Table of Contents Show
- NICE Recommendations for the prescription of medical cannabis
- Medical cannabis eligibility in the UK – which conditions can be treated?
- Can my GP prescribe medical cannabis?
- Finding a medical cannabis clinic
- What will happen at your appointment?
- What happens when you are prescribed medical cannabis
- What medical cannabis products might be prescribed?
- Types of medical cannabis products in the UK
- How much does a medical cannabis prescription cost in the UK?
- What if I can’t afford a medical cannabis prescription?
- Practical things to know as a medical cannabis patient
- When will medical cannabis be available to more patients on the NHS?
On November 1st, 2018, the law in the UK officially changed to allow the prescription of cannabis-based medical products – known more commonly as medical cannabis. The reclassification of cannabis from schedule I to schedule II of the Misuse of Drugs Act 1971 meant that specialist doctors who are members of the General Medical Council’s specialist register could now prescribe medical cannabis for conditions for which there is evidence it may be beneficial to patients.
The move was largely influenced by the high-profile cases of several British children who had experienced significant improvements in their epilepsy symptoms with the help of cannabis based products. Since then, however, only a handful of NHS prescriptions have been granted for medical cannabis flower, while cannabis-based medicines can only be accessed for a limited number of conditions. Years after the law changed, the vast majority of patients can only access legal medical cannabis through private clinics. Due to the high costs often associated with these prescriptions, a reported 99% of patients are still getting their cannabis from illegal sources.
This figure isn’t surprising when you consider that a large portion of the population is still unaware that medical cannabis in the UK is legal. According to a recent poll, only 32% of the population agree that cannabis should still be illegal in the UK, highlighting public support for meaningful medical cannabis reforms and improved patient access to these potentially life-saving medicines. Nonetheless, the NHS is strongly influenced by the recommendations of the National Institute of Health and Care Excellence (NICE) – guidance that currently only recommends the prescription of medical cannabis products for three conditions.
NICE Recommendations for the prescription of medical cannabis
According to NICE recommendations, cannabis-based medicines should only be considered for the treatment of chemotherapy-induced nausea and vomiting, spasticity associated with multiple sclerosis, and severe intractable epilepsy. But prescribing cannabis-based medicines, even for one of these conditions, is still not as straightforward as it may seem – hence the extremely low rate of NHS prescriptions. Furthermore, the NICE recommendations even go as far as to recommend against the use of medical cannabis-based products in cases of chronic pain, despite this being one of the most commonly reported reasons for using medical cannabis, globally.
But despite these restrictive recommendations, specialist clinicians can still choose to prescribe medical cannabis for any condition for which there is some evidence of efficacy. Therefore, private clinics are able to offer medical cannabis prescriptions to a much wider variety of patients – albeit at a cost.
Medical cannabis eligibility in the UK – which conditions can be treated?
In order to receive a medical cannabis prescription from a private medical cannabis clinic, a patient will need to have a qualifying condition. As mentioned above, this is essentially any condition for which there is evidence that medical cannabis may be beneficial. Furthermore, patients will also have tried at least two other prescription medications or treatments to manage their condition or symptoms.
While medical cannabis may be considered as a treatment for a condition, such as to reduce seizures in different forms of epilepsy, it may also be considered to help manage symptoms of another condition; for example, anxiety and/or insomnia associated with post-traumatic stress disorder (PTSD).
The main conditions for which medical cannabis treatment may be considered, include:
Can my GP prescribe medical cannabis?
Unfortunately, current legislation means that general practitioners are unable to prescribe medical cannabis for any condition. However, they may refer you to an NHS specialist doctor or a private clinic that can help you to move forward. It is possible that you may face some discomfort or uncertainty when discussing medical cannabis with your GP as most medical professionals in the UK are still not trained in this area. Nonetheless, your GP is in a good position to provide you with support and reliable resources.
Finding a medical cannabis clinic
Since 2018, a number of private medical cannabis clinics have been established around the UK. Despite these clinics all operating under the same laws and regulations, there can be some variation between clinics in the conditions treated and medicinal cannabis products prescribed. This can be due to a number of factors, such as the specialist clinicians associated with each clinic. Furthermore, different clinics also have different costs associated with their services.
Non-profit community interest company PLEA has compiled a list of clinics, breaking down the conditions each specialises in and the associated costs for a medical cannabis prescription. A similar list has also been compiled by Drug Science of participating clinics in the Project Twenty21 scheme.
Project Twenty21 is one of a number of schemes designed to make medical cannabis more accessible by subsidising the cost of treatment. You can find more information on these access schemes further down the page.
