Will the NHS go green? Regulatory prospects of medicinal cannabis in the UK

Amelie Bamford, Junior Consultant
17/10/2024

Medicinal cannabis has been a topic of evolving debate and policy in the UK. Public opinion is shifting, and more countries are adopting a progressive approach towards regulation. Private medicinal cannabis clinics are experiencing a rise in patients, one clinic in Westminster has seen an increase in patients by more than 10 times since 2023, rising from 250 to 2,750. Is now the time for the Government to act on this demand?

The Government took a significant step by legalising the prescription of cannabis-based products for medicinal use under specific conditions in November 2018. This followed a high-profile campaign led by families of children with severe epilepsy who found traditional treatments were ineffective and cannabis-based medications provided substantial relief.

Despite this, there is still a general caution in the approach to drug regulation, particularly with substances that have been traditionally viewed as dangerous or have a high potential for misuse. Cannabis, despite its medicinal applications, remains closely associated with recreational use and the wider illicit drug trade, both areas the Government has been keen to regulate strictly.

Despite the change in law, access to medicinal cannabis remains limited with relatively few patients receiving prescriptions through the NHS. There are significant barriers, including a limited pool of doctors authorised to prescribe medicinal cannabis, and the reluctance of many doctors to do so often results in a lack of robust clinical data and clear guidelines.

Under the current legislation, cannabis remains a controlled substance classified as a Schedule 1 drug under the Misuse of Drugs Act 1971. This classification designates cannabis as having no recognised medicinal value, making it illegal to possess, distribute, or cultivate except for research purposes. However, certain cannabis-based products are now classified as Schedule 2 drugs, meaning they can be prescribed legally in specific circumstances. These include products such as Sativex (for treating multiple sclerosis) and Epidyolex (for epilepsy), both of which have been approved by the Medicines and Healthcare products Regulatory Agency (MHRA).

Most patients who want to use medicinal cannabis turn to private clinics, where prescriptions can be obtained at significant cost. This has created a two-tier system, where access to medicinal cannabis is available primarily to those who can afford it.

While Labour has not yet fully committed to comprehensive reform, there is an increasing push within the Party to make access to medicinal cannabis easier for patients suffering from conditions such as epilepsy, multiple sclerosis, and chronic pain through expanding the ability of healthcare professionals to prescribe these treatments and removing unnecessary barriers for patients in need.

The Conservative Party's stance remains cautious. Since the 2018 amendments to the Misuse of Drugs Regulations, which allowed specialist doctors to prescribe cannabis-based products for medicinal use, progress has been slow. Although individual MPs and advocacy groups continue to campaign for greater access, the issue has not gained the kind of political momentum necessary to drive significant policy change.

Another important consideration is the medical community’s stance on the issue. While there is growing evidence supporting the use of medicinal cannabis for specific conditions, such as chronic pain and epilepsy, much of the data remains anecdotal or limited to small-scale studies. The UK’s National Institute for Health and Care Excellence (NICE), which provides clinical guidelines for treatments, has expressed hesitance about recommending the widespread use of medicinal cannabis, citing the need for more rigorous clinical trials.

Public opinion and political pressure are significant factors in shaping future policy. Support for medicinal cannabis is growing, with surveys suggesting a majority of the UK public supports broader access to cannabis-based treatments. But with so many other, arguably more pressing, issues on the political agenda, medicinal cannabis regulation has not been high on the list.

Given the current focus on other pressing national issues, medicinal cannabis reform is unlikely to happen any time soon. The continued success of medicinal cannabis programs in other countries, such as Canada, Germany, New Zealand, and parts of the United States, gives a growing body of data on the safety and efficacy of cannabis-based treatments. As evidence from these countries accumulates, pressure may mount for the UK to follow suit in relaxing its restrictions.