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Many clinicians contact the Medical Cannabis Clinicians Society looking for clarity about what is and is not permitted when it comes to prescribing this treatment option for patients. Our expert committee has produced the following guidelines to support you on your journey.

The information which follows guides you through the steps required to satisfy these requirements, with further information about the practical steps you should take to ensure you are confident, compliant and well informed.

Please note, that all information is correct at the time of writing and will be updated each month. Scroll down to start learning, or click below to download as a PDF.

  • Download How to begin prescribing medical cannabis V1.4

Can I prescribe medical cannabis?

If you are a GMC specialist consultant or a doctor who can prescribe with direction under Shared Care arrangements, then you can prescribe medical cannabis.

According to the General Medical Council, doctors can prescribe if they satisfy the following requirements:

  • Doctors are aware of the misuse of drugs regulations
  • Doctors have a good awareness of the available guidelines
  • Doctors are aware of the evidence base for this treatment
  • Doctors are prescribing within their own area of expertise

Read on to find out how you can begin prescribing this treatment for your patients.

How do I become a medical cannabis prescriber?

1. Find a supportive community


Join The Medical Cannabis Clinicians Society here. Membership gives you access to a peer support network of prescribing doctors, expert mentorship, regular sector updates and reduced entry for events and training.

Speak to our committee members, some of whom are already prescribing. Share your experience of learning and training, share evidence and research and ask for support, 24/7.

It’s a good idea to explore what’s out there in terms of private clinics and groups in the sector and attend events. Search Eventbrite for medical cannabis and connect with those talking about the sector on Twitter and LinkedIn.

2. Familiarise yourself with the guidelines


Since Medical Cannabis became legal in 2018, the Government, NHS, NICE, Royal Colleges, licensed producers of medical cannabis products and training providers have all produced guidelines for clinicians. Here is an overview of what is currently available:

1. Recommendations and Guidance on Medical Cannabis under Prescription with the All-Party Parliamentary Group for Medical Cannabis under Prescription

The Medical Cannabis Clinicians Society, Jan 2020

The Guidance, newly revised for 2020, includes information about who can prescribe medical cannabis, prescribing and prescriptions, conditions, funding and more.

2. Cannabis-based medicinal products – guideline [NG144]

NICE, November 2019

This guideline covers prescribing of cannabis-based medicinal products for people with intractable nausea and vomiting, chronic pain, spasticity and severe treatment-resistant epilepsy.

3. Recommendations on cannabis-based products for medicinal use

Royal College of Physicians, 31 October 2018

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.

4. Use of cannabis-based products in neurology – ABN interim guidelines

Association of British Neurologists, December 2018

The ABN guidance recommends that for both Dravets syndrome and Lennox-Gastaut syndrome the BPNA guidance is consulted and they recommend that cannabidiol should be prescribed in these cases.

5. Guidance on the use of cannabis‐based products for medicinal use in children and young people with epilepsy

British Paediatric Neurology Association, 2018

The BPNA highlights the key questions specialist clinicians should address before considering prescribing and also provide guidance on appropriate dosage and treatment regimes.   It has been approved by the Association of British Neurologists and the British Chapter of the International League Against Epilepsy.

6. The supply of unlicensed medicinal products ‘specials’, guidance note 14

Medicines and Healthcare products Regulatory Agency, 2014 with recent updates

Guidance on manufacturing, importing, distributing and supplying specially manufactured or ordered products, including cannabis-based products for medicinal use in humans (CBPMs), known as ‘specials’.

7. Cannabis-based medicinal products PS05/19

The Royal College of Psychiatrists, November 2019

3. Get some training and explore the evidence 


It is crucial to access robust, evidence-based training and product information when learning to prescribe medical cannabis.

