A UK public health institute has approved the use of cannabis-based medicines by the National Health Service (NHS) for a limited number of conditions.

Under the new guidelines, issued by the National Institute for Health and Care Excellence (NICE), cannabis-based medicines prescribed by specialist doctors are authorized for the treatment of multiple sclerosis, vomiting and nausea brought on by chemotherapy, and two types of severe childhood epilepsy.

The recommendations take immediate effect in England and Wales, while Northern Ireland will determine the use of cannabis-based medicines on a case-by-case basis. Scotland, with its own health and care guidance institute, is unaffected by the changes but is likely to bring in similar recommendations next year.

The two rare forms of epilepsy covered by the guidelines are Lennox Gastaut syndrome and Dravet syndrome, which affects 5,000 and 3,000 children in England, respectively. Clinical trials with an oral solution containing cannabidiol (CBD) indicate that the drug could reduce seizure incidences by up to 40 percent.

Campaigners welcomed the new guidelines, but many argue that they do not go far enough.

“Today’s announcements represent an important step forward for people affected by severe and treatment-resistant epilepsies,” said Simon Wigglesworth, deputy chief executive of the non-profit Epilepsy Action.

Galia Wilson, chairperson of Dravet Syndrome UK, said: “Many families come to us asking about the potential of cannabis-based medicines, particularly cannabidiol, and we are thrilled that one is now available on the NHS.”

Many parents who have children with epilepsy are currently importing drugs, at a cost of thousands of pounds a month, from Europe, Canada, and the US, which contain both THC and CBD. NICE’s guidelines for NHS treatments do not approve the use of both components in cannabis-based medicines, so parents will have to continue to pay up privately. Medical treatment on the NHS is free at the point of use.

“This restrictive guidance is condemning many patients to having to pay for life-transforming medicine privately, to go without or to consider accessing illegal and unregulated sources,” said Millie Hinton, spokesperson for the campaign group End Our Pain.

NICE’s guidelines include the implementation of a four-week trial of a cannabis-based oral spray to treat the muscle spasms of patients with multiple sclerosis, for whom other treatments have had no effect.

Genevieve Edwards, director of external affairs at the Multiple Sclerosis Society, said “it was brilliant NICE has finally listened” after years of campaigning for access to the spray for the 100,000 people in Britain who live with multiple sclerosis.

But she is concerned that many patients will miss out because the drug would be provided by local bodies on tight budgets. She also argues that NICE’s guidelines do nothing to provide for cannabis-based medicines to relieve the pain of multiple sclerosis patients.

“No cannabis-based treatments have been recommended to treat pain, a common symptom of multiple sclerosis,” said Edwards.

NICE also recommends the use of the cannabis-based product nabilone, as a supplementary treatment for adult patients undergoing chemotherapy who experience severe nausea and vomiting, and for whom other drugs have not helped.

NICE’s decision comes more than a year after the widely-reported case of an epileptic child, Billy Caldwell, who had his potentially life-saving cannabis-based medicine confiscated at Heathrow Airport.

The ensuing publicity prompted a change in UK law to allow specialist doctors to prescribe medicinal cannabis. Though with strict restrictions still in place, only a small number of patients have actually been prescribed cannabis-based medicines.

The news of NICE’s guidelines were greeted approvingly by Charlotte Caldwell, Billy’s mother, in a television interview.

“This is how our NHS should be,” she said. “It is an incredible day for the U.K.”

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