A Structured, Consultant-Led Clinical Pathway

THE CANN-ABI CLINICAL PATHWAY

Medical cannabis prescribing for Acquired Brain Injury requires careful governance, neuropsychiatric oversight and formalised risk management.

Cann-ABI operates a staged, consultant-led pathway designed specifically for complex ABI presentations.

Refer a patient

HOW THE PATHWAY WORKS

Every patient progresses through three defined stages

1. Instruction & Capacity Review

2. Specialist Neuropsychiatric Assessment & Protocol Design

3. Tiered Maintenance & Ongoing Clinical Monitoring

Movement between stages is conditional upon safety, documentation and suitability.

STAGE 1

Instruction, Eligibility & Capacity Review

This stage ensures legal and ethical compliance before any prescribing consideration

1.1 Referral & Instruction

Where capacity may be impaired, referrals must originate via:

  • Case Manager

  • Court-appointed Deputy

  • Legal representative

  • Responsible clinician within an existing MDT

 

Self-referrals may be considered only where capacity is clearly intact.

1.2 Treatment Resistance Confirmation

In line with UK prescribing guidance, the following must be demonstrated:

  • Failure of at least two licensed treatments

  • Inadequate symptom control or intolerable side effects

  • Persistent functional impairment

A Summary Care Record (SCR) is retrieved from the GP to confirm:

  • Current medications

  • Relevant diagnoses

  • Cardiovascular history

  • Seizure history

  • Psychiatric history

No assessment proceeds without record verification.

1.3 Mental Capacity Assessment

Capacity is assessed in accordance with the Mental Capacity Act 2005. The clinician evaluates whether the patient can:

  • Understand the nature of CBMP treatment

  • Retain relevant information

  • Weigh risks and benefits

  • Communicate a decision

Where capacity is lacking:

  • A Best Interests framework is initiated

  • Deputy / MDT consultation occurs

  • A written Best Interests rationale is documented

This documentation forms part of the permanent clinical record.

1.4 Risk Screening & Exclusion Criteria

Before progression to Stage 2, screening includes:

  • Active psychosis

  • Unstable mania

  • Significant cardiovascular instability

  • Uncontrolled epilepsy

  • Active substance misuse beyond harm-reduction scope

High-risk patients may require stabilisation prior to consideration.

STAGE 2

Specialist Neuropsychiatric Assessment & Protocol Design

This stage determines clinical suitability

Initial Assessment: £495     
Protocol Setup: £645   
Duration: 60 minutes (Consultant Psychiatrist)

2.1 Comprehensive Neuropsychiatric Evaluation

Assessment domains include:

A. ABI-Specific Review

  • Executive dysfunction
  • Impulsivity
  • Emotional regulation
  • Social communication deficits
  • Frontal lobe behavioural syndromes

B. Psychiatric Stability

  • Mood disorders
  • Trauma history
  • Anxiety spectrum symptoms
  • Psychosis vulnerability
  • Forensic history

C. Neurological Considerations

  • Seizure threshold
  • Head injury severity
  • Sleep disruption patterns
  • Cognitive slowing baseline

2.2 Harm-Reduction Suitability Matrix

Where illicit cannabis use is present, the clinician evaluates:

  • Current street use frequency

  • Risk of exploitation or financial coercion

  • Forensic vulnerability

  • Impact on rehabilitation engagement

The aim is structured replacement with monitored prescribing where appropriate — not reinforcement of dependency.

2.3 Risk-Benefit Formulation

A formal clinical formulation is produced including:

  • Target symptoms

  • Expected therapeutic aims

  • Potential adverse effects

  • Functional improvement goals

  • Safeguarding considerations

Only where the benefit-risk ratio is appropriate does prescribing proceed.

2.4 Protocol Design & Titration Framework

Where clinically suitable, a personalised treatment protocol is established. Typical structure may include:

Baseline Stabilisation:

  • THC:CBD oil for systemic regulation

Daytime Activation:

  • Sativa-dominant cartridge via medical vaporiser

Night-time Sleep Regulation:

  • Indica-dominant cartridge

All prescribing is:

  • Vaporiser-only

  • Medical-grade device controlled

  • Smoking strictly prohibited

Clear titration schedules are documented.

STAGE 3

Tier 1 – Sustain Tier

£300 per month

Suitable for:

  • Behaviourally stable individuals

  • Lower forensic risk

  • Predictable presentation

Includes:

  • Monthly Clinical Nurse Specialist review (20 minutes)

  • Structured side-effect checklist

  • Script authorisation

  • Deputy liaison as required

Escalation to Tier 2 occurs if instability emerges.

