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Why Aren’t Doctors Prescribing Medical Cannabis?

Despite the fact that medical cannabis has now been legal for 12 months, a shockingly limited number of patients have been able to access cannabis-based medicines due to a lack of doctors prescribing in the UK. But why is this the case? Let’s take a closer look at this issue.

The Background

Back in 2018, the UK legalised medicinal cannabis when cannabis was rescheduled to a Schedule Two substance due to its recognised medicinal benefit in certain circumstances. Now, in 2019, the current, confusing recommendations from the government about prescribing cannabis-based products means we still remain firmly behind our European neighbours in terms of progress on this front. While countries like Italy, Switzerland, Spain and Ireland have definitively put in place actionable medical cannabis access programmes, in the U.K, as reported by Prohibition Partners in their U.K cannabis report: ‘only a handful of doctors out of the UK’s 180,000 have been trained in the endocannabinoid system.

Even when cannabis was rescheduled in 2018, only doctors who were on the General Medical Council’s Specialist Register were allowed to prescribe these medicines for a limited group of patients in a very limited number of circumstances. So in actuality, only the estimated 80,000 specialists on this register will be able to prescribe these medicines, not the whole 180,000 doctors in the U.K more generally.

If the already limited access by those on the Specialist Register wasn’t enough to prevent a large number of prescriptions, further restrictions to access were put in place when it was deemed that these cannabis-based medicines should only be prescribed by the specialists when:

  1. Exceptional clinical circumstances had been established
  2. All regularly used medical alternatives have been tried and deemed ineffective
  3. An agreement is reached with an NHS Trust medical director around the proposed product’s use
  4. Agreement is gained from a medical director at the NHS trust

So, what’s stopping doctors prescribing?

In addition to the ways listed above that severely limit the ability and likelihood of the specialist doctors prescribing, a lack of education around cannabis, cannabinoids and the endocannabinoid system means medical professionals have little confidence in their ability to prescribe safely for their patients.

Indeed, in their December report on cannabis in the UK, Prohibition Partners highlighted that: ‘As greater access to education and training emerges, like those provided by the Academy of Medical Cannabis or by the Drug Science initiative, confidence in prescribing practices are likely to improve, especially when coupled with an evidence base that supports the medicines’ efficacy’.

Additionally, a lack of clinical evidence in the form of randomised controlled trials (despite there being a huge number of case studies and real-world data supporting the use of such products) means that regulatory bodies like the National Institute for Health and Care Excellence (NICE) are reluctant to recommend the use of cannabis-based medicinal products for a number of conditions. Indeed, despite the NICE draft guidelines being updated in early November, the number of conditions for which medical cannabis is recommended is still highly limited.

However, with more clinical trials set to be carried out in the not-so-distant future, for instance those set to take place as part of Project TWENTY21, it is hoped that the evidence garnered will encourage such advisory bodies to advise cannabis treatment of a greater number of conditions, which in turn will encourage doctors to prescribe with less fear.

For more studies on cannabis and its efficacy as a medical treatment, take a look at our evidence base, a ground-breaking systematic review of the history of research in this area and a global first-of-its-kind searchable database for clinical referencing.

The rest of our comprehensive resources on medical cannabis are available on our website.

We strongly urge anyone considering the use of medical cannabis products to consult with a trained medical professional prior to beginning use.

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