More research required on cannabis based products-reports from NICE & NHS

Two reports recently published in the UK regarding the use of cannabis based products for a number of medical conditions have pointed to the need for further clinical evidence & research regarding their use to treat severe treatment-resistant epilepsy.

In separate reports published by both NICE (National Institute for Health and Care) and the NHS, neither gave a distinctly positive nor negative opinion regarding the use of cannabis based products in epilepsy. However, both were clear in their recommendations that further evidence was required.

The NICE report states that “Because there is no good quality evidence in this population, the committee were unable to make a recommendation on the use of cannabis-based medicinal products for severe treatment-resistant epilepsy. Therefore, they made research recommendations to promote further research and inform future practice”.

In its rationale, NICE state:

“There are some reports of individual patients having fewer seizures with these products when other treatments have not fully controlled the seizures. But current research is limited and of low quality, making it difficult to assess just how effective these products are for people with epilepsy. Published randomised controlled trials have focused on the use of pure cannabidiol in people with Dravet and Lennox-Gastaut syndrome. People with these epilepsy syndromes also report a very high rate of adverse events”.

“The committee discussed the limited evidence and agreed that it did not warrant a practice recommendation. However, they also agreed that they should not make a recommendation against the use of cannabis-based medicinal products as this would restrict further research in this area and would prevent people who are currently apparently benefiting from continuing with their treatment”.

The NHS Report meanwhile found that clinical understanding of medicinal cannabis is variable and that some clinicians “do not have the specialist professional education needed to make fully informed prescribing decisions”. It also highlights “that the lack of evidence into the safety and effectiveness of [cannabis based products] has weighed heavily on prescribing decisions in cases of severe treatment-resistant paediatric epilepsy”. In particular, “published studies for use of THC-containing products have tended to be observational, have lacked a control group and had low patient numbers. These studies are important and can contribute to the evidence base but are lower quality sources of evidence compared to [randomised controlled trials] and are not routinely used to make population prescribing decisions or recommendations”. It calls for the immediate establishment in the UK of randomised clinical trials in severe treatment-resistant paediatric epilepsy.

The report from NICE can be accessed here while the NHS report can be accessed here.

Epilepsy Ireland will continue to monitor emerging worldwide research and recommendations on the use of medicinal cannabis and provide updates on both our website and social media channels. In the interim, further details on the use of cannabis based products in Ireland can be found at the following link and should you have any questions regarding the use of cannabis based products, please consult with your medical team.