This year, to mark Dignity Action Day, we decided to take a look at how medical cannabis is seen, or used, in care homes and hospitals across the UK.
For many, the thought of staying overnight on a hospital ward, or moving into a care facility, is scary for a number of reasons. But, for medical cannabis patients, how their medication may be received by the staff, despite being legal, or how their treatment plan may be affected, is often at the top of their list of concerns.
So, we’ve designed this article to put their minds at ease. Here, we explore the rules and regulations that protect and respect dignity for inpatients in NHS hospitals and residents in Care Quality Commission (CQC) regulated care homes, paying particular attention to cannabis-based treatments.
Overview of medical cannabis in the UK
Despite being legalised in November 2018 for medicinal purposes, there is still a lot of stigma surrounding cannabis usage in the UK. Now, patients who have been unsuccessful in managing their health condition or symptoms with conventionally prescribed medications can have their eligibility for medical cannabis treatments assessed, to see if this may be a more appropriate option.
Cannabis-based treatments have shown promise in treating and relieving symptoms of neurological conditions like Parkinson’s disease, as well benefiting chronic pain conditions, like arthritis, and psychiatric conditions like depression - and so, they can be prescribed to patients with these conditions (and many others) in appropriate circumstances.
Licensed and unlicensed cannabis based medicines
NHS guidelines state that qualified doctors can prescribe licensed cannabis based medicines, like Epidyolex, Nabilone and Sativex, to treat severe and rare forms of epilepsy, cancer-related side effects and spasticity in patients with multiple sclerosis, respectively. However, in reality, these medicines are very rarely prescribed.
Of the 32,000 people using cannabis-based medicines in the UK, an overwhelming majority access these options through private cannabis clinics like Releaf. At medical cannabis clinics, specialist doctors that have been registered by the General Medical Council, have more freedom with their prescribing options, and can issue patients with prescriptions for unlicensed cannabis based products, like prescription cannabis oil or medical cannabis flower.
Empowering medical cannabis patients: The Equality Act 2010
Because unlicensed medical cannabis treatments like cannabis flower are not prescribed by the NHS, it's understandable that many are concerned their medication may not be permitted on NHS grounds, or their treatment plan and dosing schedules could be interrupted if they become an inpatient.
However, rest assured, these services have a duty of commitment and care to ensure everyone is treated as an individual, and receives the best healthcare possible.
In the UK, most of the health conditions eligible for medical cannabis treatments also meet the statutory definition of a disability according to the 2010 Equality Act. Under this act, service providers are able to adapt care services to be ‘on more favourable terms to a disabled person compared to a non-disabled person’, and so, extra accommodations should be made when necessary.
Vaping medical cannabis in hospitals
According to the East London NHS Foundation Trust, e-cigarettes or vaporisers can be used outside in hospital grounds, and in single/private bedrooms. But, their use in day rooms, clinical or communal areas, or during therapy sessions has to be authorised by the ward manager out of respect for other service users.
However, this guidance relates to the use of electronic cigarettes - not to medication that is administered using a similar device.
In fact, requesting medical cannabis patients who vaporise medical cannabis flowers follow these guidelines when administering their medication could be seen as a breach of the Equality Act, or as a discriminatory action. This is because everyone is entitled to a safe space to take their medicine, and requesting medical cannabis patients do so in smoking areas, puts them at risk of inhaling dangerous, carcinogenic second hand tobacco smoke.
Regulation and policy: The Mental Health Capacity Act 2005
The next law of interest here is The Mental Health Capacity Act.
When prescribing medicines of any sort in the UK, health professionals have to ensure that the person they are treating has the capacity to make decisions relating to their care and treatment plan. This is also known as assessing capacity to give informed consent, under The Mental Health Capacity Act 2005.
If you understand your treatment plan, the reasoning behind it, and you are able to self-administer your medication: you are deemed to have capacity, and are in complete control of your health. This includes making informed decisions about what medications you do, or do not, want to take.
This means, if you are a medical cannabis patient with the capacity to give informed consent, healthcare professionals in hospitals and care homes should not alter your treatment plan without your consent, and they are not permitted to stop you from administering your prescribed medicine.
Self administration care plans
The National Institute of Care Excellence advise that healthcare staff should assume all patients have the ability to make decisions about their care and self administer their medication and staff should respect their independence to do so, unless it has been deemed that they lack this capacity in a risk assessment.
