In a day of scouring media sources and outlets for what's new in the world I am happy to ~ nd a prescribing-related article that isn't ‘hidden’ because of the media coverage of Brexit and/or the General Election. Very often these days, important news or articles are harder to ~ nd due to what media outlets perceive to be better ‘clickbait’ or more relevant news. But this one popped into my feed along with the more politically time-sensitive information. The prescribing of medicinal cannabis is still a hot topic, and over the past few weeks has grabbed media attention again in the way it did in November 2018 with the change from schedule 1 to schedule 2 for medicinal grade products. This month we see the approval of two cannabis-based products for use in the UK with speci~ c prescribing remits (Walsh, 2019).
The areas for prescribing are in epilepsy and multiple sclerosis, but analysis of the information gives us, as healthcare professionals, more information than the attention-grabbing headline suggests. The headline leads people to believe that this is a wide extension to prescribing, but in reality, there are strict constraints on who, what and to whom they can prescribe, and under which speci~ c circumstances. Epidyolex has been approved for children with two rare forms of epilepsy, namely Lennox-Gastaut syndrome and Dravet syndrome. The hope is that the drug can reduce seizures by up to 40%, providing real hope for children diagnosed with these conditions, and their families. But it is very speci~ c, and there is no guidance to extend the prescribing of this newly approved medicine to other forms of epilepsy in children or adults at this point. The GW Pharma has agreed to provide the drugs to the NHS at a discounted price, making it more cost-effective. The estimated population with these types of epilepsy that may bene~ t is around 8000 children, a small percentage of all epilepsy diagnoses.
The second drug is Sativex, a name possibly more familiar as it has had previous approval in other countries and can be prescribed in an oral spray to treat stiffness and muscle spasticity in multiple sclerosis. It speci~ cally states it should not be used to treat pain, compounding restrictions on prescribing.
Reactions to this news from the medical profession seem to welcome this as a positive change. However, patient groups say it does not go far enough. Epidyolex only contains CBD and not the psychoactive component of cannabis, THC, which many parents claim has a more profound effect on seizures. They are currently travelling abroad and self-funding to obtain these medicines for their children. Other patient groups suggest that not allowing Sativex prescribing for pain is short-sighted, as when patients in other countries have been using the drug, an analgesic effect is notable.
What is clear is that prescribing has been extended and a period of prescribing, audit and review is required before any further extension to prescribing will be considered. This includes whether or not to extend the prescribing of these drugs from specialist doctors only to a wider range of prescribers. As they say, watch this space!
I hope you enjoy the range of articles and features that we have for you in this month's edition. JPrP