Choosing the right medical cannabis clinic can be a daunting prospect, but there are some resources that may help. For example, 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 will happen at your appointment?
The exact structure of your appointment with your chosen clinic will, again, vary; however, they will always require access to your medical records in order to confirm that you have a condition that may qualify for medical cannabis treatment. In order to grant this access, you will have to inform your GP that you require a copy of your Summary Care Record – the medical cannabis clinic will be able to assist you with this.
Next, you will need to attend a consultation with one of the clinic’s consultants – this can be in person or over a video call. If you would like to participate in a scheme, such as Project Twenty21, you should inform your consultant at this stage. During your consultation, the consultant will ask a number of questions relating to your condition, your previous medications and/or treatments, and how symptoms have impacted other aspects of your life (e.g., sleep, mobility, etc). You will also be asked about any previous cannabis use, including self-medicating for your condition.
While this might feel a little scary, remember that the doctors and consultants are there to help you; always try to give the most accurate and truthful responses to all the questions asked during your consultation. This appointment is also a good opportunity to ask any questions or discuss any fears you may have with a professional. You might find it helpful to take notes and you are always entitled to ask that anything discussed is left off clinical records.
If you are eligible for medical cannabis treatment
If your consultant believes that you may benefit from medical cannabis treatment, they will discuss your options with you before moving forward. Sometimes, a clinic may first present your case to a multi-disciplinary team before deciding if a prescription is appropriate. Typically, these meetings are held weekly, so you may have to wait a while to find out their decision.
What happens when you are prescribed medical cannabis
Once confirmed with your consultant, your prescription will be confirmed in writing and be fulfilled by a specialist pharmacy. While your chosen clinic may recommend a specific pharmacy to fulfil your prescription, you are entitled to choose your own. Again, prices and delivery times will vary between pharmacies, so doing your research is recommended.
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.
What medical cannabis products might be prescribed?
Medical cannabis – also referred to as “cannabis-based medical products” or CBMPs – can come in a variety of forms. In the UK, the most commonly prescribed CBMPs are cannabis flower and cannabis oil. The product prescribed to you will depend on a number of factors, including your condition, the severity of symptoms, your overall health, and your age.
The amounts of CBD and THC (the most common cannabinoids used in CBMPs) will also be determined by your clinician. You may be prescribed a number of different products containing varying levels of CBD and THC to determine the dose that works best for you. There are currently four types of medical cannabis products available in the United Kingdom.
Types of medical cannabis products in the UK
Sometimes referred to as Flos, cannabis flowers are the buds of the cannabis plant. The flower contains the full natural cannabinoid and terpene profile of the cannabis plant. This product should be broken down into smaller parts using a grinder, heated and inhaled using a dry herb vaporiser; however, it is never recommended that you smoke your product, due to the obvious health risks associated with smoking. Instead, your clinician may recommend a vaporiser.
Medical-grade vaporisers heat up the cannabis flower to a point where the natural oils in the product begin to evaporate. Importantly, though, temperatures are not high enough to cause combustion. As a result, you are able to inhale the active ingredients of the cannabis flower without consuming harmful and toxic substances.
Medical cannabis oils
Cannabis oils are generally applied sublingually – that is, under the tongue. Your 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.
Medical cannabis vape cartridges
Vape carts are small containers which hold cannabis oil that has been prepared for inhalation. The cartridges are attached to an atomiser, which is a heating element attached to a rechargeable battery commonly referred to as a pen. Cartridges are screwed onto the pen, the user presses a button which heats the oil, allowing the patient to inhale vaporised cannabis oil, providing similar effects to vapourised flower.
You may be prescribed cannabis vape cartridges to allow better control over dosing or for greater convenience, however, the cost for this type of cannabis medication is higher than others.
Medical cannabis capsules
Cannabis capsules are small tablet-sized capsules filled with pre-measured doses of cannabis oils. They may contain only CBD, or a mixture of CBD and THC. Your doctor will advise how many capsules to take each day and when. Ingested THC has a longer-lasting effect, which means it is suitable for managing conditions such as long-term pain.
How do I take medical cannabis?
As mentioned above, you will be prescribed at least one of four medical cannabis products; flower, oil, carts or capsules. The way in which you take these products will vary and your clinician will walk you through how to properly dose and administer your medication.
How much does a medical cannabis prescription cost in the UK?
The cost of a medical cannabis prescription can vary significantly, both between clinics and depending on your required products/dose and whether or not you are participating in an access scheme. For example, your initial consultation with a medical cannabis clinic can cost anywhere between £49 and £200 and follow-up consultations fall in the range of between £65 and £150. You should also be aware that some clinics will also charge a monthly fee.
