NICE Updates Medical Cannabis Guidelines for Chronic Pain
The National Institute for Health and Care Excellence (NICE) has published updated technology appraisal guidance on cannabis-based medicinal products for chronic pain, recommending that specialist pain clinicians consider CBMPs for patients with neuropathic pain unresponsive to at least two standard treatments. The guidance stops short of recommending routine NHS funding but acknowledges significantly improved evidence compared to the 2019 appraisal, and calls for an NHS pilot programme to evaluate cost-effectiveness at scale.
The National Institute for Health and Care Excellence (NICE) has published updated guidance on cannabis-based medicinal products (CBMPs) for chronic pain, in what advocates are calling the most significant regulatory shift since medical cannabis was legalised in the UK in 2018.
The updated Technology Appraisal guidance, published on 12 May 2026, recommends that specialist pain clinicians may consider CBMPs for adult patients with neuropathic pain who have failed to respond adequately to at least two first-line treatments — typically including an anticonvulsant (pregabalin or gabapentin), an antidepressant (amitriptyline or duloxetine), and/or opioids. The guidance specifically references dried cannabis flower for vaporisation and cannabis oils as the primary formulations.
Crucially, NICE stops short of recommending routine NHS commissioning of CBMPs for chronic pain, citing uncertainty about long-term outcomes and cost-effectiveness. However, the guidance notes a "substantially improved evidence base" compared to the previous 2019 appraisal, which was widely criticised for dismissing observational evidence and setting an "unrealistically high evidential bar".
NICE has also called for an NHS England pilot programme — to be established within 12 months — to evaluate the cost-effectiveness of CBMPs for neuropathic pain in a real-world NHS setting, with results expected to inform a further guidance revision by 2028.
Professor Karen Yeung, pain specialist at Sheffield Teaching Hospitals and member of the NICE guideline development group, said: "This guidance is a significant step forward. It gives clinicians the green light to consider cannabis for patients who have exhausted other options, and it creates a clear pathway towards NHS coverage."
In the interim, most patients will continue to access CBMPs through private specialist clinics. Compare UK clinic fees and products at LeafMe, or read our guide on medical cannabis for chronic pain.
