Medicinal use of cannabis

7 April 2022

Dear                                         ,

ATISN 16208 – Medicinal use of cannabis

Thank you for your request to the Welsh Government for information under the Freedom of Information Act (2000) received on 28 March 2022 regarding cannabis-based products for medicinal use in humans. You have requested the following:

1. Across all medical conditions, how many patients in Wales have been prescribed unlicensed CBPMs by specialist doctors since 1 November 2018? Please break down this figure by the primary condition for which the prescription was given.

2. How many patients in Wales with refractory epilepsy (also known as severe treatment-resistant epilepsies or intractable epilepsy) have been prescribed unlicensed CBPMs by specialist doctors since 1 November 2018?
   1. How many of those patients were under 18?
   2. What products/medicines were those patients prescribed?
   3. Which NHS Trusts provided those prescriptions?
   4. What reasons were provided by the specialist clinician/Drug and Therapeutics Committee/other clinician or body, to justify the approval of those prescriptions?
   5. What was the cost of those prescriptions to the NHS?

3. How many patients in Wales with refractory epilepsy (also known as severe treatment-resistant epilepsies or intractable epilepsy) have been refused a prescription for an unlicensed CBPM by specialist doctors since 1 November 2018?
   1. How many of those patients were under 18?
   2. What products/medicines had those patients requested?
   3. Which NHS Trusts refused those prescriptions?
   4. What reasons were provided by the specialist clinician/Drug and Therapeutics Committee/other individual or body, to justify the refusal of those prescriptions?

4. How much has each NHS Trust in Wales spent on funding CBPM prescriptions for paediatric refractory epilepsy since 1 Nov 2018?

5. How many health professionals in Wales completed this e-learning module about CBPMs commissioned by NHS England and NHS Improvement to the University of Birmingham, both as a raw figure and as a percentage of the total eligible to access the module?

6. How many clinicians in Wales listed on the Specialist Register of the General Medical Council have completed the above e-learning module, both as a raw figure and a %?

7. Has any other education been made available to health professionals working under NHS Wales about CBPMs since the publication of this review on 8 August 2019?

8. Has there been an increase or decrease in the prescribing of CBD products in Wales since 1 November 2018, if so, by how much? 

9. Has there been an increase or decrease in NHS prescribing of THC-containing products in Wales since 1 November 2018, if so, by how much? 

10. How many patients in Wales have accessed Epidyolex since it was authorised by the EMA on 19/9/2019? Is this an increase or decrease compared to access via compassionate use and early access programmes pre-authorisation?

11. According to intelligence from Accountable Officers for Controlled Drugs, how many patients in Wales have had private prescriptions issued for a CBPM in an independent secondary/tertiary care setting, to date

12. How many NHS prescriptions for CBPMs have been issued in primary care in Wales since November 2018?  

13. Where are CBPM products supplied to NHS Wales manufactured, and which companies are manufacturing them?

Our response

1.  Welsh Government does not hold this information. You may wish to contact NHS Wales Shared Services Partnership (NWSSP) for Primary Care data and Health Boards for hospital data. Digital Health and Care Wales may hold additional data for hospital prescriptions. For your convenience, I have provided organisations contact details in annex 1.

2.  Welsh Government does not hold this data.  You may wish to contact the Health Boards for this information and Digital Health and Care Wales may hold additional data for hospital prescriptions.  Contact details for these organisations are provided in annex 1.

3.  Welsh Government does not hold this data and you may wish to contact the Health Boards for this information.  Contact details are provided in annex 1.

4.  As Q2. Welsh Government does not hold this data

5.  Welsh Government does not hold this information - may wish to refer to education provider for details

6.  As above (5)

7.  No

8.  As Q1.  Welsh Government does not hold this data. You may wish to contact NHS Wales Shared Services Partnership (NWSSP) for Primary Care data and Health Boards for hospital data. Digital Health and Care Wales may hold additional data for hospital prescriptions. Contact details for these organisations are provided in annex 1.

9.  As Q1. Welsh Government does not hold this data. You may wish to contact NHS Wales Shared Services Partnership (NWSSP) for Primary Care data and Health Boards for hospital data. Digital Health and Care Wales may hold additional data for hospital prescriptions. Contact details for these organisations are provided in annex 1.

10.  As Q1. Welsh Government does not hold this data. You may wish to contact NHS Wales Shared Services Partnership (NWSSP) for Primary Care data and Health Boards for hospital data. Digital Health and Care Wales may hold additional data for hospital prescriptions. Contact details for these organisations are provided in annex 1.

11.  Welsh Government does not hold this information and you may wish to contact the health boards to obtain contact details for the Controlled Drugs Accountability Officers.

12.  Welsh Government does not hold this information and you may wish to contact NHS Wales Shared Services Partnership (NWSSP) for Primary Care data.

13.  “CBPMs” (Cannabis Based Products for Medicinal use) is a defined group of drugs under the Misuse of Drugs Act and therefore only covers unlicensed medicines or medicines used in clinical trials. The licenced drugs Sativex, Epidyolex and Nabilone are scheduled in their own right and are not captured under the CBPM definition.

We are not aware of any NHS Wales prescriptions being filled, and therefore no supply of CBPM products being supplied to NHS Wales. Any response to this question would be theoretical.

We are able to refer you to the following document that has been published by the MHRA (Medicines Healthcare products Regulatory Agency) which may provide further information on unlicensed CBPMs. Cannabis Guidance unlicensed CBPMs updated 2020.pdf (publishing.service.gov.uk)

Next steps

If you are dissatisfied with the Welsh Government’s handling of your request, you can ask for an internal review within 40 working days of the date of this response. Requests for an internal review should be addressed to the Welsh Government’s Freedom of Information Officer at:

Information Rights Unit, 
Welsh Government,
Cathays Park, 
Cardiff, 
CF10 3NQ 
or Email: Freedom.ofinformation@gov.wales

Please remember to quote the ATISN reference number above.

You also have the right to complain to the Information Commissioner. The Information Commissioner can be contacted at:

Information Commissioner’s Office, 
Wycliffe House, 
Water Lane, 
Wilmslow, 
Cheshire, 
SK9 5AF

However, please note that the Commissioner will not normally investigate a complaint until it has been through our own internal review process.

Yours sincerely