The UK government provides guidance on the supply of unlicensed medicinal products¹. These products, also known as specials, are specially manufactured or ordered products, including cannabis-based products for medicinal use in humans (CBPMs)¹. The NHS Pharmaceutical Quality Assurance Committee states that currently, none of the CBPMs available as unlicensed medicines in the UK are licensed anywhere else in the world². They are supplied as specials made either in the UK under a Manufacturer’s Specials (MS) Licence or made overseas and imported via an MS licence².

For more information on manufacturing, importing, distributing, and supplying unlicensed medicinal products (specials), you can refer to the guidance provided by the Medicines and Healthcare products Regulatory Agency (MHRA)¹. The MHRA guidance note 14 provides detailed information on the supply of unlicensed medicinal products ‘specials’¹. Additionally, you can find information on the supply of unlicensed cannabis-based products for medicinal use in humans¹.

Please note that most cannabis-based medicinal products have not been granted a license for use in the UK. Therefore, doctors need to apply for specialist funding or request their NHS trust to fund them directly when prescribing these products³.

Source:

• ¹: Supply unlicensed medicinal products (specials) – GOV.UK
• ²: NHS Pharmaceutical Quality Assurance Committee Advice to Chief …
• ⁴: Rescheduling of cannabis-based products for medicinal use in … – GOV.UK
• ³: The NHS can prescribe medical cannabis. So why are desperate patients …

The regulations for prescribing cannabis-based products in the UK are as follows:

• Only doctors on the GMC Specialist Register can prescribe unlicensed cannabis-based medicinal products (CBPMs) for a patient with an unmet clinical need on a named patient basis¹²³.
• Licensed CBPMs, such as Sativex, can be prescribed by any practitioner with the authority to do so under the 2001 Regulations³.
• Doctors must be satisfied there is sufficient evidence or experience to support the safety and efficacy of the CBPMs they prescribe⁴.
• Doctors must give patients (or their parents or carers) sufficient information about the CBPMs they propose to prescribe, to allow them to make an informed decision⁴.
• Doctors must consult experienced colleagues with relevant specialist expertise and clinical knowledge, and follow any local procedures in place⁴.
• Doctors must report any adverse reactions to the MHRA Yellow Card scheme⁴.
• For NHS services, the decision to prescribe CBPMs needs to be approved by the chair of the trust’s drug and therapeutic committee or the trust’s medical director².
• After the initial prescription, subsequent prescriptions can be made under a shared care agreement¹.

For more information, you can refer to the NICE guidance on cannabis-based medicinal products⁵, which covers prescribing for intractable nausea and vomiting, chronic pain, spasticity and severe treatment-resistant epilepsy.

The GMC Specialist Register is a list of doctors who are eligible for appointment as substantive, fixed term or honorary consultants in the health service in the UK¹. It is a legal requirement to be entered on the Specialist Register before taking up a consultant post in the NHS².

There are two routes to specialist registration:

• Certificate of Completion of Training (CCT): This is for doctors who have completed a GMC approved programme of training in their specialty³.
• Certificate of Eligibility for Specialist Registration (CESR): This is for doctors who have not completed a GMC approved programme of training, but can show they have knowledge, skills and experience equivalent to the approved curriculum for their specialty⁴.

Only doctors on the GMC Specialist Register can prescribe unlicensed cannabis-based medicinal products (CBPMs) for a patient with an unmet clinical need on a named patient basis .

Source:

• ¹: The Specialist Register – GMC
• ⁴: Certificate of Eligibility for Specialist Registration or Certificate of Eligibility for GP Registration application – GMC
• ³: Applying for specialist or GP registration – GMC
• ²: Certification of training & specialist registration | RCOG
• : Rescheduling of cannabis-based products for medicinal use in … – GOV.UK
• : NICE guidance on cannabis-based medicinal products

There are two routes to specialist registration: Certificate of Completion of Training (CCT) and Certificate of Eligibility for Specialist Registration (CESR)¹. A doctor can get on the Specialist Register by following one of these routes, depending on their qualifications, training and experience.

• CCT: This is for doctors who have completed a GMC approved programme of training in their specialty². They can apply for specialist registration within 12 months of completing their training³.
• CESR: This is for doctors who have not completed a GMC approved programme of training, but can show they have knowledge, skills and experience equivalent to the approved curriculum for their specialty². They can apply for specialist registration by submitting a portfolio of evidence to demonstrate their equivalence⁴.

For more information on how to apply for specialist registration, you can refer to the GMC website¹ or contact the GMC certification team at [email protected].

