Precription of medicinal cannabis products

WQ.82/2019

WRITTEN QUESTION TO THE MINISTER FOR HEALTH AND SOCIAL SERVICES BY SENATOR S.C. FERGUSON

ANSWER TO BE TABLED ON TUESDAY 12th FEBRUARY 2019

Question

In light of the agreement that medicinal cannabis products may be prescribed, will the Minister advise –

1. whether any G.P.s are still unwilling to prescribe such products and, if so, will he undertake to confirm whether this is due to a lack of knowledge, education, support from his Department, or cultural resistance from more senior colleagues;
2. whether any pharmacies are unwilling to supply such products and, if so, whether it is due to any lack of clarity or specificity regarding the products made available which thereby renders such products subject to costs on the private tariff; and
3. if there are such G.P.s or pharmacies, what he is going to do to deliver on the agreement that such products may be prescribed; and

will the Minister explain whether any pharmacies have not yet moved the drug Sativex from the private list of products to the free prescription list and, if there are such pharmacies, why that is the case?

Answer

1. The recent changes in legislation have removed the legal barrier to prescribing quality assured cannabis- based medicinal products and, as with any other prescription medicine, the decision to do so is a clinical one to be taken by the prescriber. The decision to prescribe or not to prescribe is entirely a matter for individual GPs as independent healthcare professionals. All medical practitioners registered to practise in Jersey are required to be licensed to practise by the General Medical Council (GMC) and must at all times adhere to the GMC's standards of good medical practice, including good prescribing practice. Apart from jeopardising their GMC licence to practise, any medical practitioner deviating from these standards would also compromise their medical indemnity cover.
2. The recent changes in legislation specify the manufacturing and quality control measures which any cannabis-based medicinal product must comply with and therefore does not impose a restriction to any specific named products. Pharmacists are under a professional obligation to only dispense medicinal products where they can guarantee the quality of the product. Compliance with Good Manufacturing Practice (GMP) requirements by the manufacturer provides pharmacists with such an assurance regarding the quality of the product. Any cannabis-based medicinal product dispensed by a community pharmacist in response to a GP prescription would be on the basis of a private prescription.
3. Quality assured cannabis-based medicinal products can now be legally prescribed by any doctor or approved prescriber in Jersey following the legal change approved by the Minister.
4. To date, no application has been made for any cannabis-based medicinal product, including Sativex, to be placed on the approved list.

The list of community-dispensed items available at no cost to the patient is maintained by the Social Security Minister under the Health Insurance Law. Pharmacies cannot unilaterally move products to the approved list. Under the Health Insurance Law, the Social Security Minister must take advice from the Pharmaceutical Benefit Advisory Committee (PBAC) before making any changes to the approved list. The PBAC comprises an independent chair, 3 GPs, 2 community pharmacists, 1 community dentist, 2 Social Security representatives, 2 Health and Social Services representatives, the Medical Officer of Health and the Chief Pharmacist at the General Hospital. Any local prescriber (doctor, dentist, approved non-medical prescriber) can make an application to the PBAC for an item to be added to or removed from the approved list.

The PBAC considers applications in light of current clinical evidence and expert advice, with the aim of ensuring that patients in Jersey have access to an appropriate range of modern, safe and effective treatments from their GPs and other community prescribers at a proportionate cost to the Health Insurance Fund. The approved list does not include a range of more specialist items which are only available on prescription from an  appropriate  specialist prescriber (doctor, dentist or non-medical prescriber) working in the Hospital.

The (UK) National Institute for Health and Care Excellence (NICE) provides evidence-based guidance and advice for health, public health and social care practitioners. NICE is currently developing guidance in respect of cannabis-based products for medicinal use and this guidance is expected to be published in October 2019.