The guidance on cannabis-based medicinal products says prescriptions should be initiated by a doctor on the GMC specialist register with a special interest in the condition being treated. However it said that subsequent prescriptions could be issued by other prescribers as part of a shared care arrangement.
If this happened it would still be the specialist doctor's responsibility to monitor, evaluate and adjust doses, NICE said. A shared care agreement should set out the responsibility of all parties - including the patient and their family.
The new draft guidance recommends that cannabis product nabilone can be used as an add-on treatment for adults with chemotherapy-induced nausea and vomiting.
However, NICE said medicinal cannabis should not be used to manage chronic pain because the treatment effect was 'modest' and the evidence did not show any reduction in opioid use among those it was prescribed to.
It also advised against prescribing THC:CBD spray, which is licensed in the UK under the brand Sativex, for treating spasticity in patients with MS. NICE said that while there were no adverse effects of the treatment and some reductions in patient-reported measures of spasticity, the evidence was low-quality.
It also said that that it was 'highly unlikely that THC:CBD spray could be considered a cost-effective treatment', adding that further research was necessary.
NICE was unable to make a recommendation on the use of cannabis products in severe treatment-resistant epilepsy because of a lack of available evidence. It recommended that further research should be undertaken in this area.
NICE also said there was a need for further research on the use of medicinal cannabis in patients with fibromyalgia or persistent treatment-resistant neuropathic pain and in children and young people with 'intractable cancer-related pain and pain associated with specific diseases'.
The guidance comes as NHS England published a review into the use of medicinal cannabis. The review recommended that NHS England and the DHSC should fund one or more randomised controlled trials into the use of cannabis in severe treatment-resistant epilepsy in children.
At the end of last year the RCGP published guidance on prescribing cannabis. The guidance provides advice on how GPs can approach conversations with patients about medicinal cannabis should the issue arise in consultations.