Cannabis based products for medicinal use (CBPMs)
Introduction
On 1 November 2018, the law in the United Kingdom changed following a Home Office review regarding the use of Cannabis and Cannabis Based Products for Medicinal use. The scheduling of Cannabis Based Products for Medicinal use (CBPM) under the Misuse of Drugs legislation enabled England, Wales, Scotland and Crown Dependences such as the Isle of Man to allow medicinal cannabis to be supplied and consumed in limited circumstances.
To inform a policy stance for the Island, the Department of Health and Social Care ‘the Department’ opened a consultation with the public, seeking views on the development of a framework for medical use of cannabis on the Isle of Man. From 3,285 responses, 99.2% of respondents were supportive of medical cannabis being available under a quality assured and accredited process.
In April 2022, the Department led a competitive process to grant a licence to a local registered Pharmacy to import and supply CBPM’s to individuals with private prescriptions.Subsequently, Karson’s Pharmacy was granted a licence to supply medicinal cannabis in these circumstances.
This frequently asked question set has been developed to provide information about CBPM’s, and accessing CBPM’s from December 2022.
As a new service, there will naturally be a period of bedding-in so you can expect more information about the service will become available over the coming months. This FAQ’s will be updated accordingly.
The Department is aware that some patients have been assessed by a clinic on Island which is not inspected or approved by the CQC. This means that currently Karsons will be unable to accept any prescriptions from patients who accessed this service. We understand the Clinic is working with CQC registered clinics in England to ensure an alternative provision is put in place. We recommend you speak with the provider for further guidance.
Frequently Asked Questions
What are CBPM’s?
Cannabis Based Products for Medicinal use (CBPM’s) are products that contain cannabis, cannabis resin, cannabinol or a cannabinol derivative.
At present, the most commonly supplied types of cannabis are:
- Flower
- Sublingual Oils / Tinctures
- Vaping Oils
CBPM’s differ from over the counter cannabis/hemp oils. CBD and hemp oils are readily and legally available to purchase on the high street or online. These products are classed as food supplements, and to be legally sold, they must not contain more than 1mg of THC. The safety, quality and content of the products are not tested and regulated as strictly as with CBPM’s.
CBPM’s are unlicensed medicines, which means these products have not been assessed by the medicines regulator (the Medicines and Healthcare products Regulatory Agency (MHRA) or the European Medicines Agency (EMA] for safety, quality or efficacy.
What medical conditions can CBPM’s be prescribed for?
There is not an exhaustive list of conditions that CBPM’s can be used to treat. The decision to prescribe medicinal cannabis lies with the individual prescriber.
CBPM’s can be considered as a potential treatment option for patients who have tried taking other prescribed medicines to alleviate their symptoms. Examples conditions which could potentially benefit from CBPM’s include:
- Pain conditions – chronic pain, rheumatoid arthritis, Ehlers Danlos syndromes, fibromyalgia, chronic regional pain syndrome, migraines, cluster headaches, neuropathic pain, palliative care.
- Psychiatric conditions – attention deficit hyperactivity disorder, obsessive-compulsive disorder, post-traumatic stress disorder, autistic spectrum disorder, Tourette’s syndrome, insomnia, anxiety, agoraphobia, depression.
- Cancer – cancer-related appetite loss, anxiety, chemotherapy-induced nausea and vomiting, cancer-related pain, depression, palliative care.
- Gastrointestinal conditions – Crohn’s disease, ulcerative colitis, irritable bowel syndrome.
- Neurological conditions – multiple sclerosis, neuropathic pain, Parkinson’s disease.
What age do I need to be to access CBPM? Can I access CBPM for my child?
There are no legal age limits set for using CBPM’s. The prescriber will consider age as part of their decision whether to prescribe a CBPM.
For children under 18 years of age, CBPM’s can only be prescribed by a paediatric specialist, within their field of expertise.
Prescription Process
How do I get a prescription for Cannabis Based Products of Medicinal use?
You will need to make direct contact with a private prescribing clinic. A simple web search should provide you with quick and easy access to a range of clinics. The clinic will evaluate your eligibility, and if approved, will provide you with a private prescription.
As part of the conditions upon which the Department has granted a licence to Karsons Pharmacy, they are only able to dispense prescriptions issued from CBPM clinics who are CQC inspected and approved. Karsons will also publish a list of clinics on their website to assist you.
We recommend seeking advice directly from Karsons Pharmacy, who will be able to provide advice, guidance and signposting to appropriate private prescribing clinics.
Who can prescribe Cannabis Based Products for Medicinal use?
Only medical practitioners listed on the Specialist Register of the General Medical Council (GMC) are able to prescribe CBPM’s. In order to access this service, it is recommended that you contact the prescribers via the CBPM clinic through which they operate.
