Medical cannabis – a broad term used to refer to any medical products including whole cannabis flower, capsules, oils, and sprays containing cannabinoids – was legalised for use on prescription in November 2018 after being re-scheduled from a schedule 1 to a schedule 2 drug.
Often referred to as cannabis-based medicinal products (CBMPs), some patients find medical cannabis useful for pain and palliative care, psychiatric conditions, neurological conditions, Parkinson’s disease, gastrointestinal conditions, and unresponsive skin conditions such as psoriasis and acne.
The challenges faced by patients and clinicians to legalise medicinal cannabis
Despite the change in regulation, Sativex, Nabilone, and Epidyolex remain the only licensed medical cannabis products in the UK, and must be prescribed by a specialist clinician supported by a multi-disciplinary team for diagnosed conditions where first line therapies have failed.
When it comes to unlicensed products, a lack of true clinical evidence for medical cannabis means it is only prescribed privately and dispensed through specialist distance selling pharmacies.
Matthew Rawding, medical cannabis specialist pharmacist at MHRA-approved Specials manufacturer Rokshaw Laboratories – the first company to manufacture medical cannabis in the UK, and now part of the world’s largest cannabis company, Curaleaf – says: “There’s still this huge stigma surrounding cannabis that can have a negative impact on its perception by government and clinicians – as well as patients – who might not be aware of its medical potential”.
Mr Rawding estimates around 35,000 patients in the UK are currently prescribed medical cannabis, and says that one reason clinicians may be reluctant to get on board is “a lack of randomised double-blind controlled trials, which are the ‘bread and butter’ of evidence, because the UK is still not the most data rich environment when it comes to medical cannabis”.
Nonetheless, Mr Rawding says in the last year there have been “positive conversations” in the corridors of power with lobbying groups “doing good work” that he is hopeful will eventually lead to wider access to medicinal cannabis in the UK.
“Last year saw a real uptick in patients accessing medical cannabis from us. From our perspective it does feel we are slowly but surely moving in a more positive direction in the UK”, he says.
Rokshaw’s formulations
With a range of formulations of medical cannabis, Rokshaw is well placed to meet patient needs both now, and if and when licensing updates happen.
“The current most prevalent forms of medical cannabis across all companies are oils for sublingual use, and dried cannabis flower – also known as Flos – but we are definitely looking at more novel and exciting dosage forms that will appeal to the prescriber and patient demographic”, says Mr Rawding.
“For example, I think a lot of prescribers who are new to the cannabis space or talking about it won’t be as comfortable prescribing something like a dried flower preparation that they’ve got very little experience with, compared to something like a controlled dose inhalation form that mirrors something that’s been used across medicine for decades,” he explains.
Rokshaw Pharmacy Partnership Scheme
Education and support are key to engaging prescribers and patients, and last October’s Pharmacy Show saw Rokshaw address this issue with the launch of its Pharmacy Partnership Scheme, which helps community pharmacies enter this emerging area of medicine and provide a private service.
The scheme helps pharmacists support patients who may be eligible for medical cannabis by referring them to specialist clinics for an initial consultation. If this shows they are eligible, the patient will be prescribed medical cannabis with the prescription sent to the patient’s nominated partner pharmacy to order from Rokshaw. The medication is delivered to the pharmacy the next working day. Patients benefit by better triaged access to prescribers, and the pharmacy incurs a fee for the dispensing phase, as well as the margin on the product that is supplied.
Peak Pharmacy Group in Ilkeston, Derbyshire, is a member of Rokshaw’s Pharmacy Partnership Scheme and has seen some obvious benefits to patients.
“One of our customers lives with chronic pain and anxiety, and says she is getting a lot of benefit from the medical cannabis we are able to dispense through the scheme, with both these issues being very well controlled”, says Mark Young, Peak Pharmacy branch manager, who adds “I’d definitely recommend the scheme to other pharmacists. In the past we had people coming in asking to buy medical cannabis over the counter and I couldn’t do anything for them, so it’s great to have this option.”
For those willing to take the leap, Mr Rawding says it’s a market with huge growth potential. “There’s believed to be around 1.8 million people who are using cannabis for medical purposes, but if only 35,000 are active patients that leaves over 1.7 million who are getting theirs from an illicit space,” he explains.
“If we can make these people aware that there are legal avenues to obtain medical cannabis from, we are not only keeping them on the right side of the law, but also giving them access to standardised products, prescribed by experts in their field, that can make a real difference to their lives,” he concludes.
More information can be found at Rokshaw’s website.