There are different ways that doctors can train in medicinal cannabis, depending on their location, specialty and interest. Here are some examples of medical cannabis training courses and resources available for doctors:

• In the UK, the Medical Cannabis Clinicians Society offers a live course called Medical Cannabis Explained, hosted by Professor Mike Barnes, a leading expert and prescriber of medical cannabis¹. The course covers the history, evidence, indications, products, dosages and legal aspects of medical cannabis prescribing¹. The Society also provides guidance, peer support and mentorship for doctors who want to prescribe medical cannabis or learn more about it².
• In Australia, there are several online courses that educate medical professionals on the use of medicinal cannabis, such as the Medicinal Cannabis Education Program by the Australian Centre for Cannabinoid Clinical and Research Excellence (ACRE)³, the Medicinal Cannabis Course by the Australian College of Rural and Remote Medicine (ACRRM), and the Medicinal Cannabis Training Course by the Australian Medical Association (AMA). These courses cover topics such as the pharmacology, clinical evidence, prescribing process, safety and monitoring of medicinal cannabis³ .
• In Canada, there are various accredited continuing medical education (CME) programs that provide doctors with up-to-date knowledge and skills on medical cannabis, such as the Medical Cannabis Certificate Program by the Canadian Consortium for the Investigation of Cannabinoids (CCIC), the Medical Cannabis Curriculum by MD Briefcase, and the Medical Cannabis Essentials by Advancing Practice. These programs cover areas such as the endocannabinoid system, cannabinoid therapeutics, patient assessment, dosing strategies and adverse effects of medical cannabis .

These are just some examples of how doctors can train in medicinal cannabis. There may be other courses or resources available in different countries or regions. Doctors who are interested in learning more about medical cannabis should consult their local regulations, professional bodies and peers for guidance and support.

Medicinal cannabis is a term for any cannabis-based product that is used to treat or relieve symptoms of certain medical conditions. It is not the same as recreational cannabis, which is used for non-medical purposes and may contain higher levels of THC, the psychoactive component of cannabis.

Medicinal cannabis is only available on prescription in the UK for a very small number of patients who have specific conditions and have not responded to other treatments. These conditions are:

• Children and adults with rare, severe forms of epilepsy
• Adults with vomiting or nausea caused by chemotherapy
• People with muscle stiffness and spasms caused by multiple sclerosis (MS)

To know if medicinal cannabis is right for you, you need to consult a doctor who is on the GMC Specialist Register and has experience in prescribing cannabis-based products. They will assess your condition, medical history, current medications and other factors to determine if medicinal cannabis is suitable and safe for you. They will also explain the potential benefits, risks and side effects of medicinal cannabis, and how to use it properly.

Medicinal cannabis is not a cure for any condition, but it may help to improve your quality of life and reduce your suffering. However, it is not a first-line treatment, and it may not work for everyone. You should always follow your doctor’s advice and monitor your response to medicinal cannabis. If you have any concerns or questions, you should contact your doctor or pharmacist.

For more information on medicinal cannabis, you can refer to the following sources:

• Medical cannabis (cannabis oil) – NHS
• Medicinal cannabis: information and resources – GOV.UK
• Medical Cannabis in the UK: Eligibility, Benefits, & Risks
• Medical cannabis available on the NHS: what you need to know

Medicinal cannabis is a term for any cannabis-based product that is used to treat or relieve symptoms of certain medical conditions. Depending on the type of medicinal cannabis you take, it’s possible to develop side effects such as¹²:

• decreased appetite
• diarrhoea
• feeling sick
• weakness
• a behavioural or mood change
• dizziness
• feeling very tired
• feeling high
• hallucinations
• suicidal thoughts

Some of these side effects may be more likely or severe if the medicinal cannabis contains THC, the psychoactive component of cannabis that makes you high. THC can also cause psychosis, dependence or addiction in some people².

The risk and severity of side effects may vary depending on the dose, frequency, duration and method of use of medicinal cannabis. They may also depend on your individual factors, such as your age, weight, health status and other medications you are taking.

If you experience any side effects from medicinal cannabis, you should contact your doctor or pharmacist as soon as possible. They may advise you to stop or reduce your use of medicinal cannabis, or switch to a different product or formulation. They may also monitor your response and adjust your treatment accordingly.

Medicinal cannabis is not a cure for any condition, but it may help to improve your quality of life and reduce your suffering. However, it is not a first-line treatment, and it may not work for everyone. You should always follow your doctor’s advice and prescription when using medicinal cannabis.

