More research needed on cannabis-based medicinal products

NICE has published its draft recommendations on the use of cannabis-based medicinal products following a comprehensive evaluation of their clinical and cost-effectiveness.

The fast-tracked guidance follows the re-classification of these products last year to allow specialist doctors to prescribe them where the clinical needs of patients cannot be met by licensed medicines. It considers the use of these products for people with intractable nausea and vomiting as a result of chemotherapy, chronic pain, spasticity, and severe treatment-resistant epilepsy.

NHS England has also published a review aimed at assessing the barriers to prescribing cannabis-based medicinal products where it is safe and clinically appropriate, highlighting that the lack of evidence about the long term safety and effectiveness of medicinal cannabis has weighed heavily on prescribing decisions and recommends two clinical trials be set up.

The draft NICE guidance makes eight separate recommendations for further research across all the indications and cannabis-based medicinal products covered in the guidance, reflecting the overall lack of clinical and cost-effectiveness evidence for these products.

Paul Chrisp, director of the Centre for Guidelines at NICE, said: “We recognise that some people will be disappointed that we have not been able to recommend the wider use of cannabis-based medicinal products. However, we were concerned when we began developing this guidance that a robust evidence base for these mostly unlicensed products was probably lacking. Having now considered all the available evidence it’s therefore not surprising that the committee has not been able to make many positive recommendations about their use.

“In most cases, the draft guidance recommends that more research is carried out, echoing the recent call by the National Institute of Health Research for research proposals for these products. To that end NICE welcomes the recent suggestion from the House of Commons Health and Social Care Committee that companies should be encouraged to undertake or enable research into their medicinal cannabis products.”

Dr Keith Ridge, chief pharmaceutical officer at NHS England said: “Without sufficient evidence to help them balance potential benefits against potential harms when they are deciding whether to prescribe medicinal cannabis to children with very severe epilepsy, it is clear clinicians are very reluctant to prescribe.

“We heard loud and clear the concerns and frustration the children’s families are feeling, but these recommendations aim to help us develop the evidence base to understand how safe these products are, and ensure education and expert advice is available to support clinicians across the UK.”