Typically, medical cannabis is prescribed to adults in the UK on a self administration care plan. This means medical cannabis patients are responsible for ordering, storing, dosing, administering, and disposing of, their own medical cannabis treatments, and this should remain intact should they become an inpatient in a hospital, or a resident in a care facility, so long as they retain the capacity to make these choices.
Staff in hospitals and care homes should make reasonable adjustments to support patients in their independence, and aid their ability to self-administer when they are residing at the facility, such as by providing a safe and appropriate area to store or administer their medical cannabis.
NHS guidelines for medical cannabis use in hospitals
The NHS is an incredibly complex organisation made up of 229 individual trusts, 154 of which are Foundation Trusts. NHS Foundation Trusts design the services offered by the NHS around their local communities, and so, often update guidance or policy to reflect the needs in their area.
In London, the Royal Marsden NHS Foundation Trust focuses on cancer care, and treats around 50,000 patients every year. The Royal Marsden Trust are one of the very few UK trusts who have directly addressed how cannabis-based products can be used in their hospitals. Their guidance states:
“If you are admitted to hospital, please ensure you bring supplies of your medical cannabis and any documentation that came with the product with you, as it is unlikely the hospital will be able to provide further supplies.”
However, they also warn:
“If you or your carer brings in a supply of an unlicensed cannabis medicinal product into The Royal Marsden (sourced illegally or outside the UK), then as current practice, this will need to be removed and destroyed.”
This implies that so long as you can prove your prescribed cannabis treatment is from a legal source and is being used for a legitimate, medicinal purpose, your treatment plan would not be affected should you become an inpatient at The Royal Marsden.
Controlled medicine policy in CQC regulated care homes
In the UK, adult care homes and nursing homes are regulated and monitored by the Care Quality Commission (CQC). The CQC regularly update guidelines and policies to facilitate independence for the residents of these homes, however, currently there are no guidelines that directly relate to the use of cannabis-based medicines in these settings.
There are, however, numerous guidelines that reinforce that residents in care homes should be treated as individuals, and care plans should be designed to accommodate needs on a case by case basis, with the individual's best interests at heart.
Because cannabis-based medicines are classed as controlled, schedule 2 drugs, the CQC say they must be stored in a controlled drug's cupboard in adult care home settings.
However, the CQC also state that residents who are on self administration plans (including controlled drugs) may be able to store their medicines in a lockable cupboard or drawer in their own room, and be responsible for their medication management so they can access them as and when required.
NICE advice for prescribing in care homes
The National Institute for Care Excellence have also released guidelines for supporting patients managing their own medicines in adult care home settings. They advise:
“A person that is taking medicines that need special storage should be able to get their medicines when they need them.”
“When a person is taking controlled drugs and is responsible for their own medicines, the care home should have a process that clearly sets out how this should be done, including what the staff should do when they are given drugs the person no longer needs and how to get rid of them.”
Dignified experiences with medical cannabis in care settings
In this article, we’ve explained the laws and policies in place to protect a patient’s rights to choose their course of treatment in care settings, but often hearing of the experiences others have actually had can be even more reassuring.
On Reddit forums a number of medical cannabis patients have opened up and discussed how they were permitted to vape their medical cannabis, or administer prescribed cannabis oil, whilst being an inpatient on NHS wards, and how they were relieved at how easy it was to continue their treatment plans while staying in hospital.
Other stories, like Louise McConnell's, have been picked up by major news outlets like The Belfast Live. Louise McConnell suffers with chronic pain caused by Spina bifida and osteoarthritis, but with the help of medical cannabis she has managed to reduce her pain levels dramatically, improve her quality of life, and has gone from using over 40 tablets a day to just five.
Louise spoke to The Belfast Live about her medical cannabis treatment, she said:
“I have even been allowed to vape it on recent hospital stays because the staff are aware of how beneficial it is.”
“What I’m doing is fully legal and has been prescribed to me by my doctor, so I am thankful that they have been so helpful and supportive of me and my medication, as they have been able to see first hand the benefits it has given me.”
Medical cannabis: Considerate care
Because medical cannabis and cannabis based treatments have only been a legally approved option for the last five years, it's expected that patients may have concerns about staying in hospital, or moving into a care facility, in regard to what this may mean for their medical cannabis treatment. However, we hope that this article has put your mind at ease.
At Releaf, we always believe in compassionate care, but for Dignity Action Day we felt it was especially important to clarify the rights patients have in NHS healthcare settings and CQC regulated care homes with respect to their choice of medication.
