chronic pain

Standardised Medications: Sativex

Sativex (clinical name- nabiximols) is an oromucosal spray containing cannabinoids and is the first cannabis-based medicinal product to be licensed in the UK. Sativex is currently the only licensed drug in the UK for the treatment of spasticity caused by Multiple Sclerosis.

Much like many other cannabis-based medicinal products, Sativex is only recommended for use when other conventional treatments have proved ineffective, or if an individual’s side effects are proving intolerable.

Sativex can also be used in some rare instances in combination with an individual’s usual anti-spasticity medications.

How do you use Sativex (nabiximols)?

Sativex comes in an oromucosal spray form which you administer into orally.

In this spray is an equal combination of CBD and THC and you can take up to 12 doses a day, although the starting dose is only once per day before increasing to responsiveness.

This dose can be increased over a number of days until the optimal dosage is achieved for the patient in question. Required dosages can differ from person to person, so finding the correct number of sprays for each person should be figured out by evaluating how many doses give good relief of symptoms whilst giving the fewest side effects.

If the drug hasn’t had any noticeable effect on spasticity symptoms after 4 weeks, the patient is encouraged to stop taking it and to look for alternate therapies.

How well does it work?

Sativex is not guaranteed to work and often doesn’t work for a lot of people. However, for people who are receptive to the drug, Sativex makes their spasticity symptoms significantly better.

About 50% of people in one study found that Sativex reduced their symptoms by 20% within a four-week period.

Interestingly, despite the fact that Sativex is licensed only for the treatment of spasticity symptoms, many people have reported that Sativex helps with other symptoms of multiple sclerosis like bladder problems, pain, difficulty sleeping and tremor. A 2014 study seemed to confirm that Sativex was ‘probably effective’.

Side Effects:

Possible side effects of Sativex include:

  • Headaches
  • Dry mouth
  • Diarrhoea
  • Dizziness
  • Tiredness

Sativex could also potentially make some side effects of MS worse, for instance fatigue.Side effects generally lessen after a few weeks though and can usually be reduced by taking fewer doses.

Another side effect that is sometimes reported is a high similar to the high experienced when smoking cannabis. This is likely due to the THC in Sativex although you can still drive whilst using the drug, unless it makes you dizzy, sleepy or is affecting your eyesight. A study in 2018 further confirms this advice as it found Sativex did not affect driving and there was no increase in motor vehicle accidents in those taking the drug. Using heavy machinery or driving is not recommended in the first few days of treatment however, as side effects are most common during this period of time.

Side effects common with recreational cannabis use including memory, mental health and dependency issues are not experienced by those using Sativex, despite its THC content. If any side effects similar to these occur, individuals are encouraged to contact their doctors immediately as these symptoms will need to be monitored until they stop.

This drug is not recommended for those who have serious mental health problems, a history of psychosis, are under the age of 18 or those who are pregnant or breastfeeding. It is also not recommended for those with kidney or severe liver problems.

Getting Sativex prescribed

Because Sativex is a cannabis-based medicinal product it is currently a Class B controlled drug under the 1971 Misuse of Drugs Act, which suggests that although there may be some medicinal benefits to the drug, it does have a potential for harm which must be counteracted by prescription limitations.

Sativex is currently placed in Schedule 4 of the Misuse of Drug Regulations (2001) which means it can be legally prescribed in the UK by a specialist doctor with experience treating MS spasticity. This means consultant pain specialists, consultant neurologists and rehabilitation specialists can prescribe the drug.

Despite the fact that doctors can legally prescribe Sativex in the UK, NHS access to the drug is very limited as Sativex is not considered to be a cost-effective treatment for the NHS in England, Scotland or Northern Ireland.

Sativex can be prescribed in Wales however, although the actual availability of such treatment is understood to be very limited despite the fact that prescription is only suggested when other treatment fails to be effective.

Regardless of where you are in the UK, Sativex can be prescribed privately, usually by neurologists, with a month’s supply tending to cost around £500.This is rare though, even with changes in the law in November 2018 that theoretically made it easier for neurologists to prescribe such medicines to a limited number of people with MS. This is also an expensive option, so it is not possible for many people in any case.

The future of Sativex

A proposed update of the 2014 MS Guideline from NICE mentions new evidence that “indicates that [Sativex] may be cost effective”. If new guidelines do emerge reflecting these findings, it would seem likely that Sativex would become more widely available on the NHS through out the UK.

Updated guidelines from NICE are expected to be published in November, 2019.

Further investigation and research into medicinal cannabis and alternative medical options is thoroughly encouraged by The Academy, particularly through the use of our own online coursesevidence base and whitepapers.

The rest of our resources are available on our website. We urge anyone considering use of medical cannabis products to consult with a trained medical professional prior to beginning use.

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