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["Baseline assessment: Cannabis-based medicinal products"]
["NG144"]
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[]
["Published: November 2019"]

{"sheet":"Introduction","index":1,"n_rows":23,"n_cols":1,"rows_kept":23,"cut":false,"hidden":false,"merged":[]}
["Baseline assessment tool for cannabis-based medicinal products (NICE guideline NG144)"]
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["This baseline assessment tool can be used to evaluate whether practice is in line with the recommendations in Cannabis-based medicinal products.  It can also help to plan activity to meet the recommendations."]
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["The tool can be used by individual services or organisations. Alternatively, an assessment completed with the involvement of all relevant services or organisations would help to develop a picture of activity in the local area."]
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["It should be used in conjunction with cannabis-based medicinal products (NICE guideline NG144)."]
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["In the first instance, consider whether the guideline is relevant and record the conclusion in the box below."]
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["Is the guideline relevant?"]
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["The data sheet contains the recommendations from the guideline. Information can be entered about current activity relevant to the recommendation, actions needed to meet the recommendation, deadlines and the names of the responsible leads.  Useful documents can be added as hyperlinks."]
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["The table can be adapted to include any other local information that is thought to be useful."]
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["If it would be helpful to group the recommendations, for example those that are key priorities for implementation or by deadline, use the filter function in the data menu. "]
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["Tools and resources to help put the guidance into practice are available on the NICE website. "]
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["National Institute for Health and Care Excellence\nLevel 1A, City Tower, Piccadilly Plaza, Manchester M1 4BT; www.nice.org.uk\n\nCopyright\n© NICE 2022. All rights reserved. Subject to Notice of rights.\n"]

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["Baseline assessment tool for cannabis-based medicinal products (NICE guideline NG144)"]
[]
[null,null,null,"Number of relevant recommendations",{"$f":"COUNTIF(C8:C993,\"Yes\")","v":0}]
[null,null,null,"Number of recommendations met",{"$f":"COUNTIF(E8:E993,\"Yes\")","v":0}]
[null,null,null,"Percentage of recommendations met",{"$f":"IF(ISERROR(E4/E3),\"\",E4/E3)","v":""}]
[]
["NICE recommendation","Guideline reference","Is the recommendation relevant?","Current activity/evidence","Recommendation met?","Actions needed to implement recommendation","Is there a risk associated with not implementing this recommendation?","Is there a cost or saving?","Deadline","Lead"]
["1.1  Intractable nausea and vomiting  "]
["Consider nabilone as an add-on treatment for adults (18 years and over) with chemotherapy-induced nausea and vomiting which persists with optimised conventional antiemetics.","1.1.1"]
["When considering nabilone for adults with chemotherapy-induced nausea and vomiting, take into account potential adverse drug interactions, for example, with central nervous system depressants and other centrally active drugs.","1.1.2"]
["1.2  Chronic pain"]
["Do not offer the following to manage chronic pain in adults:\n•\tnabilone\n•\tdronabinol\n•\tTHC (delta-9-tetrahydrocannabinol)\n•\ta combination of cannabidiol (CBD) with THC.","1.2.1"]
["Do not offer CBD to manage chronic pain in adults unless as part of a clinical trial.","1.2.2"]
["Adults who started cannabis-based medicinal products to manage chronic pain in the NHS before this guidance was published should be able to continue treatment until they and their NHS clinician think it appropriate to stop.","1.2.3"]
["1.3  Spasticity"]
["Offer a 4-week trial of THC:CBD spray to treat moderate to severe spasticity in adults with multiple sclerosis, if:\n•\tother pharmacological treatments for spasticity are not effective (see the recommendations on spasticity in NICE’s guideline on multiple sclerosis in adults)\n•\t\tthe company provides THC:CBD spray according to its pay-for-responders scheme.\nAfter the 4-week trial, continue THC:CBD spray if the person has had at least a 20% reduction in spasticity-related symptoms on a 0 to 10 patient-reported numeric rating scale.","1.3.1"]
["Treatment with THC:CBD spray should be initiated and supervised by a physician with specialist expertise in treating spasticity due to multiple sclerosis, in line with its marketing authorisation.","1.3.2"]
["1.4 Severe treatment-resistant epilepsy"]
["NICE has made research recommendations on the use of cannabis-based medicinal products for severe treatment-resistant epilepsy."]
