Intended for healthcare professionals

Practice Guidelines

Cannabis-based medicinal products: summary of NICE guidance

BMJ 2020; 369 doi: (Published 21 April 2020) Cite this as: BMJ 2020;369:m1108
  1. Stacey Chang-Douglass, senior technical analyst in health economics1,
  2. Caroline Mulvihill, technical adviser on behalf of NICE Guideline Updates Team1,
  3. Steve Pilling, director of Centre for Outcomes, Research and Effectiveness, chair of Guideline Committee2
  4. on behalf of the Guideline Committee
    1. 1National Institute for Health and Care Excellence, London, UK
    2. 2Centre for Outcomes, Research and Effectiveness, University College London, London, UK
    1. Correspondence to: Caroline Mulvihill MedicinalCannabis{at}

    What you need to know

    • The rescheduling of cannabis-based medicinal products (CBMPs) allows their prescription when there is an unmet clinical need

    • Initial prescription of CBMPs must be made by a doctor on the Specialist Register with a special interest in the condition being treated. For children and young people, the initiating prescriber should also be a tertiary paediatric specialist

    • Subsequent prescriptions of CBMPs may be issued by another prescriber, such as a general practitioner, as part of a shared care agreement under the direction of the initiating specialist prescriber

    • Offer THC:CBD spray for moderate to severe spasticity in adults with multiple sclerosis if other pharmacological treatments are not effective. Consider nabilone as an add-on treatment for adults with intractable chemotherapy-induced nausea and vomiting. Cannabidiol (CBD) with clobazam is recommended for treating seizures associated with Lennox-Gastaut syndrome and Dravet syndrome

    • Do not offer CBMPs to manage chronic pain in adults. Do not offer CBD to manage chronic pain in adults unless as part of a clinical trial

    In September 2018, in light of the UK chief medical officer’s review and in response to the Advisory Council on the Misuse of Drugs advice, ministers in the UK announced changes to the existing regulations on cannabis-based medicinal products (CBMPs). CBMPs would be rescheduled from Schedule 1 of the Misuse of Drugs Regulations 200112 to Schedule 2 controlled drugs and that prescribing would be restricted to doctors on the Specialist Register of the General Medical Council (GMC). Rescheduling allows CBMPs to be legally prescribed. However, many CBMPs currently do not have marketing authorisation from the Medicines and Healthcare products Regulatory Agency (MHRA), and so existing prescribing guidance and governance arrangements in place for unlicensed medicines continue to apply. Unlicensed medications should not be considered as first line treatments and should be used only when there is …

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