Many people with MS spasticity face significant barriers to accessing Sativex. Despite a NICE recommendation that Sativex is a cost-effective add-on treatment for MS spasticity, fewer than 13% of people who are eligible in England can access it, according to a new report from the MS Society. People living in Wales, Scotland and Northern Ireland also face significant difficulties accessing NHS prescriptions for this treatment.
The NICE Guideline on Cannabis-based Medicinal Products, published in November 2019, recognises that Sativex is a cost-effective treatment for the NHS in England. The Guideline recommends that, providing the local NHS health authority (clinical commissioning group, or CCG) is willing to pay for continued treatment, people with moderate to severe spasticity which has not improved with first line treatments should be able to try Sativex for 4 weeks, in addition to their existing treatment; if their spasticity-related symptoms are reduced by at least 20%, they can continue taking Sativex. The cost of Sativex for the 4-week trial is covered by the manufacturer’s “Pay for Responder” scheme.
Despite this recommendation, many people with MS spasticity face significant barriers to accessing Sativex. There are multiple reasons for this: in England, more than half of the CCGs have not revisited local funding decisions in the light of the 2019 NICE guideline (and the impact of Covid-19 and lockdown on NHS services has not helped); the big impact of relatively small improvements in spasticity symptoms on care and quality of life for people with MS and their carers may not be recognised; in many areas of the country there is a lack of appropriate pathways for assessing spasticity or handing over responsibility for prescribing Sativex from hospital consultants to GPs; Scotland has not yet assessed Sativex for NHS use.
The MS Trust has called for a fair assessment of Sativex since it was licenced in 2010 and we have made strong cases for its approval in appraisals by NICE and other decision makers. Sativex doesn't work for everyone but when it does it can greatly improve quality of life for people with MS and their carers. The MS Society’s report highlights the problems people continue to face and we support their recommendations to ensure that everyone eligible can access this treatment.
- David Martin, Chief Executive Officer, MS Trust
Sativex is a mouth spray prepared from cannabis plants and contains two chemicals - tetrahydrocannabinol (THC) and cannabidiol (CBD) - in equal proportions. The number of sprays is gradually increased each day until a dose is reached which relieves muscle stiffness but with the fewest side effects.
Sativex has been studied extensively in clinical trials and is licensed in the UK as an add-on treatment for spasticity where other drugs have failed. It can only be prescribed by specialist doctors with experience of treating MS spasticity – consultant neurologists, consultant rehabilitation specialists and consultant pain specialists. For those who respond to Sativex, ongoing prescriptions can be managed by a GP.
Although Sativex can be prescribed, it is not considered to be a cost-effective treatment for the NHS in Scotland or Northern Ireland. In England and Wales, it is considered cost-effective and is approved as an NHS treatment, although availability is still limited.
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