The United Kingdom, known for its progressive stance and diverse society, operates a sophisticated healthcare system governed by intricate regulations. Recent shifts in medical cannabis laws have spurred growth in this sector, prompting innovative approaches to delivering prescribed cannabis medications to patients. Navigating this evolving landscape can be complex, filled with regulations and hurdles. This article aims to clarify the path through the UK’s medical cannabis regulatory process, focusing on how services like Releaf are making access easier.
While recreational cannabis remains illegal in the UK, medical cannabis products are legally accessible, but under strict conditions. Prescriptions must come from a specialist doctor registered with the General Medical Council and are typically limited to specific conditions such as chronic pain, epilepsy syndromes like Dravet and Lennox-Gastaut, multiple sclerosis, and chemotherapy-induced nausea [1]. Although the National Health Service (NHS) has restrictive guidelines, private medical practices offer broader access to medical cannabis for a wider range of medical needs. It’s crucial to understand that possessing or growing marijuana without a valid prescription remains a criminal offense in the UK, classified as a Class B drug with potential prison sentences. The NHS route to obtaining medical cannabis can be challenging, highlighting the ongoing limitations in legal access within the UK.
Understanding the Current UK Medical Cannabis Laws
The legal framework surrounding medical cannabis in the UK has evolved significantly over the past decade. CBD oil became widely available in health stores and supermarkets, marking an initial step towards acceptance. Currently, using medical cannabis is legal with a prescription from a registered private doctor, often accessed through specialized medical cannabis clinics. However, it’s essential to differentiate this from recreational use; illegal cultivation can still lead to severe penalties, even for individuals with medical conditions.
The NHS currently recognizes a limited set of conditions for medical cannabis prescriptions: Dravet syndrome, Lennox-Gastaut syndrome, multiple sclerosis, and nausea resulting from chemotherapy. In 2021, NHS prescriptions for Cannabis Based Medicinal Products (CBPMs) were notably low, with only 977 issued, according to the Cannabis Industry Council [2]. Private clinics offer more flexibility, prescribing for a wider spectrum of conditions and thus expanding access to legal medical cannabis. However, progress in law and guideline changes has been slow, although events like Cannabis Europa conferences and research from organizations like Drug Science are working to raise awareness and push for better access. Many patients who could benefit from medical marijuana still face significant barriers due to prescription limitations, which in turn drives up costs for patients seeking this treatment. Public perception is gradually shifting, yet accessible medical marijuana remains a critical unmet need.
To secure a medical cannabis prescription, eligibility is paramount. The process typically starts with an evaluation by a specialist doctor, followed by an application via the Home Office. Licenses are granted only when medical cannabis is deemed an appropriate treatment option by healthcare professionals. Despite the legal restrictions, Public Health England research indicates that approximately 7.4% of UK adults have used cannabis in the past year [3], underscoring the challenges faced by those without legal medical access who may resort to illegal sources.
Like all medications, medical marijuana products carry potential risks, including memory impairment, dizziness, slower reaction times, and the possibility of addiction. Patients must carefully consider these against the potential benefits. However, it’s important to note that these side effects are often less severe than those associated with traditional treatments, especially when using low-THC strains. Drug Science’s Project Twenty21 study [4] suggests that patients on CBMPs often experience minimal negative side effects. The risk-benefit assessment for medical marijuana should be approached similarly to any other prescription medication. For instance, chemotherapy, while potentially life-saving, has severe side effects; yet, its benefits often outweigh the risks in appropriate cases.
Now that we’ve outlined the current legal status, let’s examine recent legal changes and their impact on patients seeking legal medical cannabis products.
Image showing medical cannabis flower, highlighting the natural form of cannabis used in treatments.
Recent Legal Developments in UK Medical Cannabis
The medical use of cannabis in the UK was legalized in November 2018 [5]. However, due to its classification as a controlled drug, prescriptions are restricted to specialist doctors. This legal change emerged after significant public campaigns, notably involving cases of children with severe epilepsy, contrasting sharply with readily available over-the-counter CBD products.
The case of Alfie Dingley in 2018 was pivotal. Alfie, suffering from a rare, severe form of epilepsy, became the first child in the UK to receive a medical cannabis prescription. His case dramatically shifted public perception and compelled the government to address the regulation and accessibility of medicinal cannabis.
