People have the right to be involved in discussions and make informed decisions about their care, as described in making decisions about your care.
Making decisions using NICE guidelines explains how we use words to show the strength (or certainty) of our recommendations, and has information about prescribing medicines (including off-label use), professional guidelines, standards and laws (including on consent and mental capacity), and safeguarding.
1.1.1 Consider nabilone as an add-on treatment for adults (18 years and over) with chemotherapy-induced nausea and vomiting which persists with optimised conventional antiemetics.
1.1.2 When considering nabilone for adults with chemotherapy-induced nausea and vomiting, take into account potential adverse drug interactions, for example, with central nervous system depressants and other centrally active drugs.
To find out why the committee made the recommendations on intractable nausea and vomiting and how they might affect practice, see the rationale and impact section on intractable nausea and vomiting.
1.2.2 Do not offer CBD to manage chronic pain in adults unless as part of a clinical trial.
1.2.3 Adults who started cannabis-based medicinal products to manage chronic pain in the NHS before this guidance was published (November 2019) should be able to continue treatment until they and their NHS clinician think it appropriate to stop.
To find out why the committee made the recommendations on chronic pain and how they might affect practice, see the rationale and impact section on chronic pain.
other pharmacological treatments for spasticity are not effective (see the recommendations on spasticity in NICE's guideline on multiple sclerosis in adults)
the company provides THC:CBD spray according to its pay-for-responders scheme (it funds the first 3 x10-ml vials if there is agreement for continued funding for people with at least a 20% reduction in spasticity-related symptoms on a 0 to 10 patient-reported numeric rating scale after 4 weeks).
After the 4-week trial, continue THC:CBD spray if the person has had at least a 20% reduction in spasticity-related symptoms on a 0 to 10 patient-reported numeric rating scale.
1.3.2 Treatment with THC:CBD spray should be initiated and supervised by a physician with specialist expertise in treating spasticity due to multiple sclerosis, in line with its marketing authorisation.
To find out why the committee made the recommendations on spasticity and how they might affect practice, see the rationale and impact section on spasticity.
NICE has made research recommendations on the use of cannabis-based medicinal products for severe treatment-resistant epilepsy.
To find out why the committee made the research recommendations on CBD, and THC in combination with CBD for severe treatment-resistant epilepsy, see the rationale section on severe treatment-resistant epilepsy.
1.5.1 Initial prescription of cannabis-based medicinal products (excluding nabilone, THC:CBD spray [Sativex] and medicines not classed as controlled drugs such as cannabidiol) must be made by a specialist medical practitioner (a doctor included in the register of specialist medical practitioners [the Specialist Register], see section 34D of the Medical Act 1983). They should also have a special interest in the condition being treated (see the GMC's information for doctors on cannabis-based products for medicinal use). For children and young people under the care of paediatric services, the initiating prescriber should also be a tertiary paediatric specialist.
current and past use of cannabis (including any over-the-counter and online products)
history of substance misuse including the illicit use of cannabis
potential for dependence, diversion and misuse (in particular with THC)
mental health and medical history, in particular, liver impairment, renal impairment, cardiovascular disease
potential for interaction with other medicines, for example, central nervous system depressants and other centrally active drugs, antiepileptics and hormonal contraceptives
pregnancy and breastfeeding (breastfeeding is a contraindication for Sativex and nabilone; there is limited evidence on the safety of cannabis-based medicinal products during pregnancy and breastfeeding).
1.5.6 When prescribing cannabis-based medicinal products for babies, children and young people, pay particular attention to the:
potential impact on psychological, emotional and cognitive development
potential impact of sedation
potential impact on structural and functional brain development.
1.5.7 When prescribing cannabis-based medicinal products, advise people to stop any non-prescribed cannabis, including over-the-counter, online and illicit products.
1.5.8 Prescribers should record details of treatment, clinical outcomes and adverse effects for people prescribed cannabis-based medicinal products, using local or national registers if available.
1.5.9 For more information on safe prescribing and use of cannabis-based medicinal products, see the recommendations in the NICE guideline on controlled drugs.
To find out why the committee made the recommendations on factors to think about when prescribing and how they might affect practice, see the rationale and impact section on prescribing: factors to think about when prescribing.
In this guideline cannabis-based medicinal products include:
the licensed products delta-9-tetrahydrocannibinol combined with cannabidiol (Sativex) and nabilone
plant-derived cannabinoids such as pure cannabidiol (CBD)
synthetic compounds which are identical in structure to naturally occurring cannabinoids such as delta-9-tetrahydrocannabinol (THC), for example, dronabinol.