Medical cannabis at work: Everything you need to know

Is cannabis available as a prescription medicine?

A limited number of cannabis-based medicines are available on NHS prescription in the UK. Currently, very few prescriptions are issued for rare and severe forms of epilepsy, chemotherapy induced nausea and vomiting and certain symptoms of multiple sclerosis. Cannabis-based prescription medicines may also be prescribed to patients participating within clinical trials for other symptoms, such as chronic pain. Cannabis-based medicines are always prescribed by specialist doctors.

A licensed medicine meets acceptable standards of efficacy, safety and quality. While a small number of cannabis-based medications are licensed for specific situations, specialist doctors can also prescribe cannabis-based medicines that have not been licensed (this is called prescribing an unlicensed drug). It is also possible to prescribe cannabis-based medicines that have been licensed for a specific situation for a different situation that medicine has not been licensed for (off label use). In these situations, prescribers regard it necessary to prescribe an unlicensed drug or prescribe off label when no licensed suitable alternative is available.

What does this mean in practice?

This is relevant to all workplaces as it is possible that people employed within your organisation are prescribed cannabis-based medicines. The goal of these medicines is symptom control, and therefore people will be prescribed cannabis-based medicines when they help to manage their long term condition. This is important context, because for some individuals, cannabis-based medicines may help symptom management with a significant impact on function, which could be the difference between work and sickness absence. 

For example, Mr P works remotely as an administrator and is currently receiving cancer treatment. He  is unable to work during chemotherapy as he experiences severe nausea and vomiting with no improvement after trialling various side effect management medicines. His treating team prescribes a cannabis-based medicine and his symptoms are better controlled to the extent they can return to some work.

So if cannabis-based medicines are helpful, what else do we need to know about them?

Any medicine can be relevant to the workplace. Reasons include side effects, timings and method of administration. Cannabis-based medicines are no different. Cannabis has some specific risks, which relate to the Tetrahydrocannabinol (THC) component of the drug, which can be linked to psychotic illness and dependency with regular use. The amount of THC component will vary in different preparations, and some forms of medical cannabis do not contain THC.

Side effects that may develop with use of prescribed medical cannabis include

-        Diarrhoea

-        Dizziness

-        Fatigue

-        Suicidal thoughts

-        Hallucinations

As with any drug, side effects may have relevance to the workplace. For example, if Mr P, the administrator from the case study above develops severe diarrhoea, it may be difficult for him to continue to work without adjustments. In certain roles, certain side effects can be more concerning from the perspective of risk. For example, if a scaffolder develops dizziness as a side effect of a cannabis-based medicine, they may not be able to work safely.

Given that cannabis prescriptions can be off label and off license, this can also make risk assessment in the occupational context more challenging and nuanced. This is because without having gone through a licensing process for a particular prescribing situation, there is less known about the efficacy, safety and quality around the use of a drug.  

Is prescribed medicinal cannabis any different to any other prescribed medicine when we think about health and work?

No. All health conditions and treatment options at work are relevant until proven otherwise. Cannabis-based medicines may be less familiar to many and may even have a stigma attached but should be treated no differently. There are other more commonly prescribed medicines that have similar side effect profiles. Each case, whatever the health condition and its treatment, must be assessed and treated in context. Singling out any conditions or treatments could be discriminatory. 

What about non-prescribed cannabis containing drugs?

It is essential to understand the difference between cannabis containing medicines that are prescribed by specialist doctors and non-prescribed cannabis/ cannabis containing products. Cannabis is illegal for recreational use in the UK and is a class B drug. Cannabis- containing products can be purchased online and in some stores. These may be dangerous and illegal, even when they are used to self-medicate. CBD preparations and products must meet very specific requirements may to be exempt from the restrictions around these drugs. People who are using cannabis or cannabis containing products or any other non-prescribed drugs would benefit from occupational health input. Understanding and safely managing non-prescribed drug use at work, including alcohol, cannabis and other types of recreational drugs can also be critical to safe working. Occupational health services can help employers navigate the substantal grey areas in this space. This could include assessment and management of non-prescribed drug use through risk assessment and referral to and liaison with treating teams, working in context of the law as well as organisational drug and alcohol policy.

So how can prescribed cannabis-based medicines be managed safely and legally in the workplace?

Here are a few top tips. You’ll notice they can be applied widely and are not limited to cases of prescribed-cannabis use.

1)     Create policies, culture and infrastructure to support individuals to come forward with information on their health. A safe, confidential route to clinical support through occupational health helps with this. Employees can speak to third party experts in work and health about whatever is going on with their health and how to optimise the relationship between work and health. This helps maintain confidentiality, as commonly, individuals do not wish to share their personal health information with their boss or their colleagues.

2)     Ensure there are processes in place for comprehensive risk assessment and management where this is required, particularly in relation to safety critical (SC) work. Often, it is hard to assess for and manage relevant risks without specific clinical training. It is not uncommon to see individuals continuing to work without adjustments where these would be beneficial to control risks to self or others, simply because these risks have not been recognised and appraised.

3)     Raise awareness on health at work. While executing on both points one and two above can require occupational health support, raising awareness is something all organisations can do, regardless of whether or not they have an OH offering. Raise awareness on the relevance of health and work, including symptoms, management, and treatment side effects. Some organisations could have all the infrastructure in place but nobody leveraging the offering due to lack of awareness around work and health. Ensuring there is an organisation-wide understanding of what is required of each individual when it comes to work and health will help maintain a proactive approach and therefore support productivity.

4)     Where there are concerns regarding fitness to undertake SC work, it is recommended that prompt occupational health advice is sought, and it may be necessary to remove the employee from SC duties until an opinion on fitness can be clarified.

If in any doubt, it is recommended to seek Occupational Health advice.