FOR PROFESSIONALS

Legislation

1. Legislation for Pharmaceutical Cannabis
2. Medical use of cannabis and cannabinoids

What you need to know

• Cannabis based products for medicinal use contain cannabinoids derived from the cannabis plant, including ∆9-tetrahydrocannabinol (THC), cannabidiol (CBD), or a combination of THC and CBD. Synthetic cannabinoids for medicinal use typically mimic the effects of specific cannabinoids such as THC
• THC is the constituent of cannabis that causes the “high,” whereas CBD is not intoxicating at typical doses. THC and CBD have contrasting mechanisms of action and therapeutic indications; THC carries a higher risk of adverse events compared with CBD
• Rescheduling on 1 November 2018 permits some unlicensed cannabis based products to be prescribed for the first time in the UK, but only by doctors on the relevant Specialist Register of the General Medical Council
• Indications for treatment, supported by evidence of low to moderate certainty, include chronic pain, some treatment resistant epilepsies, and nausea and vomiting caused by chemotherapy
• Non-medicinal CBD products are legal and widely available on the internet and from health food retailers, but they lack quality standards and should not be used for medicinal purposes

Key terms

• Cannabinoid—a drug that acts on the endocannabinoid system. The cannabis plant synthesises many cannabinoids such as THC and CBD
• THC—∆9-tetrahydrocannabinol, a cannabinoid used for medicinal purposes and non-medicinally for its intoxicating effects
• CBD—cannabidiol, a cannabinoid with contrasting mechanisms of action and therapeutic indications to THC. Not intoxicating at typical doses
• Cannabis based products for medicinal use—medicinal products containing cannabis or cannabinoids derived from the cannabis plant (eg, THC and/or CBD)
• Synthetic cannabinoids for medicinal use—medicinal products containing synthetically produced cannabinoids which typically mimic the effects of THC
• Non-medicinal CBD products—products containing CBD that are widely sold as herbal remedies but are not regulated as medicinal products
• Non-medicinal cannabis—material from the cannabis plant that is not regulated as a medicinal product, widely used for its intoxicating effects
• Non-medicinal synthetic cannabinoids—synthetic cannabinoids that are not structurally related to naturally occurring cannabinoids and are not currently recognised for medicinal use (eg, synthetic cannabinoid receptor agonists, which are found in products such as “Spice”)