Currently, prescribing pharmacists in the UK cannot prescribe cannabis-based products for medicinal use (CBPMs).

Prescribing of CBPMs for medicinal use in the UK is restricted to only those clinicians listed on the Specialist Register of the General Medical Council¹. The GMC² does not specify what type of speciality is needed (there are over 60 possible fields) however, it makes sense that the chosen speciality should relate to the use of the medicine.

What are CBPMs prescribed for?

There are two licenses for CBPMs in the UK Epidyolex, a purified cannabidiol used to treat Lennox-Gastaut syndrome and Dravet syndrome, rare forms of childhood epilepsy and Sativex which has an approved license for treating muscle stiffness and spasms, known as spasticity, in multiple sclerosis.

In the unlicensed realm, where the majority of cannabis medicine prescribing lies, specialist doctors could prescribe Epidyolex or Sativex for conditions other than mentioned in the SPC. Alternatively, unlicensed CBPMs or “Specials” are often prescribed for:

• Chronic pain
• Sleep disturbance
• Appetite loss
• Increasing appetite and decreasing weight loss associated with HIV/AIDS
• Improving symptoms of Tourette syndrome
• Social anxiety disorders
• Posttraumatic stress disorder

National Academy of Science Report “no or insufficient evidence“:

• Cancer
• Crohn’s disease
• Epilepsy
• Immunological disorders
• Glaucoma
• Irritable bowel syndrome
• Mental health conditions: schizophrenia and posttraumatic stress disorder (PTSD)
• Wasting syndrome (cachexia)

The two lists above have been arranged in descending order of strength of evidence in accordance with The Chief Medical Officer for England’s June 2018 review³.

So, if the Doctor who is looking to prescribe CBMPs and would like to work to Clinical Best Practice, they should specialise in childhood epilepsy or multiple sclerosis (both of which are not classified as speciality areas by the GMC). Broadening this list to conditions with less evidence, a CMBP prescribing doctor should hold a speciality in:

• Clinical oncology
• Gastroenterology 
• Palliative medicine
• Paediatrics
• Medical oncology
• Clinical neurophysiology

In fact, as mentioned at the beginning of this article any speciality would suffice. What is odd is that this ability is not available to any other type of prescriber notably nurses, midwives, pharmacists, physiotherapists, podiatrists, paramedics or optometrists.

What needs to happen for pharmacists and other prescribers to be able to prescribe medicinal cannabis?

More evidence needs to be established for the safety profile and clinical efficacy of CBMPs. Once this reaches a threshold, the government can be petitioned to loosen the unlicensed prescribing requirements from not only allowing Specialist Registrants of the General Medical Council but enable all CD prescribing clinicians to prescribe the CBMPs.

Final note.

Not all pharmacists are prescribers, however, the majority of pharmacists are involved in the other major part in medicine supply, dispensing. As such, pharmacists have a legal requirement to check the legal validity of prescriptions presented to them. As of late, it has become more apparent that prescribers do not all have the same permissions to prescribe. We have been charting this via our Prescriber Permissions Chart (see below) which as of late has had two new additions, esketamine and CBMPs.

Finally, a second potential solution to this issue is that a Specialist Register is set up within the GPhC Register which would enable willing pharmacists to undergo the required training to safely prescribe these medicines. Within our Independent Pharmacist Prescriber Group, we are currently working on a strategy to open dialogue with the GPhC see if we can make this happen.

Reference

¹https://www.england.nhs.uk/medicines-2/support-for-prescribers/cannabis-based-products-for-medicinal-use/cannabis-based-products-for-medicinal-use-frequently-asked-questions/#who-can-prescribe-a-cannabis-based-product-for-medicinal-use

²https://www.gmc-uk.org/ethical-guidance/learning-materials/information-for-doctors-on-cannabis-based-products-for-medicinal-use

³Cannabis Scheduling Review Part 1: The therapeutic and medicinal benefits of Cannabis based products – a review of recent evidence Professor Dame Sally Davies Chief Medical Officer for England and Chief Medical Advisor to the UK Government. Published on June 2018, accessed on 27th January 2021 via https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/722010/CMO_Report_Cannabis_Products_Web_Accessible.pdf