A few weeks ago, leafie’s Kevin Dinneen asked a question on LinkedIn: “Am I allowed to enjoy my prescribed medical cannabis?”
Like many other patients in the UK, Kevin uses medical cannabis after years of self-sourcing, having done so long before legislation changed in 2018. In the eyes of the law and medical profession, he’s a legitimate patient, but having come from the recreational market, there is still a level of pleasure in the consumption of his prescribed flower. From preparation rituals to discerning the smell and taste of the terpenes, and of course, that widely loved side effect: being high.
Kevin isn’t alone. Countless patients find great relief in cannabis and enjoy the feeling it produces, too. Some doctors and industry professionals will go to great lengths to clearly define the lines between recreational and medical, often pitting one against the other. But for many of those who are prescribed, the reality sits somewhere in the middle, where cannabis use both provides relief from symptoms and is enjoyable in the process. Is it time to talk about the therapeutic use of cannabis?
Michael started off using black market cannabis, but is now prescribed to help with the symptoms of treatment-resistant depression. He admits that he still notices a conflicting sense of cognitive dissonance despite being prescribed by a specialist doctor at a clinic. “It helps me function,” he tells leafie, “but I feel like I’m only saying that and I’m just using it recreationally.” These concerns, ironically, occur most when he’s medicated to quieten the depressive thoughts. “It’s guilt from feeling relaxed and enjoying that feeling, mixed with years of seeing cannabis be associated with stereotypes of laziness, a rhetoric reinforced by news outlets.”
Matt is another patient who has transitioned to medical after 25 years, using cannabis to treat dysphoria and general anxiety disorder. “The transition to medical has been a wonderful experience, but the black market is how I’ve survived this long,” he says.
“I would be dead without it. That may seem hyperbole, but it’s 100% true.”
Blurred lines
To countless patients, the binary distinction of recreational and medical simply doesn’t exist. That legal, medical status doesn’t erase the pleasure-giving properties of cannabis, so why should the enjoyment erase the medicinal benefits? Would it even work without that joyful element? “I would not use a cannabis product that did not have the high”, Matt says. “I believe that’s the bit that helps most. Without the change in how my brain works, the subtle muting of negative stimuli while allowing mirth, it would be useless to me.”
Yet some feel they are forced into performative sickness while downplaying the pleasurable side of their cannabis use to be classed as legitimate patients. Jack only realised that he was self-medicating with cannabis as he grew older. “I’ve been casually consuming weed recreationally for years. I’m not a massive stoner, but it was only when I took an enforced break thanks to my dealer going offline that I realised it was helping me beyond just getting high,” he says. “I don’t use medical cannabis every day, but it helps enormously when my stress and anxiety levels are peaking. I sometimes worry I don’t look like a real patient, and find myself over-justifying my prescription to people. But if it helps me when I need it, and I also happen to enjoy the high, then why wouldn’t I use it? No one feels the need to justify any other sort of relief.”
Not all patients are happy with that high, however. Some report the inconvenience of needing to medicate at 5 am with a day full of errands and commitments ahead, or the challenge of balancing cannabis use and needing to drive. Catherine, who has only ever used medical cannabis, says that while trying to find the right dose of oil for her condition she didn’t like the feeling when consuming too much: “I skip the chill stage and go right to anxiety,” she told leafie, but added “no hate to people who enjoy cannabis recreationally, it looks like a good time!”
Therapeutic use
The Cambridge dictionary defines the word therapeutic in two ways: relating to the curing of a disease or medical condition, and causing someone to feel happier and more relaxed, or to feel more healthy. While around 80-100,000 UK patients have prescriptions, the number of people who use cannabis sourced from outside the medical system is in the millions. Ask many of these non-prescribed users, and they’ll tell you that cannabis helps with stress, sleep, relaxation, creativity and even connection. Benefits that may or may not warrant a prescription, but all clearly have benefits to health and well-being.
And yet cannabis, thanks to years of propaganda, is constantly demonised instead of celebrated, believed by many to have no medical or therapeutic benefits. Patients feel the need to justify their prescriptions. The industry desperately tries to distance itself from the recreation market that preceded it. The stigma persists, sometimes with dangerous consequences.
I try my best to minimise my use around others, but I feel guilt when this isn’t possible
When Catherine found herself in the hospital with a life-threatening issue, the misconceptions around her prescribed cannabis oil almost led to critical care being withheld.
“The doctor was reviewing my existing conditions and medications like usual, but when she got to cannabis, suddenly nothing else mattered,” Catherine recalls. “She demanded to inspect my oil and asked me tons of questions about what dose I take, why I take it, where I get it from, if I had taken too much, and what do I do about the fact that I’m high every day?”
Catherine’s story shows that cannabis is a genuine clinical medicine, and that the medical category needs robust protection to ensure patients don’t suffer in silence or worse, risk losing access to life-saving care because of falsely held beliefs. But as many patients told leafie, their use leaves them feeling like they are sitting somewhere uncomfortable. “The stigma still gets me, even when legal,” Matt says, “but the legitimacy is a godsend.”
“I try my best to minimise my use around others, but I feel guilt when this isn’t possible.”
Is it time the industry accepted there is enjoyment as well as healing in cannabis openly, or do we persist with the myth that medicine is only effective if it’s devoid of pleasure? Is the guilt and stigma many patients carry around adding unnecessary complexity to treatment?
There is a clear need to have an honest and open dialogue about a third category of therapeutic cannabis consumption. Not to minimise medical use, but to protect it. Many patients report that talking to others has helped them shift the window on medical cannabis perceptions. “My GP and physiotherapist have both been very interested in my experience with cannabis, and they’ve shared that with other patients to give them more choice in their own treatment plans,” Catherine says. While Michael says most people he speaks to are curious to learn more.“ I initially felt like people would be dismissive of it, but to my surprise, people are intrigued and ask a few surface-level questions about it, some even asking how or where to start.” For therapeutic use to gain legitimacy, it too needs to be discussed more widely.
Pleasure doesn’t negate efficacy. In fact, it might even enhance it. Medical cannabis has been forced into a framework that isn’t fit for purpose, but ignoring therapeutic use won’t fix that broken system. The question the industry, policy makers and regulators need to address isn’t whether patients should be able to enjoy cannabis. It’s why enjoying it is a problem in the first place.
