The RCP has jointly produced recommendations on cannabis-based products for medicinal use (CBPM) with the Royal College of Radiologists (RCR) and in liaison with the Faculty of Pain Medicine of the Royal College of Anaesthetists.
CBPM for chemotherapy-induced nausea and vomiting (CINV)
There is good evidence that cannabinoids are effective in preventing CINV but they have a high side effect profile and there are more efficacious agents available. Cannabinoids should remain an option for those who have failed standard therapies but not used as a first-line treatment.
CBPM for pain
There is limited research available from which to create guidance on the effect of CBPM on pain in palliative care patients, including those with cancer. Studies show mixed results or statistically significant results of uncertain clinical significance.
In view of this and the adverse effects associated with CBPM, their place in the treatment of pain in palliative care patients is unclear and not recommended in routine clinical practice. There is no robust evidence for the use of CBPM in chronic pain and their use is not recommended.
Non-CBPM forms of ‘cannabis’
The use of unrefined dried plants containing a variety of cannabinoids and other pharmaco-active chemicals of varying quantity cannot be supported due to the variability of preparations and lack of any trial evidence. The potential for exposure to unknown significantly harmful chemicals and potential diversion to non-medical use are also strong arguments against support for their use in patients.
Therefore, only pharmaceutical grade products that are licensed by the Medicines and Healthcare products Regulatory Agency (MHRA) or supplied in accordance with MHRA guidance on the supply of unlicensed cannabis-based products for medicinal were considered.
The National Institute of Health and Care Excellence (NICE) has been commissioned to produce formal guidelines by October 2019 but in view of the need for interim guidance on the use of CBPM the RCP was asked to produce such guidance around the management of cancer, palliative and chronic pain, including in multiple sclerosis.
On the 15 August 2019, NHS England published the report of their review of systems and process relating to cannabis-based products for medicinal use. At the same time NICE published the draft guidance which they were commissioned to produce, the public consultation on the guidance is open until the 5 September.
- Dr Sarah Cox, consultant in palliative medicine; chair RCP Joint Specialty Committee for Palliative Medicine
- Dr Jeanette Dickson, vice-president clinical oncology, RCR
- Professor Andrew Goddard, president, RCP
- Dr John Hughes, vice dean, Faculty of Pain Medicine of the Royal College of Anaesthetists
- Simon Land, head of committees and consultation, RCP
- Dr Barry Miller, dean, Faculty of Pain Medicine of the Royal College of Anaesthetists
- Professor Andrew Rice, professor of pain research, Imperial College London; honorary consultant in pain medicine, Chelsea and Westminster Hospital NHS Foundation Trust.
Grateful thanks to Pharmaceutical Press for sharing the cannabinoids monograph from PalliativeDrugs.com from which this summary is taken.
Grateful thanks for their contributions to Paul Howard, consultant in palliative medicine, Mountbatten Hospice, Isle of Wight; Andrew Davies, consultant in palliative medicine, Royal Surrey University Hospital; Elaine Boland, consultant and honorary senior lecturer in palliative medicine, Yorkshire and the Humber.