In addition to the administrative costs, you will also have to pay for the prescription itself. Again, these costs will vary depending on your chosen clinic and the product prescribed. At present, the lowest cost per gram of cannabis flower is around £4.50.
What if I can’t afford a medical cannabis prescription?
The cost associated with medical cannabis treatment remains a significant barrier to access for many patients in the UK. Thankfully, there are currently a number of schemes that have been established to help with these costs.
Medical cannabis access schemes
Project Twenty21 was set up by Drug Science in 2021 to offer financial relief to patients while also gathering much-needed real-world evidence on the outcomes of medical cannabis treatment. Taking part in the T21 scheme entitles patients to a minimum discount of 5% off their prescription fees. To receive this discount, you will need to inform your doctor at the initial consultation of your intention to join the scheme. Once your prescription has been approved, your clinic will notify the dispensing pharmacy of your discount.
Sapphire Access Scheme also offers patients financial support with their prescription costs. Available exclusively for patients registered with Sapphire Medical Clinics, this scheme provides cost savings to all appointments, including initial consultation, first follow-up appointment, and quarterly check-ups. Patients are required to pay for the full cost of their prescription, however, repeat prescription fees do not apply.
Patients who enrol on the Sapphire Access Scheme will be required to consent to have certain data collected as part of the UK Medical Cannabis Registry.
The Mamedica Access Scheme, launched in 2023, is available to veterans or new patients receiving benefits who are struggling with the cost of clinic fees. For a one off upfront fee of £200, eligible patients will have full access to the Mamedica clinic team. After making the upfront fee, patients will not be charged for the initial consultation, any follow on consultations, or any repeat prescription fees. While patients will still need to pay for the cost of medication, Mamedica suggest the scheme results in 675% better value than other medical cannabis access schemes available in the UK.
Medical cannabis cards in the UK
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 qualifying condition that has not responded to two prescribed or licenced medicines or treatments. It is important to note that, 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; however, the decision to pursue further action rests with the officer in question.
Practical things to know as a medical cannabis patient
If you have managed to secure a medical cannabis prescription, whether from a private clinic or through the NHS – congratulations! But it is likely that you will still face some stigma and complications due to your prescription. There are a few things that, as a new medical cannabis patient, you will need to be aware of. For example, can you drive when you have a medical cannabis prescription? Can you travel? And what are your employment rights?
Driving when you have a medical cannabis prescription
Medical cannabis contains substances that can cause significant side effects, including drowsiness, decreased cognitive function and slower reaction times. The extent of these side effects can vary significantly from person to person and depending on the medical cannabis product used.
Regardless of impairment, however, THC can remain in the blood, saliva, and hair for weeks after consumption. This can potentially cause you to fail a road-side drug test, so you should always keep a copy of your medical cannabis prescription with you when heading out in the car.
NatCen’s government-sanctioned report on “Medical Cannabis and road safety” states: “In line with DVLA guidance, prescribers should give patients advice on driving while using medical cannabis, as they would with any other medication.” This includes being aware of possible interactions with other medications and monitoring patients’ responses to their medication – including those that could potentially impair driving.
For more information on driving with a medical cannabis prescription, take a look at our recent article on the topic.
Your rights at work
Potential side effects of medical cannabis coupled with the persisting stigma around the drug can leave many patients uncertain about their position with their employer. The most important thing to remember here is that there are statutory safeguards in place to protect people who take medication at work if required – including medical cannabis.
However, your employer has a duty of care, not only to you but to all of your co-workers. Therefore, you should always inform your employer if your medication is likely to have an impact on safety in the workplace – for example, if you work with heavy machinery. More information and guides to discussing your medical cannabis prescription with your employer can be found in this article.
When will medical cannabis be available to more patients on the NHS?
So far, 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. Epidyolex, a CBD isolate-based product can be prescribed alongside clobazam, to treat seizures associated with Lennox-Gastaut syndrome, Dravet syndrome in children and tuberous sclerosis complex. Nabilone, a synthetic THC product, can be used as an add-on treatment for chemotherapy-induced nausea and vomiting.
Current estimates suggest that around 1.4 million people in the UK are using self-sourced cannabis to treat a wide range of 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 reflect the limited high-quality clinical evidence currently available.
However, real-world data from projects such as T21 and other clinical trials alongside widespread public support will help to build a strong argument for wider adoption of evidence-based and cost-effective cannabis medicines within the NHS. But when exactly that might happen, unfortunately, remains very much unknown.