What is medical cannabis?

Medical cannabis refers to the use of the cannabis plant or its compounds, primarily THC and CBD, for therapeutic purposes. It is prescribed by healthcare professionals to alleviate symptoms and treat various medical conditions.

THC can relieve pain, promote a sense of relaxation, and stimulate appetite, while CBD has anti-inflammatory and potential anti-seizure properties, without the psychoactive effects of THC.

What conditions are medical cannabis prescribed for in the UK?

 Medical cannabis is used as a treatment method for numerous conditions, including:

• Intractable nausea or vomiting from chemotherapy (Nabilone).
• Rare or severe forms of epilepsy (Epidyolex).
• Muscle spasms or stiffness (spasticity) due to multiple sclerosis (MS) (Sativex).

Medical cannabis can also be useful for, (though it is not licensed for) chronic pain, as well as certain neuropathic and cancer pain

There are no restrictions on which conditions medical cannabis can be prescribed for. However, there must be extensive research evidence which supports the prescription.

For guidance on when to prescribe medical cannabis, it is recommended that you read the guidelines on prescribing medical cannabis products set by the National Institute for Health and Care Excellence (NICE), which advises the National Health Service (NHS) in the UK. NICE provides recommendations on prescribing, as well as evidence and research to support prescription choices.

How does medical cannabis work?

Medical cannabis works by interacting with the body's endocannabinoid system, primarily through its active compounds, THC and CBD. THC binds to CB1 receptors in the brain, altering neurotransmitter release, which can alleviate pain, induce relaxation, and stimulate appetite.

CBD has more complex effects, modulating both CB1 and CB2 receptors and reducing inflammation and oxidative stress. Medical cannabis is used for the following reasons:

• To manage pain.
• Reduce nausea and vomiting.
• Stimulate appetite.
• Control seizures.
• Treat various medical conditions.

Its efficacy varies depending on the strain and dosage, and patients should consult healthcare professionals and follow local regulations when considering its use.

What are the current cannabis regulations in the UK?

Cannabis is now Schedule 2 in some circumstances following a change in law, which took place in November 2018, by The Misuse of Drugs (Amendments) (Cannabis and Licence Fees) (England, Wales and Scotland) Regulations 2018.

Who is eligible for medical cannabis prescription in UK?

Medical cannabis will be prescribed in the best interests of the patient, although patients wishing to try medical cannabis may have to try two previous treatments without success, before taking the treatment.

It is important to note that medical cannabis is an unlicensed medication and should only be considered when the patient cannot be treated with a licensed medicine.

The five principles of prescribing medical cannabis can provide guidance to prescribing clinicians, supporting safe and appropriate uses of unlicensed medicines:

• Establish the optimal treatment for the patient.
• Understand the patient’s experience and make a shared decision.
• Identify medicines and preparations.
• Monitor and review.
• Ensure effective prescribing governance.

Who can prescribe medical cannabis?

In the UK, prescribing it is restricted to private doctors or NHS consultants who are listed on the Specialist Register of the General Medical Council.

Before prescribing medical cannabis, the General Medical Council states you must:

• Be aware of the misuse of drugs regulation.
• Be aware of existing evidence used for the treatment.
• Have an adequate understanding of the available guidelines.
• Only prescribe within your own speciality.

A specialist physician is only able to prescribe within their field expertise and assesses each prescription for medical cannabis on an individual basis.

How long does a medical cannabis prescription last for?

Monthly titration is usually required for medical cannabis, in order to produce the best results. This takes place and a follow-up takes place at a clinic, where the outcome is measured, potential side effects can be ruled out and its benefits can be established.

It can take up until 3 months or more for the effects of medical cannabis to be fully seen.