The 2018 law also facilitated the medicinal use of cannabis-based products like Sativex through private prescriptions or, theoretically, NHS prescriptions. However, regulatory complexities have hindered access, and NHS prescriptions remain rare due to healthcare provider hesitancy. September 2020 saw further regulatory amendments concerning cannabis cultivation, intended to enable domestic pharmaceutical production. Yet, stringent cultivation regulations present substantial obstacles for companies aiming to enter the medical cannabis market.
Despite legalization in specific contexts, widespread access to medical marijuana remains limited, restricting the potential therapeutic benefits for many patients. Norman Lamb, former health minister and chairperson of the Cannabis Industries Association, has emphasized that “Despite some significant steps forward in recent years such as legalising medical use there is still much work that needs to be done to ensure cannabis products are accessible to those who could benefit from them.” This situation is somewhat analogous to the initial stages of penicillin legalization – a drug with immense benefits for life-threatening conditions, yet requiring careful implementation to ensure access and appropriate use.
Having discussed recent legal changes, let’s now explore the regulations around cultivation in the UK.
Image showcasing medical cannabis oil, a common form of medical cannabis available for prescription.
UK Cannabis Cultivation Laws: What Patients Need to Know
A frequent question among patients is whether they can legally grow their own medical cannabis at home in the UK. Unfortunately, even with a prescription, cultivating cannabis without a Home Office license remains illegal [6]. Unauthorized cultivation, regardless of quantity, can lead to severe legal repercussions.
The Home Office issues licenses for medical cannabis cultivation under its “Medicinal Cannabis Licensing scheme,” imposing strict requirements. Eligibility is limited to companies and individuals with robust security protocols, detailed business plans, and comprehensive standard operating procedures. Licensed growers are also subject to stringent regulations covering cultivation, processing, storage, and distribution.
Paradoxically, despite restrictive domestic cannabis policies, the UK was the world’s largest exporter of legal cannabis in 2016, accounting for an estimated 67.7% of global medical cannabis exports [7]. Obtaining a cultivation license remains challenging due to the rigorous application process, primarily intended for cases where imported pharmaceutical-grade products are unsuitable. Furthermore, the lack of strain standardization in home cultivation poses risks of potency variations and inconsistent dosages.
While patient-led cultivation could potentially reduce costs and offer a broader range of strains with consistent potency compared to commercial products, concerns exist about potential illegal sales and uncontrolled production. Unsupervised cultivation also increases risks of contamination, improper dosing, pathogen exposure, and pesticide use.
Having addressed cultivation, let’s now turn to the licensing requirements for accessing medical cannabis in the UK.
Licensing and Accessing Medical Cannabis in the UK
Access to medical cannabis in the UK is tightly controlled by regulations from the MHRA, NICE [8], and the Home Office. Generally, patients require a prescription from a GMC-registered specialist doctor or consultant to legally use medical cannabis. For instance, a patient like Jenny seeking medical cannabis for chronic pain management needs a prescription from a physician specializing in pain management. Private practitioners specializing in cannabis-based treatments can prescribe for conditions beyond those covered by the NHS, including anxiety, chronic migraines, and various chronic pain conditions.
However, obtaining an NHS prescription for medical cannabis is significantly more challenging. The NHS restricts prescriptions to only four severe conditions: Multiple Sclerosis, Dravet syndrome, Lennox-Gastaut syndrome, and chemotherapy-induced nausea. This limited access has drawn criticism, with many arguing that UK regulations are overly restrictive. Patients with conditions like chronic pain or seizures often encounter difficulties in obtaining NHS prescriptions.
NHS prescriptions are only considered after thorough specialist evaluations, typically requiring appointments of at least 30 minutes. Patients must have also tried and failed two conventional medications [9] before medical cannabis is considered. Specialists assess if medical cannabis offers a superior treatment option compared to conventional approaches. Moreover, all recommendations are reviewed by regulatory bodies, and patients receiving THC-containing medications are registered in a controlled drugs registry.
Think of prescriptions as essential tickets for accessing treatment, much like tickets for travel. However, unlike readily available travel tickets, obtaining a medical marijuana prescription involves stringent qualification, certification, and bureaucratic processes. The ongoing public discourse around medical cannabis legalization offers hope for patients suffering from various conditions. While legal access channels exist through private practices and licensed dispensaries, individual patient cultivation remains prohibited without authorized permits, necessitating business licenses for medical cannabis cultivation and introducing a profit-driven element.
