Licensed cannabis medicines in the UK: Sativex, Epidyolex and nabilone

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Licensed cannabis medicines in the UK: Sativex, Epidyolex and nabilone

Licensed cannabis medicines in the UK: Sativex, Epidyolex and nabilone - MCPH patient guide cover

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In the UK, a small number of cannabis-based medicines have a product licence for specific uses. The names patients most often need to understand are Sativex, Epidyolex and nabilone. They are not interchangeable, and they are not the same as the unlicensed cannabis-based medicinal products that private specialist clinics may prescribe after assessment.

This guide explains the difference in plain English. It is not medical advice and it does not promise NHS or private access. Suitability, prescribing, funding, product choice, dose, route and monitoring sit with the relevant clinician or specialist prescriber.

For the wider route, start with the MCPH patient guide. For access context, read how the UK medical cannabis prescription process works. For safety context, read medical cannabis side effects.

What licensed means

A licensed medicine has a marketing authorisation for specific uses. That means the medicine has product information, a defined indication, quality controls and evidence reviewed for that indication. It does not mean anyone with a related diagnosis automatically gets it.

The key point is specificity. Sativex is not a general MS medicine. Epidyolex is not general CBD for every seizure disorder. Nabilone is not a broad medical cannabis product for nausea, appetite or pain. Each has a defined role.

Unlicensed CBPMs are different. The MHRA specials route allows unlicensed medicines to be supplied to meet an individual patient’s special clinical need, but that does not make them licensed medicines. GMC and CQC guidance expects specialist assessment, evidence-aware decision-making, consent, monitoring and proper records.

Sativex, also called nabiximols

Sativex is an oromucosal spray that contains THC and CBD. Its UK product information describes it for symptom improvement in adult patients with moderate to severe spasticity due to multiple sclerosis who have not responded adequately to other anti-spasticity medicine and who show clinically significant improvement during an initial trial.

NICE NG144 recommends a 4-week trial of THC:CBD spray for moderate to severe spasticity in adults with MS if other pharmacological treatments for spasticity are not effective and the pay-for-responders scheme applies. NICE also says treatment should continue only if there is sufficient improvement after the trial.

That is a defined MS spasticity pathway. It should not be stretched into a claim that Sativex, THC:CBD spray, or cannabis-based medicines are recommended for every MS symptom.

Epidyolex, a cannabidiol medicine

Epidyolex is a cannabidiol oral solution. Its product information describes it as an adjunctive therapy for seizures associated with Lennox-Gastaut syndrome or Dravet syndrome, in conjunction with clobazam, for patients aged 2 years and older. It is also indicated as adjunctive therapy for seizures associated with tuberous sclerosis complex in patients aged 2 years and older.

NICE has technology appraisals for these defined contexts. Those appraisals do not make over-the-counter CBD products, private oils, dried flower or other unlicensed products evidence-equivalent.

For patients and carers, the practical question is not “can I get CBD for epilepsy?”. It is whether the specific epilepsy syndrome, previous treatment history and specialist assessment fit a licensed and NICE-appraised pathway.

Nabilone

Nabilone is a synthetic cannabinoid. NICE NG144 says nabilone can be considered as an add-on treatment for adults with chemotherapy-induced nausea and vomiting that persists despite optimised conventional antiemetics.

This is a narrow cancer-treatment side-effect context. It does not mean nabilone is a general cannabis medicine for pain, sleep, appetite, mood or nausea from any cause. It also does not make nabilone the same as whole-plant medical cannabis products.

If chemotherapy sickness is the issue, the discussion belongs with the oncology or treating team that understands the cancer treatment, anti-sickness medicines already tried, risks and monitoring.

How this differs from unlicensed private CBPMs

Many private medical cannabis prescriptions in the UK involve unlicensed CBPMs. These may include oils, extracts or flower containing different amounts of THC, CBD and other constituents. They can be prescribed legally by a specialist doctor when clinically justified, but they do not have a full UK product licence for the individual patient’s condition.

The difference is not simply NHS versus private. The difference is the regulatory status and evidence base of the product for a defined use. Licensed medicines have approved indications. Unlicensed CBPMs rely on specialist judgement, individual need, evidence limits, consent and monitoring.

This is why an article should not say “medical cannabis is licensed in the UK” without explaining what that means. Some cannabis-based medicines are licensed for specific indications. Many prescribed CBPMs are unlicensed medicines used under a specialist route.

What patients can ask

If a licensed cannabis medicine has come up in your care, useful questions include:

  • Is this Sativex, Epidyolex, nabilone, or an unlicensed CBPM?
  • What exact indication or symptom is being treated?
  • Does NICE guidance apply to this situation?
  • What other treatments have already been tried or considered?
  • What side effects, interactions and monitoring should be discussed?
  • If an unlicensed product is being considered, why is a licensed medicine not suitable or not enough?
  • Who is responsible for follow-up and stopping rules if the medicine is not helping or side effects appear?

These questions are about clarity. They are not a demand for a product.

What this means in plain English

Sativex, Epidyolex and nabilone are the main licensed cannabis-based medicines patients hear about in the UK. Each sits in a narrow clinical context. They do not prove that every cannabis-based product is licensed, routinely available or suitable.

If you are researching medical cannabis, keep the distinction clear: licensed medicine for a defined indication is one pathway; unlicensed CBPM prescribing is another. Both need clinician judgement, and neither should be presented as automatic access.

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Where to go next

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Read the eligibility guide for medical cannabis in the UK

Read the eligibility guide

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