Do I need to notify my GP?
Yes. As part of any eligibility assessment with the CBPM clinic, they will ask you to obtain and share your medical records from your general practitioner (GP). It is recommended you talk to them about how long it will take for your medical records to be provided. There may be a charge to provide copies of your medical records. Upon receipt of a CBPM prescription, and throughout your treatment, you will be asked to give consent for the clinic to keep your GP informed of your treatment.
Will I get my prescription on the NHS?
No. CBPM’s are not available on NHS prescription. You will be responsible for all associated costs and charges with your prescription.
I have a medical exemption certificate. Can I receive CBPM’s on prescription?
CBPM’s are not covered under the Medical Exemption Certificate, as Medical Exemption Certificates only apply to NHS prescriptions.
What potential costs can I expect to pay?
This is a private service that will incur costs to the patient. The DHSC do not have access to all the costs involved with the process but patients wanting to access the service should expect there will be charges at the various stages of the process. Typically these may include the following:
- Initial clinic consultation
- Accessing your medical records
- Prescription writing fee
- Prescription supply fee
- Cost of the medication
- Repeat prescription fee
*this is not an exhaustive list
Karsons are happy to offer guidance on the costs involved.
Once I obtain a private prescription for a CBPM, how will I obtain my medicine?
Prescriptions issued to you by the clinic should be taken, or an original sent by post, to Karsons Pharmacy in Onchan, who will dispense your prescription. Karsons Pharmacy is a local Community Pharmacy who has been granted a licence from the Department to import CBPM products and dispense the prescriptions. Karsons will carry out a series of checks to ensure that your prescription has been provided by an approved clinic and prescriber.
How long will it take from receiving a prescription to my medicine being ready for collection at Karsons Pharmacy?
As a specially manufactured medicine containing a controlled substance, sourcing and importing CBPM’s follows a different process than routine medicinal products.
Initially, it is anticipated that it may take between 7 to 10 working days from the date of the original prescription arriving at the Pharmacy, for medication to arrive on Island. Upon arrival, a prescription may be dispensed on the same day.
We predict that the service will evolve quickly, and timescales and processes will improve. The aim for the service is for patients to be able to collect their CBPM within the same time-frame as other prescription medicines.
What support, advice and guidance can I expect Karsons Pharmacy to provide me with?
Karsons Pharmacy will provide an end-to-end CBPM service that is designed to support you through your patient journey. This includes providing:
- Information and guidance on CBPM’s
- Signposting you to CQC inspected and approved private clinics and how to contact them
- Liaising with private prescribing clinics to support you during the process
- Discussing costs with you
- Dispensing your prescription
- Ongoing advice and support
- Support with reporting adverse reactions
- Education and resources
Is Karson’s Pharmacy the only pharmacy on-island who can dispense CBPM’s?
Yes, Karsons Pharmacy in Onchan is the only pharmacy you can obtain CBPM.
Is there a delivery service?
No. CBPM’s will not be available for delivery at the launch of the service.
I’m housebound. Can someone else collect my prescription on my behalf?
Yes, you may authorise someone to collect your prescription on your behalf.
They will need to present photographic ID for both yourself (as the patient), and themselves. They will need to sign for the prescription, and state their relationship to you.
Preferably, photographic ID will be a passport, driving license or a government issued ID.
Practical Advice
My work requires me to have regular drugs tests and I have been prescribed CBPM’s. What should I do?
Prior to using CBPM’s, you should consult with your work’s HR department to determine the impact using CBPM’s could have on the drugs tests, and how it could affect your job. Please contact your prescriber or Karson’s Pharmacy for further advice re: contraindications of using specific CBPM products.
Am I allowed to drive (my own or a work vehicle) if I am using a CBPM?
All patients should always be advised to take any medication in accordance with the instructions that come with any prescription. It is strongly recommended that you consider the repercussions of driving your own vehicle (or work vehicle) irrespective if you have genuine legal grounds to obtain and consume CBPM.
Under the Road Traffic Act 1985 the Police have powers to stop motorists who may be driving under the influence of drink and drugs. Furthermore under the Road Traffic Legislation (Amendment) Act 2021, the Police have powers to administer a drug test if they reasonably suspect someone is driving under the influence of drugs.
The Isle of Man Constabulary cannot guarantee that a prosecution will be avoided, even if genuine evidence exists where an individual is able to prove that CBPM has been consumed in accordance with a prescription. In cases where there is evidence of significant impairment whilst driving, the Constabulary may prosecute with the onus on the individual to present any mitigating factors they wish to be taken into account for the court to consider.
What if I am arrested or stopped by the police and I have my prescribed CBPM in my possession?
