In November 2018, the law in the United Kingdom was changed to allow doctors who are on the General Medical Council’s specialist register to legally issue prescriptions for cannabis-based medicines when they agree that their patients could benefit from it as a treatment.
Only 32% of people in the UK still believe cannabis should be illegal, but despite overwhelming support, medical cannabis is still rarely prescribed on the NHS. Current guidelines from the National Institute for Health and Clinical Excellence (NICE) state that apart from a few conditions, there is a lack of evidence to support NHS prescriptions of cannabis-based medicines.
For the majority of people in the UK, the only way to access cannabis is through a private prescription. In order to be eligible, a patient will need to have a qualifying condition and usually will need to have tried two previous prescription medications or treatments for their condition.
Finding a medical cannabis clinic in the UK
The first step to obtaining a medical cannabis prescription in the UK is to find a private clinic. There is some variation between clinics in the conditions treated and the prescriptions issued. Equally, different clinics have different costs associated with their services. The PLEA has compiled a list of clinics, costs and conditions treated. The Drug Science backed project Twenty21 also has a list of clinics that participate in its scheme designed to collect the data to support more NHS backed prescriptions. T21 subsidise some of the cost involved for prescriptions to make them more affordable and comparable with the cost of cannabis from the illegal market.
Experiences with clinics can vary, and there are a number of community-led resources where people provide feedback on their experiences such as the UK Medical Cannabis group on Reddit, which could be useful when making decisions about which clinic to approach.
What happens at the appointment?
When you make contact with a clinic they will require access to medical records to confirm that you have a condition that is suitable for a prescription. This will usually involve informing your GP you need a copy of your Summary Care Record, the clinic will be able to assist with this. You will then be required to attend a consultation, either in person or over a video call. If you wish to participate in a scheme such as Twenty21 you will need to tell the clinic.
During the appointment, the consultant will complete an assessment and ask questions, such as why previous treatments haven’t worked or have caused problems, how symptoms from the condition being treated have impacted your life, sleep, mobility etc.
The doctor or consultant will also ask about any previous use of cannabis as a treatment. If they believe a medical cannabis prescription is suitable, they will discuss options with you. Some clinics may first present your case to a multi-disciplinary team before deciding on if a prescription is appropriate, typically, these meetings are held weekly, so you may have to wait to find out the decision.
Remember that the doctors and consultants are there to help, and also to answer any questions or fears you may have. You might find it helpful to take notes and you are always entitled to ask that anything discussed is left off clinical records.
What happens when you are prescribed medical cannabis
If your consultant is happy to prescribe medical cannabis your prescription will be confirmed in writing and will then be fulfilled by a specialist pharmacy. It is likely that your clinic will recommend a specific pharmacy but you are entitled to choose. Prices and delivery times vary so it may be helpful to shop around, resources such as MedBud have up to date information on products available, costs and prescribing pharmacies. Once you have contacted your chosen pharmacy you will be asked to make a payment for the prescription before it is dispatched.
Once you begin taking your medication, the clinic will request a follow up consultation, usually within 4 weeks, to discuss how you are getting on with your medical cannabis and to discuss if any changes need to be made. It is important you attend this consultation to continue receiving repeat prescriptions.
How will I take my medical cannabis?
During your consultation, the doctor will ask you questions to learn more about you, your condition and how medical cannabis might be able to help. You may be prescribed cannabis flower, or cannabis oil, depending on your symptoms.
If you are prescribed cannabis flower, the doctor will state the starting and maximum daily dose you need to consume. However, cannabis flower requires some work to be consumed. You will need to acquire some weighing scales with a precision of 0.01g so that you can accurately weigh out each dose. You will need to break the cannabis flower down, a grinder might help with this process, as it breaks the cannabis down into a finer and more consistent form.
Cannabis flower can only be prescribed for consumption with a dry herb vapouriser. It can not be smoked. Dry herb vaporisers heat cannabis to a temperature where the beneficial components, such as CBD and THC are vapourised. This vapour can be inhaled and is a healthier and more efficient route of administration compared to combustion (smoking).
If you are prescribed cannabis oil, the doctor will state the starting and maximum daily dose you need to consume. Usually, cannabis oils will come with a dropper top with a dose indicator on the pipette, or with syringes with a precision of 0.05ml to help you measure out each dose.
To consume cannabis oil, you will need to place the tip of the dropper or syringe under your tongue, and squeeze the bulb of the dropper or press down on the top of the syringe to release the oil. Hold the oil under your tongue for 30-60 seconds before swallowing. This will aid with the absorption of the cannabinoids.
How much does a medical cannabis prescription in the UK cost?
Costs between clinics vary, an initial consultation can cost between £49 and £200 and a follow up consultation can cost from £65 to £150. Some clinics will also charge an annual fee.
As well as paying for your consultations, you will need to pay for your medicine. Again, costs vary from pharmacy to pharmacy, at present, the lowest price is £5 per gram of dried cannabis flower. By joining the T21 scheme the costs are subsidised for approved products and capped at £150 per product per month, however, to benefit from these reduced prices patients need to agree to have certain data collected as part of the ongoing study.
What if I can’t afford a private cannabis prescription
The cost of private medical cannabis can be prohibitive to people with low incomes, especially those with conditions that mean they are unable to work and raise the funds needed to subsidise their medical needs. In response to this, a card scheme called Cancard has been launched which aims to protect those using cannabis without a prescription for medicinal purposes from arrest.
The scheme still requires patients to prove that they have a condition that has so far not responded to two prescribed or licenced medicines or treatments, and while the group behind the scheme have worked closely with police forces across the UK, the scheme is by no means a get out of jail free card.
Cancard membership costs £30, and they claim that 98% of police stops reported by the scheme members have resulted in no further police action.
When will medical cannabis be available to more people on the NHS?
At the moment, only three cannabis-based medicines are licensed and available for prescription on the NHS. Sativex, a THC and CBD spray can be prescribed to treat moderate-to-severe spasticity in adults with Multiple Sclerosis. Epidiolex, a CBD isolate based product can be prescribed alongside clobazam, to treat seizures associated with Lennox-Gastaut syndrome and Dravet syndrome in children. Nabilone, a synthetic THC product, can be used as an add-on treatment for chemotherapy-induced nausea and vomiting.
It’s currently estimated that around 1.4 million people in the UK are using self sourced cannabis to treat medical conditions. As these people are forced into criminality the issue of wider access to medical cannabis continues to be a pressing issue and a hotly debated topic. At this moment in time, NICE recommendations still only suggest cannabis-based medical products are suitable for a small number of conditions. The real-world data from projects such as T21 and other clinical trials alongside widespread public support will certainly build a strong argument for wider adoption of evidence-based and cost-effective cannabis medicines within the NHS, but when that happens is still very much unknown.