Cannabis-based medicines for chronic pain
Patient information from The Vesey, Sutton Coldfield. CQC-registered · Dr James's clinic usually runs on Tuesday mornings, in person or by video.
Since November 2018, specialist doctors in the UK have been able to prescribe cannabis-based products for medicinal use. Only a doctor on the GMC Specialist Register can start one (not a GP), after a full assessment of your diagnosis, the treatments you have tried and your wider health. At The Vesey, Dr Arul James, Consultant in Pain Medicine, considers them for chronic pain only, as one option among several.
The first consultation is by video or in person and takes about 45 minutes. Bring a list of the medicines you have taken and any specialist letters about your condition.
Who might be suitable
Dr James considers cannabis-based medicines for chronic pain only. For MS spasticity, epilepsy, sickness from chemotherapy or a mental health condition, your neurologist, oncologist or psychiatrist is the right specialist.
NICE guidance (NG144) does not recommend cannabis-based medicines for managing chronic pain in adults, other than CBD within a clinical trial, and most of these medicines are unlicensed in the UK. Any prescription is therefore an individual specialist decision, and many people will not be suitable. Dr James will want to see a confirmed diagnosis and a record of the recognised treatments you have tried, such as physiotherapy and the medicines your GP or specialist would usually offer.
When a cannabis-based medicine is not prescribed
- Patients under 18
- Active psychotic illness, a family history of schizophrenia, or unmanaged bipolar disorder
- Pregnancy, breastfeeding, or planning a pregnancy within 6 months
- Active or recent (< 12 weeks) substance-use disorder
- Recognised treatments have not yet been tried
Licensed and unlicensed medicines
A small number of cannabis-based medicines hold a UK licence for specific conditions, such as MS spasticity and some rare forms of epilepsy. None is licensed for chronic pain. Most cannabis-based medicines prescribed privately are unlicensed 'specials', which a specialist may prescribe only when they judge that a licensed option is not suitable. The evidence for their use in chronic pain is limited.
If Dr James suggests a medicine, he will explain what it is, why he suggests it, its risks and side effects, and what being unlicensed means for you. The Vesey does not sell or supply any medicine.
What happens, step by step
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Enquiry
Tell us briefly about your pain and the treatments you have tried, so we can book the right appointment and tell you what records to bring.
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Initial specialist consultation — £260, ≈ 45 min
Video or in person. A full history, examination where relevant, a review of previous treatments, and an open discussion of every option, with its likely benefits, risks and side effects. You leave with a written plan, which may or may not include a prescription.
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If a medicine is prescribed
The prescription goes electronically to a specialist pharmacy, which dispenses it and charges you for it directly.
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Follow-up review — £180
Usually about four weeks after any new treatment starts, to check whether it is helping and whether you have side effects. Treatment that is not helping is stopped.
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Repeat prescriptions — £80 administration fee
Where nothing has changed clinically, a repeat prescription has an £80 administration fee. You will still have regular clinical reviews.
Driving, work and travel
Driving
It is an offence to drive while impaired by any medicine, including a prescribed one. Your specialist will advise you about driving, including whether you need to tell the DVLA. Keep your prescription paperwork with you, and do not drive if you feel impaired.
Employment
Workplace drug tests can detect THC whether or not it was prescribed. If you work in a safety-critical role or are tested at work, tell your employer's occupational health team before starting treatment. We can provide a consultant letter on request.
Travel
The legal status of cannabis-based medicines varies widely between countries. Check FCDO travel advice for each destination before you travel, and ask us for a consultant letter.
Talk to us about a pain consultation.
Ask a question or arrange a consultation with Dr Arul James, Consultant in Pain Medicine.
Sutton Coldfield · Birmingham · Walsall · Tamworth · Lichfield · West Midlands