In the absence of a submission from the holder of the marketing authorisation, the Scottish Medicines Consortium (SMC) is unable to recommend cannabinoid oromucosal spray (Sativex®) for use within NHS Scotland as an add-on treatment for symptom improvement in patients with moderate to severe spasticity due to multiple sclerosis (MS) who have not responded adequately to other anti-spasticity medication and who demonstrate clinically significant improvement in spasticity related symptoms during an initial trial of therapy.