New guidelines around THC levels, dosages, and eligibility, aim to bring more clarity and consistency to the practice of prescribing cannabis-based medicines in the UK.
Almost seven years since medical cannabis was legalised in the UK, around 180 specialist consultants are now actively prescribing. But almost all of this is done through private clinics, and there are currently no mandated training requirements for clinicians who wish to prescribe cannabis-based medicines.
With over 40 clinics now prescribing these products – but only around half registered with the Care Quality Commission – doctors have reported significant variations in practice throughout the UK.
In its annual report, the CQC also raised a number of concerns about some of the prescribing practices at private clinics, warning of gaps in oversight, clinical justification, and compliance with advertising rules.
It comes following the publication of figures which show a 130% increase in the number of private prescriptions between 2023-2024, with industry sources suggesting around 75,000 patients are now accessing these treatments.
The concerns have led to calls for more robust and standardised guidelines around prescribing practices to ensure patients are receiving the best standard of care, and that clinicians are confident they are prescribing compliantly.
In its updated Good Practice Guidelines, the Medical Cannabis Clinicians Society sets out the responsibilities of prescribers and providers, as well as offering recommendations around dosing, outcome measures, and the use of flower and oil-based products.
This includes a recommendation that any prescription of more than 2g of flower per day, or any product containing THC levels over 25%, should be subject to a peer approval process.
“Such doses should not normally be prescribed initially but built up to slowly, with careful documentation of the effects,” the guidelines state.
“It is not appropriate for a patient to demand a specific product. There always needs to be a discussion between the patient and the prescriber.”
The MCCS has also attempted to provide some clarity on which conditions qualify for treatment with medical cannabis, and what is meant by the requirement for patients to have tried two previous treatments – neither of which are stipulated in the legislation.
Elsewhere, it is not recommended that producers use “recreational” strain names, such as ‘Girl Scout Cookie’ and ‘Gorilla Glue’ – which the MHRA has previously expressed concerns about – as they do not assist in the ‘acceptance of the medical value of the plant’.
Clinicians are also advised to move away from a reliance on the terms ‘sativa’ and ‘indica’, as this is not a ‘clinical distinction’.
Prof Mike Barnes, chair of the MCCS, commented: “Sadly, although entirely legal, the NHS sector has failed to embrace this new medicine. There are no mandated training requirements for prescribers and the Medical Cannabis Clinicians Society (MCCS) is aware of significant variations in clinical practice.
“The aim of these guidelines is to help both prescribers and our patients access this valuable medicine in a safe and sensible manner.”
Prof Barnes, will discuss the Good Practice Guidelines in more detail at Cannabis Health Symposium on Tuesday 25 November, in a session designed to build prescriber confidence and empower healthcare professionals to enable patient access whilst upholding high standards of care and compliance.
