Current Situation

Cannabis Based Medicines

Correct: Cannabis-derived, with defined and standard cannabinoid content.

The regulatory status of cannabis-based medicines does differ from one country to the next. Sativex® and Epidiolex® are examples of approved, registered cannabis-based medicines. Others are unapproved, but are expected to be of a certain quality – pharmaceutical quality, or meet a minimum quality standard.

delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are the main cannabinoids. THC and CBD interact with cannabinoid receptors (CB) within the human endocannabinoid system (ECS).

Incorrect

The correct answer was: Cannabis-derived, with defined and standard cannabinoid content.

The regulatory status of cannabis-based medicines does differ from one country to the next. Sativex® and Epidiolex® are examples of approved, registered cannabis-based medicines. Others are unapproved, but are expected to be of a certain quality – pharmaceutical quality, or meet a minimum quality standard.

delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) are the main cannabinoids. THC and CBD interact with cannabinoid receptors (CB) within the human endocannabinoid system (ECS).

Utility

Correct

Typically not a first-line treatment. Prescribed when other available registered medicines have been trialled and failed. Prescribed when other medicines’ side effects are unacceptable for patients.

Reasoning

The three cornerstone publications, NASEM (2017), EFIC (2018) and NICE (2019), conclude that cannabis-based medicines may be prescribed in spasticity due to multiple sclerosis, chemotherapy-induced nausea and vomiting, neuropathic pain conditions and treatment-resistant epilepsy with Dravet syndrome and/or Lennox-Gastaut Syndrome.

The current prescribing rates indicate cannabis-based medicine is used chiefly in the context of pain, oncology or palliative care. This is founded in that the possible clinical benefits traverse conditions as pain, nausea and vomiting, and enhancing patients’ well-being through appetite stimulation and sleep quality.

Incorrect

Typically not a first-line treatment. Prescribed when other available registered medicines have been trialled and failed. Prescribed when other medicines’ side effects are unacceptable for patients.

Reasoning

The three cornerstone publications, NASEM (2017), EFIC (2018) and NICE (2019), conclude that cannabis-based medicines may be prescribed in spasticity due to multiple sclerosis, chemotherapy-induced nausea and vomiting, neuropathic pain conditions and treatment-resistant epilepsy with Dravet syndrome and/or Lennox-Gastaut Syndrome.

The current prescribing rates indicate cannabis-based medicine is used chiefly in the context of pain, oncology or palliative care. This is founded in that the possible clinical benefits traverse conditions as pain, nausea and vomiting, and enhancing patients’ well-being through appetite stimulation and sleep quality.

Caveats to use

Correct

Clinical need, individual requirements, medicine cost.

Reasoning

The rational use of medicine requires a patient focus, with consideration of clinical need, individual requirements, length of time of use, and medicine cost. There needs to be a good clinical argument for prescribing; particularly with unapproved medicines or prescribing approved medicines off-label. In many situations, patients must pay out-of-pocket for cannabis-based medicines. Medicine cost needs to be considered within clinical decision making (i.e., will patients be able to pay for their medicine? Will they have access to it at all times, in sufficient amounts, and at an affordable price? Can patients afford to initiate and maintain therapy for the duration of treatment?).

Incorrect

Clinical need, individual requirements, medicine cost.

Reasoning

The rational use of medicine requires a patient focus, with consideration of clinical need, individual requirements, length of time of use, and medicine cost. There needs to be a good clinical argument for prescribing; particularly with unapproved medicines or prescribing approved medicines off-label. In many situations, patients must pay out-of-pocket for cannabis-based medicines. Medicine cost needs to be considered within clinical decision making (i.e., will patients be able to pay for their medicine? Will they have access to it at all times, in sufficient amounts, and at an affordable price? Can patients afford to initiate and maintain therapy for the duration of treatment?).