Online training

NHS England has developed online learning with Health Education England e-Learning for Healthcare and the University of Birmingham. This covers cannabis and cannabis-based products for medicinal use and is available for all healthcare professionals to access. It is written by Bhavana Reddy, Specialist Pharmacist Adviser, NHS England, Dr Sarah Pontefract, Lecturer in Clinical Pharmacy and Therapeutics and Hannah Vallance, SCRIPT eLearning Manager, both University of Birmingham.

The Academy of Medical Cannabis has a free introductory course for learners – Medical Cannabis Essentials – and further paid-for courses for different specialities and clinical areas. Written by MCCS Chair Professor Mike Barnes and our Vice Chair Dr. Dani Gordon, clinical specialist in cannabis medicine, the online modules provide essential guidance. It is open to everyone.

Face to face training

Some private medical cannabis organisations including Sapphire Medical Cannabis Clinics, Spectrum Therapeutics and The Medical Cannabis Clinics (via The Academy) also offer training to doctors face to face, at events and at arranged training sessions.

Know of another training provider? Let us know.

Explore and add to the evidence base

In 2020, The Medical Cannabis Clinicians Society is developing an independent database of evidence which will bring together research studies and papers featuring human and animal studies. This will give clinicians the ability to review global published research in one place.

Drug Science’s Project Twenty21 will develop a body of evidence using a real-world data (RWD) registry to document efficacy, safety, QALY, and patient reported outcomes with regards to medical cannabis use.

By the end of 2021, it will aim to enrol 20,000 patients, creating the largest body of evidence for the effectiveness and tolerability of medical cannabis. Doctors interested in adding to this evidence base when prescribing medical cannabis to patients should email [email protected].

4. Learn about cannabis-based medicinal products, their availability and interactions


Your training should include detailed information about products, possible interactions and the current landscape for prescribing as set out below.

Cannabis-based products for medicinal use (CBPM) are new to the vast majority of prescribing doctors. According to NHS England, products are classed as CBPMs of they satisfy the following  three requirements:

  • The product is or contains cannabis, cannabis resin, cannabinol or a cannabinol derivative
  • It is produced for medicinal use in humans; and
  • It is a product that is regulated as a medicinal product, or an ingredient of a medicinal product.

It is important to note that CBD oil products available to purchase without prescription are not classed as medical cannabis as they do not contain THC.

Importing CBPMs into the UK

At the time of writing, the Medicines and Healthcare products Regulatory Agency (MHRA) allow CBPMs to be brought into the country via wholesalers, through a specialist import licence on a prescription-by-prescription basis only.

In late 2019 the first bulk import licence was awarded, which in time should significantly increase the range of available products and reduce the time patients wait for their medication.  At present this is restricted to two individual products – Bedrocan flower products and Tilray 10:10.

 

Availability of cannabis based medicinal products

All products are available through importers so you will need to check availability with them directly.

The Medical Cannabis Clinicians Society members contribute to a product list from a range of sources, which is accessed via the member’s area of the website. Sign up or sign in here to get the latest information.

Importers we are currently aware of are:

Astral Health

Grow Biotech / Logist Pharma

 

Drug interactions and adverse effects

The NHS Specialist Pharmacy Service has published information on potential drug interactions for both CBMP and CBD.

Published 29th November 2018, updated 3rd January 2020

Published 30th November 2018, updated 10th January 2019

5. Find suitable premises


Doctors wishing to prescribe medical cannabis in the UK must do so from a premises with CQC Registration. In their November 2019 update, the CQC stated:

Specialist doctors who intend to prescribe and treat patients with cannabis-based medicinal products must be able to provide assurance and demonstrate that they deliver safe and effective care in line with relevant legislation and guidance. 

Doctors wishing to prescribe medical cannabis can do so:

  • From rooms in a private practice or rooms in a clinic with CQC registration
  • As an employee of a medical cannabis clinic
  • If they have practising privileges or if you have a contract in an existing service with CQC registration

If you would like to see patients in their own home, the CQC Statement of Purpose must include home visits.

