Medical Cannabis UK

Medical Cannabis in the UK: An In-Depth Look at the Industry and Its Challenges

Introduction

In case you weren't already aware, medical Cannabis, aka CBPMs (Cannabis-Based-Prescription-Medicines), was made legal back in 2018. There were undoubtedly many patients who celebrated this moment as the moment the first domino fell. However, following the law change, other than the patient's campaigning, most people were unaware of how to access it. Moreover, as primarily the public campaign was centred on two severely epileptic children whose lives were being seriously diminished due to the illegality of medical Cannabis, the widespread belief was that it would be tough to access and would be out of reach for most individuals. That may have been true six years ago, but in 2024, a vast number of medical cannabis clinics, 48 as of 21/11/2024, are trading across the UK, Jersey, Guernsey and Isle of Man. The only requirement for legal Cannabis is a long-standing condition; this can be physical, such as in the realm of pain management, or it can be for psychiatric benefit.

Even though there are numerous outlets to facilitate medical cannabis prescriptions, the widespread view is that it remains one of the most inaccessible markets for the average patient; in reality, it simply requires a chronic issue that has been attempted to be resolved medically from an officially documented perspective through your GP. Once this requirement is met, in theory, a patient can self-refer to a clinic and seek to register as a patient there. Some clinics will have strict guidelines, such as the patient must not have a history of psychosis for them to be considered, but many clinics will judge each patient on a case-by-case basis.

The National Health Service (NHS), which is the primary source of healthcare for the majority of UK residents, has only prescribed medical Cannabis to a mere handful of patients since its legalization in 2018. On the other hand, dozens of thousands of patients are turning to the private sector to access this treatment. This blog explores the current state of medical Cannabis in the UK, including the number of clinics, estimated patient numbers, popular forms of cannabis treatment, and the key issues facing the industry.

The Current State of Medical Cannabis in the UK

NHS Access: A Rare Occurrence

Since medical Cannabis was legalized in the UK in November 2018, fewer than five patients have been able to access it through the NHS. Strict guidelines and reluctance from healthcare professionals to prescribe cannabis-based treatments have left many in need of alternative solutions. The process is restrictive due to NICE guidelines, where medical Cannabis is not recommended for the vast majority of conditions due to the lack of UK-recognized studies regarding efficiency versus a cost basis. Despite this, some patients have petitioned their local NHS trust to peruse and provide funding for their medical cannabis treatment. Medical Cannabis has to be prescribed by a doctor registered on the GMC specialist register, and they should only decide to prescribe within their area of practice and training, meaning your GP won't undertake prescriptions on your behalf.

Furthermore, NHS training teaches that Cannabis has extremely limited medical benefits, meaning that many doctors would be deterred from even prescribing it.

Private Clinics: The Dominant Source of Access

Due to the barriers within the NHS, the private sector has stepped in to meet patient demand. The UK, Channels Islands and Isle of Man are home to 30 private medical cannabis clinics, catering to a growing number of patients. These clinics operate outside the NHS framework and provide a more straightforward path to access medical Cannabis. However, consultations and prescriptions can be prohibitively expensive, making it inaccessible for many. Due to the number of clinics offering service, there is a wide range of prices available, and some do provide one-off lifetime payment for those on benefits or who are army veterans, etc.

Patient Numbers and Forms of Treatment

Estimated Number of Patients

As of 2024, it is estimated that by the end of 2024, the number of legal prescription patients could reach up to 63,000, accessing their medication through private prescriptions. This figure continues to grow as awareness increases and more clinics open nationwide.

Forms of Medical Cannabis

Medical Cannabis is available in several forms, with the most common being cannabis flower, followed by cannabis oil. Patient preference and medical needs dictate the choice:

• Flower: Approximately 78% of patients are prescribed cannabis flowers. It is prescribed for medication via inhalation using a vaporizer, providing rapid relief for conditions like chronic pain and anxiety. Smoking your medication is explicitly illegal as per the legislation. Patients typically value the immediate effects and the ability to control their dosage.
• Oil: Around 30% of patients use cannabis oil, typically administered sublingually (under the tongue). Oils are popular for those with conditions such as epilepsy or multiple sclerosis, as they offer a more consistent and long-lasting effect than flowers. Often, the relief is slow as the oil needs to build up in your system, and it can be a lot more challenging to titrate compared to cannabis flowers.
• Vape Carts are another option that allows immediate effects and also provides an excellent level of discretion.
• Edibles recently added some pastille gums to their product list. These are available in 5MG and 10MG THC options, as well as a balanced 10mg THC to 10MG CBD ratio. Both edibles and vape cars are prescribed to far fewer patients than flowers and oils.
  
