Medical cannabis: “restrictive” guidance lets patients down, say campaignersBMJ 2018; 363 doi: https://doi.org/10.1136/bmj.k4654 (Published 01 November 2018) Cite this as: BMJ 2018;363:k4654
All rapid responses
Hurley reported varied reactions to advice from the General Medical Council to GPs (“not to prescribe unlicensed drugs containing naturally occurring cannabinoids…”) and from NHS England to patients (“not [to] approach GPs to ask for these products.”).(1) The advice was state of the art and wise. As Schleider and colleagues’ summarise: “There is a serious gap between the public perception of cannabis as being a 21st century panacea and the medical establishment view that cannabis is a 21st century snake oil.”(2)
Following scoping (draft scope consultation closes 4 December 2018), NICE will report on cannabis-derived products for medicinal use next autumn.(3) Promising indications using by-products such as cannabidiol for rare cases of epilepsy or nabiximols for spasticity have nothing in common with cannabis itself. With steadily rising tetrahydracannabinol concentration in marijuana, this increasingly powerful drug contains hundreds of compounds with variable concentrations, is responsible for cognitive impairments, interaction with mood state, and an adverse course of psychotic symptoms, even excluding the devastating consequences of smoking tobacco. Nevertheless, NICE guidance should specifically protect women of childbearing age: professional associations warned about teratogenicity with ventricular septal defect and Ebstein's syndrome in 2007 (3) and adverse impacts of cannabinoid receptors’ stimulation on fetal brain development cannot be overlooked.(4)
Lastly, guidelines are only meaningful with implementation monitoring, especially considering the overblown misrepresentation here. Cannabis associated US Emergency Department visits are increasing, with children aged 12-17 years having the highest risk.(5) A Pubmed search (Emergency Department Visits Cannabis) failed to find any publications from a European country. It is mandatory to monitor the real life setting.
1 Hurley R. Medical cannabis: "restrictive" guidance lets patients down, say campaigners. BMJ 2018;363:k4654.
2 Bar-Lev Schleider L, Abuhasira R, Novack V Medical cannabis: aligning use to evidence-based medicine approach. Br J Clin Pharmacol 2018;84:2458-2462.
3 National Institute of Health and Social Care Excellence.Cannabis-based products for medicinal use https://www.nice.org.uk/guidance/indevelopment/gid-ng10124
4 Jenkins KJ, Correa A, Feinstein JA, et al. Noninherited risk factors and congenital cardiovascular defects: current knowledge: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young: endorsed by the American Academy of Pediatrics. Circulation 2007;115:2995-3014.
5 Higuera-Matas A, Ucha M, Ambrosio E. Long-term consequences of perinatal and adolescent cannabinoid exposure on neural and psychological processes. Neurosci Biobehav Rev 2015;55:119-46.
6 Shen JJ, Shan G, Kim PC, Yoo JW, Dodge-Francis C, Lee YJ. Trends and related factors of cannabis-associated emergency department visits in the United States: 2006-2014. J Addict Med 2018. Online Nov 9. doi: 10.1097/ADM.0000000000000479.
Competing interests: No competing interests