NHS Trust Approves UK-First Inpatient Medical Cannabis Policy

 

The mental health and learning disability trust is the first in England to establish procedures for verifying prescriptions, storing medicines, and administering treatment safely where appropriate, since medical cannabis was legalised in 2018. 

 

Until now, decisions about the use of these medicines in hospitals have been left to individual clinicians and, ultimately, to the position of the trust. But the lack of formal procedures around this has led to confusion among patients and staff.

 

According to the advocacy group PatientsCann UK, patients admitted to the DPT inpatient unit previously faced a ‘confusing’ and often ‘distressing’ situation, with staff ‘uncertain’ about how to handle products or simply confiscating them.

 

What’s in the policy?

 

The Standard Operating Procedure (SOP) known as CD21, ratified by the trust’s Medicines Safety Committee, makes a clear distinction between licensed cannabis medicines (Sativex, Epidyolex and Nabilone), unlicensed prescribed cannabis medicines from specialist clinics, commercial CBD products and illicit cannabis.

 

Where an unlicensed cannabis-based medicine is confirmed to be legally prescribed, the policy states that this can continue to be administered while the patient is admitted to hospital, if the prescriber, in discussion with the multidisciplinary team, considers it appropriate to do so.

 

Staff at the trust do not need to issue a new prescription and will not dispense these medicines.

 

The patient’s existing prescription can be transcribed onto the inpatient prescribing record as part of a ‘medicines history/reconciliation process’ and is ‘not considered prescribing’ but a ‘patient-specific direction to administer a CBMP while the patient is an inpatient’

 

If a new prescription is needed during an admission, patients must obtain this through their existing private clinic and staff should support them in arranging this. 

 

While the use of CBPMs is ‘generally supported’ by the trust, the policy requires an individual care plan is in place for each patient to ‘support administration’. This should covers issues such as how the medicine will be taken, where administration can safely occur, supervision requirements and the management of any vaporiser equipment.

 

Verifying legal prescriptions 

 

A detailed section explains how staff should verify whether a patient’s cannabis is legally prescribed. This includes confirming:

 

• the product was dispensed by a pharmacy
• it remains in its original packaging
• it has a legible dispensing label showing the patient’s details, product, dosage and THC/CBD content
• where necessary, legality can be checked through prescribing documentation or directly with the prescribing clinic.

 

It notes that a ‘medical cannabis card’ can not be used to authenticate the legality of the prescription.

 

If the cannabis has been transferred into another container, has no dispensing label, or staff cannot verify its legal origin, it cannot be prescribed or administered by the hospital should instead be managed under the trust’s illicit drugs policy. 

 

Once verified, unlicensed CBMPs are treated as other Schedule 2 controlled drugs and are subject to standard procedures such as secure storage, record keeping and oversight from the trust’s Controlled Drugs Accountable Officer.

 

Smoking is not permitted in line with UK regulations, and cannabis flower must be administered via a ‘heated nebuliser’ or dry herb vaporiser.

 

It states: “Any patient who smokes their CBMP, even if it is legally obtained, can be considered to be carrying out illegal activity.”

 

Psychological therapies ‘should not be a barrier’

 

Patient advocates say the introduction of this policy is especially significant given that DPT is a mental health and learning disability trust, recognising the use of CBPMs for conditions including PTSD, anxiety, OCD and depression.

 

According to the policy document, the use of these products ‘needs to be taken into consideration’ when patients are undergoing psychological therapy but ‘should not be a barrier’ to use.

 

It notes a 2022 study which found frequent cannabis use was associated with poorer outcomes in CBT for anxiety and related disorders. Despite this, individuals who used cannabis frequently still experienced a statistically significant decrease in their anxiety symptoms.

 

A 2024 meta-analysis of evidence-based PTSD treatments also found that outcomes were similar regardless of cannabis use, with trauma-focused treatment being particularly efficacious for individuals reporting recent use. 

 

A ‘vital new standard’

 

Mohammad Wasway, founder of PatientsCann, said the trust had set a “vital new standard” and the focus would now be on encouraging others to follow its lead.

 

“Devon Partnership NHS Trust has set a vital new standard with the CD21 SOP, going far beyond vague, bare-minimum policies we see elsewhere,” he told Cannabis Health.

 

“Medical Cannabis has been legal since 2018, and for too long, patients have faced terrifying uncertainty when admitted to hospital, often worrying their legal medication will be confiscated or their care affected. By providing frontline staff with clear, practical guidance, DPT ensures that patients can continue their treatment safely and with dignity.”

 

Wasway added: “At PatientsCann UK, we are proud to have supported the Trust with practical toolkits and staff training. We urge NHS trusts across the country to follow DPT’s lead and put patient well-being first.”