NICE Make Official Recommendations for Medical Cannabis on NHS

11th November 2019

The National Institute of Health and Care Excellence (NICE) has published its official recommendations for medical Cannabis prescriptions on the NHS. The guidelines assess the efficacy and cost-effectiveness of Cannabis-based Medical Products (CBMPs) on a number of conditions.

The recommendations laid out by NICE have changed since the draft publication, released earlier this year. The institute has made two recommendations for the use of medical Cannabis through the NHS.

Recommendations for Medical Cannabis

Intractable Nausea and Vomiting

The prescription of a CBMP has been approved for use in Intractable nausea and vomiting. However, the CBMP Nabilone – a synthetic copy of THC – is only recommended as an add-on treatment, if the patient is aged 18 or older. Due to a lack of evidence for children, the institute has not recommended the use of Nabilone for this group.

Chronic Pain

Charities and spokespersons have praised the “first step” of the NICE institute. However, there has also been criticism, as it claims that the recommendations do not go far enough. Advocates are especially disappointed that no recommendations have been made for CBMPs in pain management.

CBMPs, be that plant preparations or extracts, or synthetic cannabinoids, have not been recommended for treatment of chronic pain, unless as part of a clinical trial.

The new guidelines also state that adults who were prescribed CBMPs before these recommendations were made, should be permitted to continue their treatment, for as long as appropriate.

Genevieve Edwards, director of external affairs at the MS Society, said:

“These guidelines are an important first step, but don’t go far enough. No cannabis-based treatments have been recommended to treat pain, a common symptom of MS.”


However, NICE has recommended the use of medical Cannabis through the NHS, to treat spasticity. Both stiffness and spasms are symptoms of spasticity and are common in Multiple Sclerosis patients. The institute has recommended the use of CBD:THC spray, though the recommendation comes with conditions.

Medical Cannabis must only be prescribed for spasticity if other treatments have failed. Patients may only begin a four-week trial, under the conditions of a ‘pay-for-responders agreement’. This agreement sees that the supplying company will fund the first 3 X 10ml vials of the medication.

What’s more, continued use of the medication is only recommended in patients who see at least a 20% improvement in symptoms. Despite the conditions, this is a step forward for MS patients, as CBMPs were previously not recommended as a cost-effective treatment option.

Severe Treatment-Resistant Epilepsy

The official NICE guidelines permit the prescription of Epidyolex for the treatment of two rare forms of Epilepsy. Patients who suffer from Lennox-Gastaut, or Dravet Syndrome Epilepsies will, in theory, be granted access to the medication,

However, NICE has not wholly recommended the use of CBMPs for all severe treatment-resistant Epilepsy syndromes, quoting a lack of evidence. Despite not making a full recommendation for use, the institute has not recommended against the use of medical Cannabis for these conditions. This was decided in order not to discourage or prevent clinical research in this area.

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