this barrier, he says, is simple: “More pressure is needed on governmental bodies to open access to medical cannabis to enable cost-effective treatments to patients who need this most.”

Medical cannabis education

Rokshaw works with a number of specialist clinics and prescribers in the UK, which are providing patients with medical cannabis treatment, and promotes the importance of education for developing patient access to medical cannabis.

“Outside of the specialisms of healthcare professionals tailored to cannabis, it is a largely unknown field in the medical community,” Rawding acknowledges. “I graduated from university as a pharmacist in 2018 and never heard the word ‘cannabis’ in a medical sense, outside of negative connotations associated with it.”

However, he hopes that this may be set to change. “There are a lot of groups/persons lobbying for GP prescribing, but the education is not currently there, as well as the framework to implement this,” he says. “Police education is also a large issue at present, and we have had so many reports of patients who have had their medication wrongly confiscated.”

And, of course, another barrier is that you can't advertise any medicine that is not licensed by the MHRA. Nonetheless, Rawding estimates that by the end of this year, there will be “between 25,000 and 45,000 cannabis patients in the UK.”

As a result, one of Rokshaw's ― and Curaleaf's ― missions this year is to help community pharmacies enter this growing market with confidence. In partnership with Rokshaw, community pharmacies will be able to refer their eligible patients to a UK leading medical cannabis clinic.

The resulting private prescriptions written by the clinic would be sent to the referring community pharmacies for dispensing, rather than specialist distance-selling pharmacies currently processing these.

"This represents an excellent commercial opportunity for community pharmacy to help with growing this emerging market by giving healthcare professional credibility," says Jonathan Hodgson, CEO of Rokshaw Laboratories.