Why Clinics Need a Register of Cannabis-Based Products for Medicinal Use
Dr Elisabeth Philipps argues that a register will ensure the most up to date, accurate and relevant information is accessible to prescribers
Cannabis sativa L. has a long history as a medicinal plant, dating back more than two millennia. In recent decades, preclinical studies using both pharmacological and genetic approaches have increased our understanding of this plant and its importance in providing therapeutic strategies for a variety of conditions.
From this advancing clinical area and change in the UK legal status of medical cannabis in November 2018, we have seen a rapid increase in the production of a variety of Cannabis-Based Products for Medicinal Use (CBPMs), which are increasingly prescribed for conditions including multiple sclerosis, epilepsy and chronic pain.
However, a report commissioned by Volteface, an advocacy and communications organisation addressing evidence-based policy reform in the medical cannabis arena, recently noted:
“There are in excess of 40,000 specialist clinicians who are eligible to prescribe cannabis across the UK, yet only approximately 100 (0.25%) are actively doing so, which suggests there are more challenges facing clinicians than purely political concerns. Therefore, it is vital to understand the reluctance to prescribe cannabis, and what needs to change.”
The report identifies several potential barriers preventing specialist clinicians from prescribing CBPMs. Key obstacles to increasing prescriber confidence include lack of understanding of the medical cannabis prescribing process and the wide range of products currently available, including different Cannabis sativa L. cultivars (strains) of cannabis flos (whole, dried flowers of the cannabis plant), which can be delivered in different forms such as oral drops or via the inhalation route.
It is clear that prescribers, and those clinicians interested in prescribing CBPMs, need greater support in their endeavours. There are a number of policy interventions that would help achieve this, but one of the most valuable resources for clinicians would be a comprehensive, gold-standard list of all the approved unlicensed CBPMs in the UK.
This would enable prescribers to have a complete overview of all the UK quality-assured products that are available for them to prescribe to patients, and create a more comfortable prescribing environment through increasing clarity and transparency for clinicians, and supporting prescribing that is more suitable for each individual patient to produce better health outcomes.
Whilst a centralised up-to-date formulary is desirable, this presents industry and current evidence-based challenges. For this reason, the publication of a comprehensive ‘register’ of unlicensed CBPMs that the Home Office and MHRA have permitted for prescription in the UK would provide a satisfactory intermediate solution.
Certain publicly available websites detail currently available products, but resources such as this are generally not suitable for clinicians. They do not provide the depth of clinical knowledge that clinicians require, instead being designed for and to cater to patients.
Creation of a UK CBPM register will ensure the most up to date, accurate and relevant information is accessible for all CBPM products available to prescribers in the UK. The current paucity of CBPM clinical research is something that also needs to be addressed, and a product register will help to advance this area.
There is a similar model that has been produced by the Therapeutic Goods Administration (TGA) in Australia. The TGA retains a list of all unapproved medicinal cannabis products to assist prescribers and pharmacists in prescribing and supplying, although this list is not prescriptive or indicative of availability. The list is publicly accessible and provides a sound model for which the MHRA and UK industry can proceed with.
Dr Elisabeth Philipps is a clinical neuroscientist and integrative medicine practitioner who founded a consultancy specialising in brain health, the endocannabinoid system and phytocannabinoids including CBD and medicinal cannabis.
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