  

Challenges in the UK Medical Cannabis Industry

Inconsistent Medication

One of the most frequent complaints raised by patients online is the low quality of Cannabis flowers; the issue facing patients and clinicians is the inconsistent quality of medical Cannabis. Unlike pharmaceuticals, where uniformity is standard, the quality of Cannabis can vary from batch to batch; some strains' genetic profiles might not match the names they are sold as, frequently, strains are discontinued or sold out for months. Patients have reported fluctuations in the efficacy of their medication, which can disrupt treatment outcomes and lead to mistrust in the system.

Contamination: Mould and Bugs

Another issue plaguing the industry is the presence of mould and insect contamination in some medical cannabis products. Strict testing protocols are in place to ensure safety, but the presence of contaminants raises concerns about the cultivation and storage standards employed by some suppliers. Medical Cannabis flower in the UK is allowed to have a certain percentage of foreign bodies present as long as it is less than 2% weight. Unfortunately, many medicines with bugs present are sold on the UK medical cannabis market. Mould seems to be another issue in an alarming number of patients' treatments, though getting this officially recognized is incredibly difficult.

Radiation Treatment

Most medical Cannabis in the UK is treated with gamma radiation to ensure it meets safety standards. While this process eliminates microbial contaminants, it also allows Cannabis grown to substandard levels to pass regulatory tests; it is a fail-safe method of passing the tests, though it is detrimental to the patient. Critics argue that this approach prioritizes market availability over quality, as irradiated Cannabis can lose some of its natural properties, including terpenes and cannabinoids, which are crucial for therapeutic effects. There are also medical cannabis flowers treated with beta radiation. Gamma Radiation uses high-energy photons which break down volatile organic compounds such as terpenes; therefore, of the bunch, beta-irradiated flowers are likely to have retained more of their intrinsic goodness.

Cost Barriers

The private nature of the medical cannabis industry in the UK makes it an expensive option for most patients. Typical private prescription costs can vary massively, with Epeltic patients sometimes requiring thousands of pounds worth every month. Many users will spend around 150-300, which is out of reach for many, particularly those who rely on the NHS for their healthcare needs.

Radiation vs. Black Market Cannabis

One striking difference between legal medical Cannabis and black-market Cannabis in the UK is the use of radiation. While the black market does not subject its products to such processes, it lacks standardized quality control. However, the heavy reliance on radiation in the legal market has led some patients to question the superiority of medical Cannabis. The argument is that while legal Cannabis is safer from a microbial perspective, it may not offer the same therapeutic value as non-irradiated Cannabis.

The Future of Medical Cannabis in the UK

Potential Reforms

Advocacy groups and patient organizations are pushing for reforms to make medical Cannabis more accessible through the NHS. Suggestions include:

• Simplifying the prescribing process.
• Providing more training for healthcare professionals.
• Subsidizing costs to make private prescriptions affordable.
• Getting NICE to recognise more studies in foreign countries as part of the applicable evidence base.
  
  

Expanding the Evidence Base

One of the barriers to widespread acceptance of medical Cannabis is the lack of large-scale clinical trials. Increasing investment in research could help provide the robust evidence needed to change NHS guidelines and encourage more doctors to prescribe Cannabis.

Conclusion

The medical cannabis situation in the UK is a tale of contrasts. While the private sector has made strides in serving thousands of patients, the NHS remains inaccessible, mainly to the most seeking this treatment. Issues such as inconsistent quality, contamination, and reliance on radiation undermine patient confidence and highlight the need for industry reform. With proper investment in research, training, and regulatory changes, the UK has the potential to transform its medical cannabis industry into a more accessible and effective healthcare option for those in need.