Can the NHS Prescribe Nabilone for Chemotherapy Nausea?

Ever notice how chemotherapy-induced nausea and vomiting (cinv) remains one of the most distressing side effects for cancer patients undergoing treatment. While there are several licensed antiemetic treatments available, some patients and prescribers are interested in nabilone, a synthetic cannabinoid, as an add-on antiemetic treatment. But does the NHS prescribe nabilone for chemotherapy-induced nausea and vomiting? This blog aims to unpack the clinical, legal, and funding nuances surrounding NHS access to nabilone in this indication.

What Is Nabilone?

Nabilone is a synthetic cannabinoid drug that mimics the effects of cannabis. It has been licensed in the UK for treating severe nausea and vomiting associated with chemotherapy, especially when other antiemetics have failed. Unlike some cannabis-based medicines (CBMPs), nabilone is a controlled drug with a specific Marketing Authorisation.

The 2018 Rescheduling: What Changed?

Before 2018, cannabis and its derivatives were heavily restricted under UK law, classified as a Schedule 1 drug under the Misuse of Drugs Act 1971, meaning no recognised medicinal use and effectively banning NHS prescriptions.

However, in November 2018, the UK government rescheduled some cannabis-based products, allowing specialist doctors to legally prescribe certain CBMPs, including synthetic cannabinoids like nabilone, under Schedule 2 of the Misuse of Drugs Regulations 2001. This rescheduling meant:

Legal Prescribing Became Possible: Specialist consultants can now prescribe nabilone for appropriate indications.
NHS Funding Did Not Automatically Follow: Legal prescribing does not mean automatic NHS funding or availability in clinics.

In plain English: You could now get nabilone legally prescribed, but that doesn't mean the NHS will pay for it or routinely supply it.

Legal Prescribing Versus NHS Funding

One of the biggest misunderstandings around nabilone and cannabis-based medicines is confusing legal prescribing with NHS funding and availability.

While the 2018 rescheduling allowed specialist consultants to prescribe nabilone lawfully, NHS funding decisions are separate and guided by clinical commissioning groups and NHS England policies. Crucially:

Prescribing is legal if done by an appropriate specialist.
But the NHS is not obliged to fund or routinely supply nabilone unless it appears on local formularies or NICE guidance supports it.

Here's a story that illustrates this perfectly: wished they had known this beforehand.. Therefore, even if your doctor writes a prescription for nabilone, you may need to pay privately or attend a clinic that offers CBMPs on a private basis. Websites like medicalcannabis.co.uk help list clinics offering such treatments, but this is outside the NHS remit.

Who Can Prescribe Nabilone on the NHS?

The prescribing of nabilone for chemotherapy-induced nausea is strictly limited to certain specialist clinicians. According to UK regulations and prescribing guidance:

Only consultants or doctors on the General Medical Council's specialist register in relevant fields (such as oncology, pain medicine, or palliative care) may prescribe nabilone.
General practitioners cannot initiate or continue nabilone treatment without consultant approval.
Such prescriptions often require documentation and monitoring under specialist supervision.

This ensures that nabilone use is carefully controlled and monitored, given its psychoactive effects and controlled drug status.

What About Unlicensed Cannabis-Based Medicines?

Aside from nabilone, a number of cannabis-based medicines available in the UK are unlicensed, meaning they do not have UK Marketing Authorisation but can be prescribed under a "specials" licence.

The NHS is particularly cautious about funding unlicensed CBMPs for chemotherapy nausea due to:

Limited high-quality clinical evidence supporting their efficacy in this specific indication.
Concerns over standardisation, dosing consistency, and quality control.
Cost and commissioning challenges.

The releaf.co.uk website provides a clear explainer on how unlicensed cannabis medicines fit into NHS prescribing — notably, that clinical evidence and cost-effectiveness assessments dictate NHS availability far more than legality.

Current NHS Guidance on Nabilone for Chemotherapy-Induced Nausea

Aspect Current Status Licensing Nabilone licensed for moderate to severe CINV where other antiemetics fail Legal Prescribing Allowed since 2018 rescheduling; specialist consultants only NHS Availability Variable; some trusts include in formulary but no national mandate NHS Funding Not routinely commissioned; often private payment required Prescribing Restrictions Specialist-only; monitored prescribing

In practice, this means if you have CINV that is not controlled by first-line licensed antiemetics, your oncologist or palliative care specialist might consider nabilone as an add-on treatment. However, availability depends heavily on local NHS policies and whether your hospital trust supports its use.

Price and Access Considerations

In the sources reviewed, no specific NHS price for nabilone was stated. This reflects a common issue: costs for cannabis-based medicines vary widely, and NHS tariff information is often not publicly detailed https://highstylife.com/how-do-i-find-a-legit-medical-cannabis-clinic-in-the-uk/ unless negotiated locally.

If private prescription is the route, prices vary by supplier and formulation. For patients interested in exploring private options, the clinic directory and comparison site medicalcannabis.co.uk can help identify providers and approximate costs, but always verify current prices directly with clinics.

Summary: What Patients Should Know

Nabilone is legally prescribable on the NHS by specialist doctors for chemotherapy nausea, but not widely or routinely funded.
The 2018 rescheduling allowed lawful prescribing but did not guarantee NHS NHS availability or funding.
General practitioners cannot initiate nabilone prescriptions; only certain specialists can.
Unlicensed cannabis medicines face stricter NHS and clinical commissioning scrutiny.
Patients may have to explore private prescriptions, with careful consideration of costs and clinic reputations.

Before considering nabilone, patients should have a detailed conversation with their oncology or schedule 2 cannabis uk meaning palliative care team about all available options and what can be accessed via the NHS. For further patient-friendly information, the releaf.co.uk explainer is a good place to start.

References and Further Reading

medicalcannabis.co.uk – Clinic Directory & Comparison
releaf.co.uk – Cannabis-Based Medicines Explained
UK Misuse of Drugs Act and Misuse of Drugs Regulations (2018 Rescheduling Announcements)
NICE Guidelines on antiemetics in chemotherapy-induced nausea and vomiting
NHS England commissioning policies on cannabis-based medicines (where applicable)