The Department of Health published the ‘Clinical Guidance for Medical Use’ document in 2019. This document provides both general guidance to clinicians for prescription of CBD: THC products and specific instructions concerning the three medical indications they can be prescribed for.
The Medical Cannabis Access Programme enables a medical consultant to prescribe a cannabis-based treatment for a patient under his or her care for the following medical conditions, where the patient has failed to respond to standard treatments:
- Spasticity associated with multiple sclerosis
- Intractable nausea and vomiting associated with chemotherapy
- Severe, refractory (treatment-resistant) epilepsy.
Guidelines for Commencing Treatment with Cannabis for Medical Use
- Doctor-Patient Relationship: doctors must document that an appropriate doctor-patient relationship has been established.
- Consultant-led Care: Initial prescribing of medical cannabis can only be done by a medical consultant, with appropriate expertise, in this jurisdiction.
- Informed & Shared Decision-Making: Doctor will use professional judgment when prescribing medical cannabis and a patient will make an informed decision to accept or decline treatment. A doctor must discuss the risks, benefits, alternatives, and how the MCAP operates with the patient. If a patient is a minor, then the patient's parent or guardian will need to give consent to treatment. If the patient cannot consent, the options outlined in the Assisted Decision-Making (Capacity) Act 2015 should be taken into consideration.
- Patient Medical History: Before initiation, an accurate and thorough history should be confirmed. This may include:
- presenting symptoms
- medical history
- past medical history
- psychological and psychiatric history
- family health history
- physical examination
- clinial investiagions
- medical review
- Contradictions: The following contradictions should be considered:
- history of hypersensitivity to any cannabinoid
- severe and unstable cardiopulmonary disease (angina, peripheral vascular disease,
cerebrovascular disease and arrhythmias) or risk factors for cardiovascular disease
- current, active drug dependence, including illicit drugs, alcohol, and prescription
- Warnings & Precautions: The following should be considered:
- patients aged 18 years old and under
- personal or family history of schizophrenia or any psychotic disorder
- severe liver or renal disease
- previous drug dependence, including illicit drugs, nicotine, alcohol, and prescription
- the patient is planning to become pregnant or during pregnancy
- concomitant medications
- whether the patient is elderly
- Initial Treatment Plan: This will be discussed with the patient and should address the following points:
- Treatment goals
- Duration of treatment
- Risk management processes
- Monitoring arrangements
- regular reviews of indications
- Treatment cessation plan
- Provide patient with information and risks
- Patient written consent
Oleo is in the process of creating a mobile application to track and monitor patient usage and adverse effects. It will provide quick and valuable information for the healthcare professional.