In such scenario, the Police have every right to ask you to provide proof that the products have been legally supplied to you.
We would recommend you are able to provide:
- a copy of your prescription;
- the medicinal cannabis in its original manufacturers container with the pharmacy label attached.
- ID – preferably a driving licence or passport. Your ID should match the name on your prescription, your letter from the prescribing clinic or doctor or the medical cannabis container.
If I am paying for my prescription can I share my CBPM with family and friends?
No, the CBPM prescribed to you is for your use only. It is illegal to give your CBPM medication to another individual and you could face criminal charges for the supply of controlled substances.
Does this service mean cannabis laws on the Island are being relaxed?
No. There are no immediate plans on the Island to legalise cannabis or decriminalise its use.
Am I allowed to grow my own cannabis for medicinal purposes?
No, it remains illegal on the Isle of Man to grow cannabis, unless you have been granted the appropriate licences.
How do I get in touch with Karsons Pharmacy?
If you wish to seek further information regarding the CBPM service, or private prescriptions for CBPM please contact Karson’s Pharmacy by calling 615150 (office hours 9am-6pm Monday to Friday or by emailing dispensing@karsonspharmacy.co.uk
More information and guidance can be accessed online via this link: https://karsonspharmacy.co.uk/home
What happens if I have a reaction to the medication?
Patients should report any suspected Adverse Drug Reactions via the MHRA Yellow Card reporting website, or directly to Karsons Pharmacy.
You should also contact Karsons Pharmacy, and your prescriber for further guidance on how to manage the Adverse Drug Reaction. For any urgent medical advice, please contact your GP, MEDS, MIU and in an emergency either attend the Emergency Department at Nobles Hospital or call 999.
Are the products safe to use?
CBPM’s are “unlicensed medicines” and have not been subject to the same levels of testing to ensure their safety, quality or efficacy. In addition, they are not approved for the treatment of a particular a condition, but can be supplied if the prescriber feels it is safe for an individual patient.
I have been prescribed an oil – how do I use it?
The prescribing clinic with provide you with guidance on how they wish you to take your medicine. Karsons Pharmacy will also be able to support you with guidance.
I have been prescribed a flower – how do I use it?
The prescribing clinic with provide you with guidance on how they wish you to take your medicine. Karsons Pharmacy will also be able to support you with guidance.
Can I have a list of all the products Karsons Pharmacy will stock?
Due to the regulations around CBPM’s, we are not able to provide a list of products and their associated costs.
Karsons Pharmacy will be able to purchase the majority of CBPM’s available in the UK market, but will not hold CBPM’s in stock, at the time the service is launched.
Please speak with Karsons Pharmacy directly for advice and guidance.
Is there a price list for products?
The cost of medical cannabis depends on your prescription – the specific item, the quantity (depending on your dose) etc.
Please contact Karsons Pharmacy for further information regarding costs.
I don’t like the medicine being prescribed to me. Can I return it and have a refund?
No, as with any medication, there is no returns policy, and Karsons would be unable to accept the return of medication. If you no longer wish to take your medication you can return it to Karsons for safe destruction.
I have purchased a CBPM but I don’t want to use it, can I sell or give it to someone else.
No. Your prescription is only for you. It is illegal to sell or give someone controlled drugs that have not been prescribed for them.
What do I do if there is a problem with my medicines quality?
If you identify a problem with the quality of your medicine, please contact Karsons Pharmacy.
Karsons Pharmacy will need to report the problem to the suppliers/producers, who may require additional information from you in order to further investigate your query and find a solution.
Karsons will be able to share further information about this process, however like other special medicines, they will not be able to supply you with replacement medicine without another prescription, which will come at an additional cost.
My CBPM medication isn’t working for me - who do I contact?
Please contact the clinic who will be able to help you make an appointment to be reviewed by the doctor who has prescribed you your medicine.
Other useful information
Prescriptions for CBPM’s are only valid for 28 days from the date on the prescription. This means that once your prescription has been processed and dispensed by Karsons Pharmacy, you will need to collect your prescription within this period.
Prescribing guidelines recommend that prescriptions for CBPM’s should only be issued for 28 days supply of medicine. Patients should be mindful to arrange their next prescription to be sent to Karsons Pharmacy in good time, keeping in mind the time it takes for medicine to arrive on Island (7-10 working days).
As a private service, patients will need to pay for their medication prior to the pharmacy ordering the medicine. Karsons Pharmacy will arrange this.
References
Medical Clinicians Medical Society
https://www.ukmccs.org/start-prescribing/guidance-publications/
https://www.ukmccs.org/wp-content/uploads/2020/06/Medical-Cannabis_-Frequently-asked-questions-2.pdf
