The CQC has raised a number of concerns related to the prescribing of cannabis-based products for medicinal use in the UK, as the latest data reveals further increases in private prescriptions.
Earlier this month the independent regulator which is responsible for overseeing health and social care in England published its annual update on the safer management of controlled drugs, including CBPMs.
It raises a number of concerns about some of the prescribing practices at private clinics, warning of gaps in oversight, clinical justification, and compliance with advertising rules, as it reports an increase of 130% in prescriptions between 2023-2024.
Data collected from 35 providers registered with the regulator shows that 346,000 items were dispensed between 31 March 2023 and 31 March 2024, compared with 150,527 the previous year.
This is in line with previous data from NHS Business Services Authority, published in response to an FOI request, showing that over 300,000 items were prescribed between April 2023-24.
A new request, made public last week, gives a more detailed picture of private prescription numbers for the first half of 2024, with numbers jumping 20% in January 2024 compared to December 2023. [The way prescriptions of unlicensed CBPMs are recorded mean there is often a delay in NHS data becoming available, with previous analysis showing these figures can be subject to change up to a year after publication.]
The same request also confirms that the monthly number of NHS unlicensed and private licensed medical cannabis patients is ‘less than five’.
This comes as a new report on the European cannabis industry, from analysts at Prohibition Partners, identifies the UK as the second largest medical cannabis market in Europe, expected to exceed €300 million in 2025.
But the issues raised by the CQC have led to calls for further clarity in the regulations and even a full sector review, including all relevant regulatory bodies to “spell out” the requirements of private providers.
‘Key issues’ on prescribing of CBPMs
A key concern according to the CQC is that private clinics are currently prescribing for a ‘very wide range’ of conditions – for some of which there is ‘poor evidence to justify the use of CBPMs’.
While clinics advertise prescribing for numerous conditions, according to Professor Mike Barnes, chair of the Medical Cannabis Clinicians’ Society (MCCS), data shows the majority of prescriptions are for chronic pain, anxiety and neurological conditions, as has been the case since the legislation was introduced.
“The numbers are unchanged,” he tells Cannabis Health.
“Over 90% of prescriptions are for pain, anxiety and neurological conditions such as MS and epilepsy.”
It is ‘essential’, the CQC says, that clinicians demonstrate ‘unmet clinical need’ before prescribing to a patient, which in some cases may involve having tried ‘significantly more than two previous treatments’.
While the requirement for a patient to have tried two previous treatments is not stipulated in the legislation, it is generally considered to be the benchmark for prescription eligibility. However, there is a lack of clarity around whether this includes ‘alternative treatments’, for example over-the counter pain medications, or CBT for anxiety.
In its updated Good Practice Guidelines for the prescribing of CBPMs, published this week, the MCCS has attempted to provide some clarity on this, stating that while prescribers ‘must make a judgement themselves’, it considers ‘completion (and consequent failure) of two accepted, evidenced-based treatments for the condition is a minimum requirement’.
“The law says you can prescribe for any condition,” Prof Barnes continues.
“If someone has reached the end of the road in terms of the standard licensed medicine route, then there’s nothing wrong with trying cannabis if there’s a reasonable basis for it.”
The CQC also reports instances where providers have not communicated treatment plans and information on prescribed CBPMs in a ‘timely way’ with other healthcare professionals’ involved in a person’s care, such as GPs and secondary health services, which it says is ‘vitally important’ for patient safety.
It goes on to highlight the importance of specialists ‘retaining oversight’ of their patients — and providers in ensuring they have the time to undertake these duties, as well as having the ‘appropriate range’ of GMC specialists to carry out multidisciplinary team meetings.
Inspection activity has also revealed cases where medicines errors involving CBPMs have not been reported. A medicines error includes any ‘patient safety incident’, where there has been an error while prescribing, preparing, dispensing, administering, monitoring or providing advice on medicines.
Elsewhere, the CQC says Controlled Drug Liaison Officers have reported concerns around clinics not giving patients ‘relevant information’ about how to prove they are legally prescribed CBPMs.
In response to the issues raised by the CQC, Prof Barnes has called for further clarification in the regulations regarding the requirements of providers prescribing CBPMs.
“The CQC has published these concerns, but nowhere is it spelled out in the regulations what it is required of providers, which I think now needs to happen,” he says.
In the meantime, he has urged clinics to adhere to the Good Practice Guidelines, which set out the responsibilities of prescribers and providers, as well as recommendations around dosing, outcome measures, and the use of flower and oil-based products.
Calls for a multi-agency review
Earlier this year, the government commissioned the Advisory Council for the Misuse of Drug to carry out a formal review of the legal framework for the prescribing of CBPMs, including identifying any ‘unintended consequences which were not anticipated at the time of implementation’.
However, Prof Barnes is sceptical of what impact this would have, and is instead, calling for a multi-agency review of the sector, led by the Department of Health, and including all relevant bodies involved in the prescription of CBPMs, such as the Medicines and Healthcare Regulatory Authority (MHRA), Home Office, and the General Medical Council (GMC).
“I would personally favour a formal review of the entire sector and all agencies involved, which hasn’t happened since the law changed in 2018,” he says.
“This isn’t necessarily about tightening up regulations, but understanding where we are seven years on, what is being done well and what may still need to be addressed.
He adds: “It’s about clarifying and spelling out the regulations. The CQC cannot complain that people aren’t adhering to what they think should be happening, when it is not clear what that is.”
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