["NICE has published technology appraisal guidance on cannabidiol with clobazam for treating seizures associated with Lennox-Gastaut syndrome and Dravet syndrome."]
["1.5  Prescribing"]
["Who should prescribe?"]
["Initial prescription of cannabis-based medicinal products (excluding nabilone, THC:CBD spray [Sativex] and medicines not classed as controlled drugs such as cannabidiol) must be made by a specialist medical practitioner (a doctor included in the register of specialist medical practitioners [the Specialist Register], see section 34D of the Medical Act 1983). They should also have a special interest in the condition being treated (see the GMC’s information for doctors on cannabis-based products for medicinal use). For children and young people under the care of paediatric services, the initiating prescriber should also be a tertiary paediatric specialist in the condition being treated.","1.5.1"]
["Shared care"]
["After the initial prescription, subsequent prescriptions of cannabis-based medicinal products may be issued by another prescriber as part of a shared care  agreement under the direction of the initiating specialist prescriber, if:\n•\tshared care is appropriate and in the person’s best interest\n•\tthe person’s clinical condition is stable\n•\tthe other prescriber is confident to make a fully informed prescribing decision about cannabis-based medicinal products. ","1.5.2"]
["Efficacy and safety of cannabis-based medicinal products should be monitored and evaluated, and doses should be adjusted by the initiating specialist prescriber as part of the shared care agreement.","1.5.3"]
["A shared care agreement for a person prescribed a cannabis-based medicinal product should include:\n•\tthe responsibilities of all parties [the initiating specialist prescriber, the other prescriber(s), the patient, family and/or carers]\n•\tthe nature and frequency of monitoring and how this will be recorded   \n•\twhen treatment might be stopped, for example, if it is not effective \n•\thow suspected or known adverse reactions will be managed\n•\thow communication will be managed between the initiating specialist prescriber, the other prescriber, the patient, family and/or carers\n•\thow the treatment will be funded\n•\thow care will be maintained when the patient, initiating specialist prescriber or other prescriber moves location (including transition to adult services). ","1.5.4"]
["Factors to think about when prescribing"]
["When prescribing and monitoring cannabis-based medicinal products, take into account:\n•\tcurrent and past use of cannabis (including any over-the-counter and online products)\n•\thistory of substance misuse including the illicit use of cannabis\n•\tpotential for dependence, diversion and misuse (in particular with THC)\n•\tmental health and medical history, in particular, liver impairment, renal impairment, cardiovascular disease\n•\tpotential for interaction with other medicines, for example, central nervous system depressants and other centrally active drugs, antiepileptics and hormonal contraceptives\n•\tpregnancy and breastfeeding.","1.5.5"]
["When prescribing cannabis-based medicinal products for babies, children and young people, pay particular attention to the:\n•\tpotential impact on psychological, emotional and cognitive development\n•\tpotential impact of sedation\n•\tpotential impact on structural and functional brain development.\nNICE has produced a guideline on babies, children and young people's experience of healthcare.","1.5.6"]
["When prescribing cannabis-based medicinal products, advise people to stop any non-prescribed cannabis, including over-the-counter, online and illicit products.","1.5.7"]
["Prescribers should record details of treatment, clinical outcomes and adverse effects for people prescribed cannabis-based medicinal products, using local or national registers if available.","1.5.8"]
["For more information on safe prescribing and use of cannabis-based medicinal products, see the recommendations in the NICE guideline on controlled drugs.","1.5.9"]
["Supporting shared decision making"]
["Before prescribing cannabis-based medicinal products, discuss with people:\n•\tthe potential benefits and harms, including any risk of dependence or interaction with other medicines\n•\tthe licensing status of the medicines\n•\thow long they might take the medicine\n•\thow long it will take to work \n•\twhat it has been prescribed for and how to take it\n•\thow it may affect their ability to drive (see the advice from the Department of Transport on drug driving and medicine)\n•\tthe need to seek advice before travelling abroad about the legality of cannabis-based medicinal products in other countries (see the UK Government’s advice on travelling with medicine containing a controlled drug).\n•\tthe importance of not allowing others to use the prescribed medicine.","1.5.10"]
["When discussing cannabis-based medicinal products with patients and their families and carers, follow the NICE guideline on shared decision making.","1.5.11"]