Now that we’ve detailed access methods, let’s delve into the types of medical cannabis products available and their benefits and risks.
Medical Cannabis Clinics and Services: Releaf and Beyond
For those with an NHS prescription for legal cannabis, options for purchasing medication within the UK are currently limited. GW Pharmaceuticals’ Sativex spray, containing both CBD and THC [10], is one of the few licensed products available through UK pharmacies. Epidyolex, a CBD-only tincture, is licensed for severe pediatric epilepsy. Private medical cannabis clinics, however, offer greater flexibility in how patients access medical marijuana.
Patients with NHS prescriptions who cannot access products via traditional routes may find solutions through registered private practices. These practices can prescribe a wider range of medical cannabis products, allowing for treatments tailored to individual patient needs. While this offers hope, private practice costs can be substantial compared to illicit market prices [11]. This financial barrier often leaves patients with limited options, potentially pushing them towards unregulated and illegal sources.
This situation is akin to choosing between a regulated pharmacy and purchasing medications online from unverified sources. Regulated pharmacies ensure quality and safety but may require insurance or out-of-pocket payments. Unverified sources are less regulated and cheaper but carry higher risks. Releaf aims to bridge this gap by offering patients services like a medical cannabis card, providing reassurance and peace of mind when questioned by authorities.
Image showcasing the Releaf medical cannabis card, designed to provide patients with verification and peace of mind.
Dispensaries and Private Cannabis Clinics: Expanding Access
Accessing medical cannabis in the UK remains constrained, but options are evolving. Patients with valid medical marijuana prescriptions can obtain medication from medical cannabis dispensaries or private cannabis clinics specializing in cannabis-based treatments. These private entities can prescribe unlicensed cannabis products in the UK, provided they are produced by Schedule 2 license holders. Private clinics offer a broader selection of products, including various medical marijuana strains and cannabis oils, which can be particularly beneficial for patients who have not found relief with conventional treatments.
However, private consultations come with higher costs compared to standard GP appointments, and since NHS England generally does not prescribe cannabis for most conditions, patients typically bear the full cost of private medical cannabis treatments. The medical cannabis access bill aims to potentially allow GPs to prescribe cannabis in the future, which could significantly improve accessibility.
Choosing private medical cannabis care is similar to opting for a private tutor over public education – it involves additional expense but can offer more specialized and potentially more effective care. Just as specialized education can lead to better outcomes, private medical cannabis clinics can provide faster access to tailored treatments, potentially leading to improved patient outcomes and a better quality of life for those who benefit from medical marijuana.
References
[1] NHS, Medical Cannabis, 2022. URL: https://www.nhs.uk/conditions/medical-cannabis.
[2] Cannabis Health News, Sinclaire, S. Over 89,000 private cannabis prescriptions since 2018, fewer than five on the NHS, 2023. URL: https://cannabishealthnews.co.uk/2023/01/17/over-89000-private-cannabis-prescriptions-less-than-five-nhs.
[3] Office of National Statistics, Jones,P. Drug misuse in England and Wales: year ending June 2022. URL:https://www.ons.gov.uk/peoplepopulationandcommunity/crimeandjustice/articles/drugmisuseinenglandandwales/yearendingjune2022
[4] Drug Science, Nutt, D et al. Latest T21 Data, 2023. URL:https://www.drugscience.org.uk/t21data/
[5] UK Home Office, Javid, S. Government announces that medicinal cannabis is legal. 2018. URL: https://www.gov.uk/government/news/government-announces-that-medicinal-cannabis-is-legal
[6] UK Home Office. Controlled Drugs Licence Fees. 2021. URL: https://www.gov.uk/guidance/controlled-drugs-licence-fees
[7] Telegraph, https://www.telegraph.co.uk/news/2018/03/06/britain-largest-exporter-legal-cannabis-world-despite-ban/
[8] NICE, Cannabis-based medicinal products, 2019. URL: https://www.nice.org.uk/guidance/ng144
[9] Releaf, How it works, 2023. https://releaf.co.uk/how-it-works#:~:text=To%20be%20eligible%2C%20you’ll,schedule%20an%20online%20video%20appointment.
[10] MS Society, Sativex (nabiximols). 2021. URL: https://www.mssociety.org.uk/about-ms/treatments-and-therapies/cannabis/sativex
