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MORE RESEARCH NEEDED ON
MEDICINAL CANNABIS, SAYS NICE
MORE RESEARCH IS NEEDED on cannabis-based medicinal
products before they can be widely prescribed, says the
National Institute for Health and Care Excellence (NICE).
Medicinal cannabis products were re-classified last year
to allow specialist doctors to prescribe them where the
needs of patients could not be met by licensed medicines.
The decision followed the high-profile cases of two
children with epilepsy whose parents were unable to
legally access cannabis oil-based medicines to prevent
their seizures (DDN, July /August 2018, page 5).
NICE has issued
draft guidance for
public consultation
on the use of
cannabis-based
products for
people with severe
treatment-
resistant epilepsy,
chronic pain,
spasticity and
intractable nausea
and vomiting as a
result of
chemotherapy. The
guidance makes a
range of
recommendations
for further
research based on
the ‘overall lack of clinical and cost-effectiveness
evidence’ for the products. The guidance states that, other
than pure cannabidiol (CBD) used ‘on its own in the
context of a clinical trial’, no cannabis-based products
should be used for treating chronic pain, while Sativex
should not be used for treating spasticity in people with
multiple sclerosis as it was not found to be cost-effective
in relation to its benefits.
NHS England has also published a review of the
‘we recognise that
some people will
be disappointed
that we have not
been able to
recommend the
wider use of
cannabis-based
medicinal products’
STUBBED OUT
barriers to prescribing the products, which states that the
lack of evidence regarding their long-term safety and
effectiveness has ‘weighed heavily on prescribing
decisions’ and recommends that two major clinical trials
be set up. It also states that ‘consistency is key’ when
making decisions about the use of medicinal cannabis for
children with severe epilepsy, as without sufficient clinical
trial evidence clinicians were ‘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,’ said chief
pharmaceutical officer at NHS England, Dr Keith Ridge.
‘We recognise that some people will be disappointed
that we have not been able to recommend the wider use
of cannabis-based medicinal products,’ added director of
NICE’s centre for guidelines, Paul Chrisp. ‘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.’
Director of external affairs for the MS Society,
Genevieve Edwards, said her organisation was ‘bitterly
disappointed’ by the guidelines. ‘NICE’s refusal to
recommend cannabis for pain and muscles spasms, or to
fund Sativex on the NHS, means thousands of people
with MS will continue to be denied an effective
treatment,’ she said. ‘MS is relentless and painful, yet not
a single person with MS has benefited from medicinal
cannabis being legalised nine months ago.’
Draft guidance at
www.nice.org.uk/guidance/indevelopment/gid-
ng10124/documents. NHS review at
www.england.nhs.uk/medicines/support-for-
prescribers/cannabis-based-products-for-medicinal-use/
JUST 16 PER CENT OF
SECONDARY-SCHOOL PUPILS
HAVE SMOKED TOBACCO
compared to almost 50 per cent
in 1996, according to the latest
figures from NHS Digital. Almost
a quarter have tried drugs,
however, while 17 per cent drink
alcohol at least once a month –
rising to almost 40 per cent of
15-year-olds. Half of the young
people who had recently drunk,
taken drugs or smoked cigarettes
experienced ‘low levels’ of happiness, the report adds. Smoking,
drinking and drug use among young people 2018 at digital.nhs.uk
www.drinkanddrugsnews.com
through the use of home visits.
Learning from tragedies: an analysis of
alcohol-related safeguarding adult reviews at
alcoholchange.org.uk
SHARE AWARE
MANY PEOPLE
DELIVERING
HEPATITIS C TESTING
or treatment do not
understand which
data can be shared or
with whom,
according to a new
report from the
London Joint Working
Group on Substance
Use and Hepatitis C
(LJWG). Clear
guidance and training is needed to ensure
progress towards eliminating hep C, says
Joining the dots: linking pathways to hepatitis
C diagnosis and treatment. Report at
ljwg.org.uk. See news focus, page 8
DRUG DELUGE
THE PRISON SERVICE RESPONSE to the ‘deluge
of drugs flowing into many prisons’ in recent
years has been slow and ‘neither robust nor
sophisticated’, according to the chief inspector
of prisons’ annual report. Last year had been
another ‘deeply troubling’ year for parts of
the prison estate, with many establishments
still ‘plagued by drugs, violence, appalling
living conditions and a lack of access to
meaningful rehabilitative activity’, the report
states. The government has since promised a
‘crime crackdown’ in prisons, with ‘airport-
style’ security to tackle smuggling of drugs
and weapons. ‘We cannot allow our prisons to
become factories for making bad people
worse,’ said Prime Minister Boris Johnson.
HM chief inspector of prisons’ annual report for
2018-19 at www.justiceinspectorates.gov.uk
CHALLENGING ISSUES NEXT LEVEL
VULNERABLE ADULTS’ ALCOHOL USE IS BEING
‘MISSED OR POORLY MANAGED’, according to
a report from Alcohol Change UK, with the
mismanagement of severe alcohol problems
among people with complex needs
increasing their risk of harm and even death.
All professionals working with alcohol-
dependent people should be fully trained to
recognise the ‘complicated role that alcohol
plays in adult safeguarding’, says the
document, and stresses that a person’s
refusal of care needs to be ‘constantly
challenged’. The refusal of alcohol treatment
should not lead to someone being deemed
beyond help, it says, and treatment services
may need to adapt their models, for example THE FIRST POST-INTRODUCTORY LEVEL
INTERPERSONAL GROUP THERAPY COURSE IN
THE UK has been launched by Action on
Addiction. Based on a collaborative adult
learning model, the practice-based course is
designed to equip people with a full
understanding of how interpersonal group
therapy can be effective in facilitating character
change. Teaching takes place one Saturday per
month in Warminster from 16 November
onwards. Meanwhile, applications are open for
the foundation degree in addictions counselling
at University of Bath, offering a mixture of
academic study and work-based learning.
For more information email
[email protected]
September 2019 | drinkanddrugsnews | 5