Tier 2 – Complex Care Tier

£600 per month

Designed for:

  • Ongoing behavioural volatility

  • Active MDT involvement

  • Court-linked reporting requirements

  • High exploitation vulnerability

Includes:

  • Monthly Consultant Psychiatrist review (30–45 minutes)

  • Enhanced MDT communication

  • Court-ready summaries where required

  • Intensive risk monitoring

Tiered Maintenance & Ongoing Oversight

Prescribing without structured follow-up is unsafe in ABI populations. Patients are allocated to one of two monitoring tiers.

ONGOING MONITORING FRAMEWORK

Each monthly review includes structured documentation across:

Safety Monitoring

  • Tachycardia or cardiovascular symptoms

  • Breakthrough seizures

  • Mood activation or paranoia

Cognitive Impact

  • Fatigue

  • Executive function changes

  • Engagement with rehabilitation

Adherence

  • Vaporiser hygiene

  • Inhalation count monitoring

  • Reduction in illicit cannabis use

Safeguarding

  • Exploitation indicators

  • Financial coercion risk

  • “Cuckooing” vulnerability

Untitled (2500 x 450 px) (Poster)

DRIVING & LEGAL ADVICE

Patients are:

  • Informed of UK driving regulations regarding THC

  • Advised not to drive if impaired

  • Provided written guidance

Legal compliance is documented at initiation and reviewed periodically.

ESCALATION & REVIEW PROCESS

The pathway is dynamic. Escalation triggers include:

  • Psychiatric destabilisation

  • Cardiovascular adverse events

  • Seizure threshold concerns

  • Forensic risk increase

Treatment may be:

  • Adjusted

  • Paused

  • Escalated to higher tier

  • Discontinued

Clinical safety overrides continuation.

DISCONTINUATION POLICY

Where clinically suitable, a personalised treatment protocol is established. Typical structure may include:

Baseline Stabilisation:

  • THC:CBD oil for systemic regulation

Daytime Activation:

  • Sativa-dominant cartridge via medical vaporiser

Night-time Sleep Regulation:

  • Indica-dominant cartridge

All prescribing is:

  • Vaporiser-only

  • Medical-grade device controlled

  • Smoking strictly prohibited

Clear titration schedules are documented.

AUDIT & GOVERNANCE STANDARDS

Cann-ABI maintains:

  • 100% GP notification compliance

  • 100% capacity documentation compliance

  • Yellow Card reporting for serious adverse events

  • Formal audit review of safety and efficacy metrics

Efficacy indicators include:

  • Sleep improvement

  • Anxiety reduction

  • Reduction in crisis behaviours

  • Decrease in illicit cannabis use

Summary

The Cann-ABI pathway is designed for:

  • Structured oversight

  • Legal compliance

  • Neuropsychiatric precision

  • Behavioural stabilisation

  • Risk reduction

This is specialist prescribing within governance — not consumer cannabis access.

Frequently Asked Questions

The information provided addresses common enquiries about our clinical pathway, legal framework, safety processes and treatment approach.

If your question is not covered, our team can provide further guidance through the appropriate enquiry pathway.

CBMPs may be considered where conventional treatments have not adequately controlled symptoms such as agitation, anxiety or sleep disturbance, or where side effects have been problematic. While research into the use of Cannabis-Based Medicinal Products (CBMPs) for Acquired Brain Injury (ABI) is still evolving, early clinical evidence and patient reports suggest they may play a supportive role in managing complex, treatment-resistant symptoms.

For many ABI survivors, CBMPs—which contain varying ratios of CBD and THC—are considered for their potential to alleviate neuropathic pain, spasticity, severe sleep disturbances, and secondary anxiety. Emerging studies also highlight the neuroprotective properties of certain cannabinoids, which may assist in modulating neuroinflammation.

Treatment may aim to support:

  • Emotional regulation

  • Sleep stabilisation

  • Anxiety reduction

  • Behavioural control

  • Harm reduction where illicit use exists

No. CBMPs do not reverse brain injury. They may support management of symptoms in selected cases.

No. Suitability depends on individual factors including psychiatric history, cardiovascular health and risk profile.

Treatment may not be appropriate where there is:

  • Active psychosis

  • Severe cardiovascular instability

  • High risk of adverse psychological reactions

  • Inability to meet governance requirements

Adverse effects are possible and may include anxiety, cognitive slowing or cardiovascular changes. This is why structured monitoring is essential.

Where appropriate, structured prescribing may reduce risks associated with unregulated products and exploitation. Each case is assessed individually.

The aim is stabilisation and risk reduction, not reinforcement of dependency.

Treatment may include oils or vaporised products delivered via medical-grade devices. Smoking is not permitted.

Frequency depends on the monitoring tier and clinical stability. Monthly reviews are typical.

Outcomes vary but may include improved sleep, reduced agitation and enhanced stability in daily functioning.

Treatment may be adjusted or discontinued where benefits are insufficient or risks increase.