Source:

• ¹: Medical cannabis (cannabis oil) – NHS
• ²: Medical Cannabis in the UK: Eligibility, Benefits, & Risks

Medicinal cannabis is a term for any cannabis-based product that is used to treat or relieve symptoms of certain medical conditions. According to some sources, medicinal cannabis may have various benefits, such as¹²³:

• Relieving chronic pain, especially neuropathic pain caused by nerve damage or inflammation.
• Reducing nausea and vomiting caused by chemotherapy or other treatments.
• Decreasing the frequency and severity of seizures in patients with rare and severe forms of epilepsy, such as Lennox-Gastaut syndrome and Dravet syndrome.
• Improving muscle stiffness and spasms in patients with multiple sclerosis (MS).
• Lowering blood pressure and stabilising blood sugar levels.
• Enhancing the immune response and reducing inflammation.
• Slowing the development of Alzheimer’s disease and moderating the effects of Parkinson’s disease and Crohn’s disease.

However, these benefits are not conclusive and may vary depending on the type, dose, formulation and method of use of medicinal cannabis. Moreover, medicinal cannabis may also have some side effects and risks, such as drowsiness, dizziness, mood changes, hallucinations, dependence or addiction. Therefore, medicinal cannabis is not a first-line treatment and is only available on prescription from a specialist doctor in the UK for a very small number of patients who have specific conditions and have not responded to other treatments¹⁴.

If you are interested in learning more about medicinal cannabis, you can refer to the following sources:

• ¹: Medical cannabis (cannabis oil) – NHS
• ²: Medical Cannabis in the UK: Eligibility, Benefits, & Risks
• ³: The use of medical cannabis in the UK – Open Access Government
• ⁴: Medical cannabis available on the NHS: what you need to know

The answer to your question is not very simple, as the law and the safety of driving or operating machinery while using medicinal cannabis depend on various factors. Here are some points to consider:

• In the UK, it is illegal to drive with legal drugs in your body if it impairs your driving¹. It is also an offence to drive if you have over the specified limits of certain drugs in your blood and you have not been prescribed them¹. The specified limit for THC, the psychoactive component of cannabis, is 2 micrograms per litre of blood².
• If you have a legal prescription for medicinal cannabis, you may still be prosecuted if your driving is impaired or if you exceed the specified limit of THC³⁴. You should always follow your doctor’s advice and prescription when using medicinal cannabis, and be aware of the potential side effects and risks, such as drowsiness, dizziness, mood changes, hallucinations, dependence or addiction³⁴.
• If you are pulled over by the police for suspected driving under the influence of drugs, they may ask you to take a saliva test, a blood test or a medical examination to determine if you have used any illegal substances⁴². You should always carry your legal, medical cannabis information with you when travelling, and inform the police that you have a prescription. However, this may not help you avoid a charge or a conviction⁴.
• Driving under the influence of drugs in the UK is a serious offence. Even a conviction for medical cannabis can cause you to lose your license for a year or more. Additionally, you might pay a heavy fine, and as a risky driver, your vehicle insurance can increase significantly⁴.
• The same principles apply to operating machinery while using medicinal cannabis. You should not operate any machinery that requires alertness, concentration or coordination if you are impaired by any drug, legal or illegal. You should also check your employer’s policy on drug use and testing, as they may have different rules and consequences for using medicinal cannabis at work³.

Therefore, the best advice is to avoid driving or operating machinery while using medicinal cannabis, unless you are sure that it does not affect your ability or judgement. You should also consult your doctor and follow their instructions carefully when using medicinal cannabis. If you have any doubts or questions, you should seek professional guidance and support.

Source:

• ³: Medical cannabis (cannabis oil) – NHS
• ⁴: Medical Cannabis: Driving and the Law in the UK
• ¹: Drugs and driving: the law – GOV.UK
• ²: Medical cannabis and road safety – GOV.UK

According to a report by the Centre for Medical Cannabis, there are more than 40,000 specialist clinicians who are eligible to prescribe cannabis across the UK, but only around 100 (0.25%) are actively doing so¹. The report reveals some of the reasons why UK doctors are not prescribing medical cannabis, such as:

• Lack of clear guidance and education on the evidence, safety and efficacy of medical cannabis.
• Lack of access to quality and affordable products that meet the standards of Good Manufacturing Practice (GMP).
• Lack of support and funding from the NHS and other healthcare organisations.
• Fear of legal and professional repercussions or stigma from prescribing a controversial substance.

The report also suggests some recommendations to overcome these barriers, such as:

• Developing a national framework and pathway for medical cannabis prescribing, with clear criteria and protocols.
• Providing training and resources for doctors and patients on the benefits, risks and side effects of medical cannabis.
• Establishing a national registry and database to monitor and evaluate the outcomes and experiences of medical cannabis patients.
• Creating a network of specialist clinics and prescribers to share best practices and provide peer support.

The report concludes that there is a significant unmet need and demand for medical cannabis in the UK, and that more action is needed to ensure that patients can access this treatment option safely and effectively.

Source:

• ¹: Report reveals why UK doctors aren’t prescribing medical cannabis