Medical cannabis and the NHS: A £4 billion solution for chronic pain

Medical cannabis on the NHS: the background

Medical cannabis has been legal in the UK since 2018, but, fewer than five prescriptions have been obtained on the NHS. 

NICE guidelines only recommend the prescription of three licenced cannabis-based medicines for the treatment of four conditions: Sativex for spasticity of adults with multiple sclerosis (MS), Nabilone for chemotherapy-induced nausea and vomiting, and Epidyolex for severe treatment-resistant epilepsy, i.e. Lennox Gastaut syndrome and Dravet syndrome.

NICE has called for more research to be carried out on the use of CBPMs in chronic pain, before it can make a recommendation for it to be prescribed on the NHS. 

In comparison, over 40,000 patients are now thought to be prescribed medical cannabis through private clinics such as Releaf. Real world evidence (RWE) studies consistently show that chronic pain is the condition for which patients most often use CBPMs, with many reporting improvements in symptoms and overall quality of life.

How common is chronic pain?

Millions of people in the UK are living with some form of chronic pain. It is thought to affect between one third and one half of the population, or just under 28 million adults.

Previous research has estimated that between 10.4 and 14.3% of people with chronic pain experience moderate to severely disabling pain. Researchers based their health economic analysis on around 10.4% of the population, which equates to 5,447,932 people.

But recent figures (published after the economic analysis was conducted) provided by the Health Foundation think tank suggest that the number of people with chronic pain could increase by two million by 2040.

The case for medical cannabis on the NHS

A collaborative paper, published by the Cannabis Industry Council, Drug Science, Glass Pharms, Ethypharm and RUA bioscience, in the Expert Review of Pharmacoeconomics & Outcomes Research, makes a compelling case for medical cannabis to be available on the NHS for those with chronic pain and related conditions. 

The study model

The research team, led by Dr Shanna Marrinan, commissioned the York Health Economic Consortium (YHEC) to develop a cost-effectiveness model, comparing medical cannabis with more prevalent treatments, such as analgesics, physiotherapy and cognitive behavioural therapy, for people with chronic pain, over a one-year period.

Data from Drug Science’s T21 programme was used to inform the model. It assumed a 5% increased efficacy from using cannabis medicines, based on current real-world evidence.

Key findings: health and economic benefits

The researchers found that when a patient was prescribed medical cannabis for chronic pain, instead of alternative treatments, it saved the NHS £729 each year, as well as improving their health outcomes.

If this were available as a treatment to the 5.45 million people with moderately or severely disabling chronic pain, it would equate to a total annual saving of £3.97 billion for the NHS.

The cost of CBPMs took into account both the price of doctor consultations and grams of prescribed cannabis. Other healthcare costs considered included reduction in use of other prescription drugs, GP, hospital and other healthcare appointments, and reduced spending on alternative treatments.

Primary outcomes were measured in total and incremental Quality-Adjusted Life Years (QALYs) and costs per person. 

The model also considers secondary outcomes, such as lost productivity, including the total number of hours taken off work in order to attend appointments, in addition to days taken off work due to chronic pain, and the total income loss per person. When these secondary benefits were considered, the overall savings are reported to rise to £1037 per person. 

Writing in the summary report, the researchers say the percentage improvement in the Brief Pain Index (BPI) with medical cannabis (5% or greater) is the ‘major driver’ of the results. This is said to be conservative to account for a lack of placebo control, with T21 data previously showing an 18% improvement in symptoms.

The authors state:

 “These findings highlight the substantial cost saving that CBMPs may represent for the treatment of chronic pain patients, and the benefits for healthcare providers as a treatment for this often hard-to-treat population.”

Study limitations 

The findings are significant, but they should be considered in line with the limitations of the study. As the model was based on real-world evidence, further high-quality clinical trials and systematic comprehensive capture of clinical experience with cannabis-based medicines are needed to 

Also worth noting is that the model was based on UK costs, populations, and typical NHS treatment patterns.

Main takeaways 

These results indicate that over the course of one year, cannabis medicines are estimated to be less costly when compared to analgesics, physiotherapy and CBT alone, and also more effective.

CBPMs are also associated with less hours taken off work to attend appointments and, therefore, less income loss per person.

In an accompanying summary report published by the CIC, the authors say their findings —contrary to the NICE recommendation— ‘strongly indicate’ that CBPMs can be cost-effective for the treatment of chronic pain, when taking into account real-world evidence. 

They add that the NICE assessment, based solely on RCT evidence, might not be the most helpful approach to help both patients and the healthcare system. 

Find out more about medical cannabis treatments for chronic pain and check if you could be eligible here.