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The problem with prescribing

Earlier this week, changes to legislation in import regulations for cannabis based medical products were made - enabling patients with scripts to receive their medicines within days, not weeks or months.


Up until now, legal restrictions have meant patients have been waiting often several weeks or months at a time to receive their medication, which has been causing unnecessary breaks in treatment regimes, resulting in pain or symptoms of complex needs such as severe epilepsy making more occurrences and disrupting everyday life.


However, the main problem still lies in prescribing. Let’s discuss this more.


Where is the problem

GPs are currently unable to prescribe medical cannabis to their patients; due to legislation which will only allow specialist doctors on the GMC register to initiate scripts for cannabis-based medical products. Under current NICE guidelines, GPs can be part of a shared prescribing process but in reality, this is not happening in clinical practice due to a number of factors.


This is largely due to the fact that very few scripts for cannabis-based medical products have been issued through the NHS. Many specialists still do not understand cannabis as a medicine and are reluctant to prescribe for patients; and if they do decide to prescribe through the NHS, prescriptions for unlicensed medications are commonly blocked by Trust Medical Directors.


In addition, many GPs report to us that they are receiving mixed messages about when and how to discuss medical cannabis with their patients, yet this subject matter is a recurring topic coming up time and time again in GP consultations.


Dr Leon Barron, Founder of The Primary Care Cannabis Network, speaking at the Hemp and CBD Expo earlier this week that: “GPs are seen as gate-keepers; we liaise with specialists, engage with them and so on, but we have a limited toolbox, particularly when prescribing for conditions such as chronic pain - we can’t prescribe medical cannabis yet, which is odd, as GPs are uniquely positioned to oversee medical cannabis treatments.


We are the ones who have a closer relationship with patients, understand diseases and symptoms in context of our patient’s day to day lives and we are well placed to monitor and make regular adjustments to prescriptions. The UK seems to differ from the rest of the world where we see cannabis for medical use legalised now in over 50 countries and where GPs are the main prescribers.”


One concern from all doctors is that the vast majority of cannabis-based medical products are unlicensed; however, it is worth noting that there are many medications which are unlicensed for a particular condition and yet are still routinely prescribed - such as most paediatric drug doses which have not been through large clinical trials and medications used off licence for chronic or neuropathic pain such as amitriptyline and duloxetine.


“We can see then when everything is put together, why there are so many hesitations for GPs to get involved in conversations with patients around this subject, particularly when there seems to be so many obstacles in place in the process of prescribing and obtaining scripts. We should also note that many of our patients are using street cannabis for medical purposes or over the counter CBD products and we need to have a basic understanding of how these work in the body and how these may interact with other prescribed medications and treatments etc,” continues Dr Leon.


History of medical cannabis

There is so much evidence into the history of medical cannabis and how it has been used over the course of hundreds of years. The cannabis plant has over 6000 years of documented history with many different cultures throughout the centuries recognising and utilising its medical properties for everyday health and well-being.


Dr Leon explains: "When cannabis was hijacked for political purposes in the 1950s, its use as a medicine was put to the shelf and we lost decades in research and understanding and refining the therapeutic application of this plant. Fortunately, however, as governments have started to recognise the medical benefits of cannabis and it’s excellent safety profile and relax their laws around prescriptions and research, we have seen a dramatic upsurge in the publication of academic papers - evidenced by a simple Pubmed search on cannabis/medical cannabis.


“Clearly, we need to educate doctors both current and in training; we need to look at current research and we need to provide more support to groups such as Drug Science and Project TWENTY21, who are trying to fight for the future of medical cannabis - by gathering new and improved evidence.


"There is also an urgent need to provide support in education to GPs amid growing patient interest in this emerging field. The Primary Care Cannabis Network helps to provide clarity and balanced opinion around this subject matter. We also aim to break down the stigma associated with cannabis as an alternative or additional therapy for patients. We are here to assist GPs in the process and can offer peer support and education.”


Strengthening the voice of GPs

At The Primary Care Cannabis Network, we are reaching out to and are working with other professional organisations and societies, so we can educate GPs further.


The aim is to expand the knowledge of cannabis-based medical treatments and focus on academic research, education, key-papers and open discussions.


We focus specifically on the needs of GPs and are creating a community that will enable GPs to confidently work together and speak with specialists to understand the various regulatory pathways that exist within the UK.


Moving forwards into 2020, the PCCN will host a series of events on Medical Cannabis and will also be key-note speakers at other seminars within industry. For more information on these events or to be kept up-to-date with the latest news and member meeting, subscribe to our Journal Club today