Pharmac's bid to fund a cannabis medication for multiple sclerosis has been declined by its advisory committee, in part because it says the risk of inappropriate use is too high.
Pharmac has been seeking clinical advice from its Pharmacology Therapeutics Advisory Committee on funding oromucosal spray Sativex. The spray is a cannabis-extract treatment used for various indications, including spasticity due to multiple sclerosis.
Sativex is currently the only approved cannabinoid treatment in New Zealand, but because it is unsubsidised, it costs patients around $1000 a month.
Risk of diversion in the New Zealand setting
But the committee has recommended Pharmac declines national funding of Sativex for a number of conditions, including: spasticity due to multiple sclerosis, pain, and refractory epilepsy (epilepsy with prolonged seizures), according to the just-released minutes of its 13 to 14 August meeting.
"The committee considered that the risk of diversion in the New Zealand setting, should Sativex be funded, is high due to the inherent nature of its active substances and the ease of administration."
The dosing required will also vary between patients because of the variability in how the drug interacts in different people, for example how it is absorbed and distributed through the body, the committee says.
The recommended dose is 12 sprays per day.
No or limited effect
In its assessment, the committee reviewed a number of trials and studies on the use of cannabis extract for spasticity and noted either no, or limited, effect on these indications.
One study required participants to take a maximum of 48 sprays a day - four times the usual recommended dose.
"Overall, the committee considered that there was some evidence to support the use of Sativex for spasticity due to multiple sclerosis compared with placebo, but that the strength of this evidence was weak and the quality was poor."
The committee also believes there are already a number of funded treatments available for both spasticity and pain.
Requires ministerial approval
Currently, there are legal hurdles limiting access to Sativex, even if it was funded.
Because it is a cannabis preparation, it is classified as a Schedule 2 Class B drug, under the Misuse of Drugs Act 1975, and so requires ministerial approval before it can be prescribed.
Pharmac has received six applications to use Sativex for pain via its application process for exceptional circumstances, five were withdrawn because they did not meet the pre-requisites and one was declined.
In addition, two applications to use the medication for spasticity from multiple sclerosis were withdrawn and, out of three applications to use Satviex for refractory-epilepsy, two were withdrawn and one was declined.