6. Apply for your ‘Pink Pad’


When you have a suitable premise from which to prescribe, you’ll need to apply for your private controlled drug prescription pad (CDFP10), often referred to as the ‘pink prescription pad’.

  1. Find the controlled drug accountable officer (CDAOs are responsible for all aspects of controlled drugs management within their organisation) in the area in which you would like to prescribe. The best way to do this is by searching Google for nhs england controlled drugs accountable officer + YOUR REGION. In this example for Yorkshire, you will be led to information, contacts  and relevant forms for the CDAO for the region = CDAO Yorkshire.
  2. When your application is approved, you will usually wait a few weeks for it to be printed. Your CDFP10 is sent to the premises from which you are going to practice. It can take up to two months.

7. Familiarise yourself with the specials prescribing system


When it comes to accessing the product, after prescribing, it’s important that products are prescribed in the best interest of the patient, not because there is any commercial link to the product from the doctor.

Familiarise yourself with the specials prescribing system, in these guidelines from the Royal Pharmaceutical Society. This is needed for all unlicensed products which includes all cannabis-based products except Epidiolex and Sativex from GW Pharma which are licensed medicines.

Medical cannabis treatments are classed as a controlled drug so the pharmacist has responsibility to work through the associated processes. The Royal Pharmaceutical Society has helpful guidance – Medicinal Cannabis Pharmacy Alert – which summarises what pharmacists need to do, on their website.

The best thing to do is speak to your local pharmacy, prior to issuing your first prescription, so they have some warning. Though it will depend on the pharmacy, speaking to them beforehand is likely to benefit the patient.

Some licensed producers also provide options to deliver their CBMPs directly to patients at home, so this may also be an option depending on what you are prescribing.

8. Review your indemnity insurance arrangements


In England, doctors working for NHS trusts and health and social care bodies are provided with indemnity insurance through the Clinical Negligence Scheme for Trusts (CNST). Similar arrangements are in place for Scotland, Northern Ireland and Wales.

As medical cannabis in the UK is currently only available privately, doctors must have suitable insurance.  The GMC state that doctors working in private practice in the UK must have “adequate and appropriate insurance or indemnity arrangements in place covering the full scope of your medical practice”. This means that even if doctors are working privately within an NHS or health and social care body premises, they must still be covered.

If you already have insurance in place, review the terms of your coverage. If you’re looking for insurance which covers medical cannabis prescriptions, read our guide which includes links to insurance brokers with medical cannabis in their coverage.

9. Start seeing patients


Assuming you have met all the above requirements, you will now be in the position to prescribe for your first patient.  Doctors must ensure:

  • They have discussed medical cannabis treatment options in full with the patient
  • Patients have tried at least some of the licensed treatments available to them
  • Medical cannabis treatment is in the patient’s best interest

When you have satisfied these requirements:

  1. Write the prescription and pass it to the patient
  2. Let your patient know they can take the prescription to any pharmacy. You may wish to share your knowledge about local pharmacies or previous experiences with chemists in their area

Arrange a follow-up appointment with the patient.

10. Share your experience with your peers


In the UK, prescribing medical cannabis for patients is at a very early stage. It’s so important that clinicians share their experience of the sector, treatments and products and patient outcomes with their peers, so doctors can benefit from each other’s knowledge.

You may wish to talk about your experience with applying for your pink pad, discuss the arrangement with your premises or share what your patient felt about different products.

A good way to do this is via the Medical Cannabis Clinicians Society’s secure peer support group for members. Sign up or sign in today.

11. Commit to your continuous professional development.


Commit to your ongoing learning about this rapidly changing field.

Stay up to date with the developments in legislation by signing up to the Medical Cannabis Clinicians Society’s newsletter.

Have we missed something? Or are there still questions you’re looking for answers about? This information will be updated regularly, so please don’t hesitate to email us at [email protected] to request further information or to request a revision.