Twenty21 is now live

About Project Twenty21

Project Twenty21 is a registry aiming to monitor the health outcomes of 20,000 patients using cannabis based medicinal products (CBMPs), creating the largest body of evidence in Europe for the safety and efficacy of CBMPs. Drug Science hope that the findings of Project Twenty21 will provide evidence for NHS funding where the benefits of treatment with medicinal cannabis is proven to outweigh the potential risks.

This real-world registry aims to target the following indications:

  • Anxiety Disorder
  • Chronic Pain
  • Multiple Sclerosis (MS)
  • Post-Traumatic Stress Disorder (PTSD)
  • Substance Use Disorder (as a harm reduction strategy)
  • Tourette’s Syndrome

In June 2020, the Project Twenty21 team commenced beta testing of the patient pathway and opened up access to one clinic (Medical Cannabis Clinics) for 100 patients. This was required to ensure that we could overcome any barriers to the patient’s journey through the T21 process. We have also increased the number of products that are on our formulary and I would like to thank our licensed producer partners for all their support.

The Twenty21 team has created an animation explaining the process and below you will find a patient pathway to help you navigate the project. Please remember that new clinics will come on board as the project progresses, meaning that there will be more options available to patients in the future. So if the available clinics do not suit your needs, please register for our project updates to remain informed of how the project is developing. Lastly, as more clinics join the project, there will be more competition, so the price of consultation will drop further.

How can I get prescribed Medical Cannabis through Project Twenty21?

 

Requirements

To enrol, patients must provide their chosen clinic/consultant with both:

1. A confirmed diagnosis of one or more of the following indications:

  • Anxiety Disorder
  • Chronic Pain
  • Multiple Sclerosis (MS)
  • Post-Traumatic Stress Disorder (PTSD)
  • Substance Use Disorder
  • Tourette’s Syndrome

2. A history of two licensed medications, both of which must have been prescribed and proven ineffective at managing the patients’ condition. This information must be documented in a medical summary or a referral letter from their GP practice.

 

Choosing a clinic

Project Twenty21 treatment will be provided at a network of private clinics. Private clinics retain control over their consultation fees therefore patients will need to fund the cost of their consultation. This cost will vary between clinics and initial consultation prices will be listed alongside the clinician’s biography on the Drug Science website. The clinic directory contains details of all participating clinics, including details of specialities and consultation fees to help patients decide on which clinic they would like to register with.

 

Before Consultation

Please note that medicinal cannabis consultations are not intended for the diagnosis of a condition. Some patients may require an additional appointment at a charge if further assessment is necessary.

Patients should inform the clinic that they wish to participate in Project Twenty21 before their consultation. When contacting a clinic make it very clear that you are a Twenty21 patient to access subsidised products. Furthermore, any products prescribed which are not included in Project Twenty21 cannot be subsidised.

Before scheduling a consultation, most clinics offer a pre-assessment involving a review of patient healthcare records. Please check with individual clinics as to whether there is a charge for this.

 

Consultation

Consultations will either be conducted remotely via telemedicine (access to video calling required) or face to face.

Patients must ensure that the doctor is aware they wish to participate in Project Twenty21.

The doctor will complete an initial assessment and questionnaire covering:

  • Diagnoses
  • Previous and current medications for a condition
  • Other therapies  which have been undertaken
  • How symptoms affect the patient’s quality of life e.g. impact on sleep, mobility etc…
  • Any previous cannabis use, including CBD oil.
    The clinician should be informed of:
    1.  What has been most effective at managing symptoms (including THC and CBD dosage if known)?
    2.  How this is taken – by oil, edibles, balm, smoking or vaporizing?
    3.  Any issues or side effects experienced from using cannabis previously

The doctor will decide whether to prescribe medicinal cannabis products based on the patients’ medical history and clinical need.

Attending a consultation does not guarantee a medical cannabis prescription will be provided.

 

After consultation

Clinics will determine the frequency and cost of follow up consultation, at minimum every 6 months, with data collection occurring every 3 months. Patients must attend follow-up consultations to continue receiving their medication.

 

Medication

Project Twenty21 has partnered with licensed producers to subsidise the cost of a private medical cannabis prescription to £150 per product per month (capped based on guidance from the Medical Cannabis Clinicians Society).

Please note that prescription, dispensing and delivery costs (that are normally charged for private prescriptions) are covered for Twenty21 products but these charges are NOT covered for any other non-Twenty 21 products that you may be prescribed at the same time.

Some cannabis-based medicinal products that may be recommended by the clinician will not be subsidised through Project Twenty21. Patients can accept these medications but must expect to pay for these products at full price. Alternatively, patients can refuse these prescriptions if they are unable or unwilling to pay for these products. The prescribing doctor will send the Twenty21 medicinal cannabis prescription to the pharmacist. Patients will be contacted by the pharmacist to make payment for the medication, this process may vary for each product. Medication will be delivered to the patients’ address following payment.

Patients should be aware that due to current Home Office restrictions, there may be delays of up to 6 weeks in receiving their 1st medication. In this instance, dispensing pharmacies should update patients on expected arrival dates. Project Twenty21 is working to resolve these issues.

To receive medication at a subsidised rate, patients must consent to have their medical data collected by Drug Science. This information will be anonymised and kept confidential. The data will be used to examine the benefits and side effects of CBMPs. We hope that this analyses will inform future medical cannabis policy in the UK.

We have a range of products from these licensed producers:

The formulary includes CBD oils with varying CBD/THC ratios, flower and synthetic preparations, working together to support T21 from around the world.

We are aware that the Twenty21 formulary might not suit all patients. This is why clinicians have the freedom to prescribe whatever product is best for the patient, from all the products they are able to access, if the patient’s needs are not fulfilled by a Twenty21 product.

We are also working with Alta Flora who are creating a patient support app that will be downloadable in the Autumn.

 

What’s next?

With the project now live, we are now inviting patients to contact a prescribing clinic to see whether they might be suitable for a Cannabis-based medicinal product. Patients who are unable to meet medication costs may be eligible for the patient medication assisted access scheme. This assisted access scheme will cover the cost of medication only (not consultation costs) for up to 1,000 patients. This support is yet to be confirmed and eligibility criteria for the scheme will be decided on by an external body, not project Twenty21.

Project feedback

Patient-Led Engagement for Access (PLEA) welcomes patients to provide feedback on Project Twenty21 through an online form. This is separate from the Project Twenty21 study and will be used by PLEA to understand patient experiences and improve access for future patients. This will be submitted via PLEA and patients can remain anonymous.

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