Explaining NHS cannabis prescriptions

A (very brief) history of medical cannabis in the UK

Like many Western countries, cannabis was made illegal in the UK back in the late 1920s.

The demonisation of the plant had begun almost half a century before that, but it was in 1928 when cannabis became a prohibited substance. Up until that point, you could take a stroll down to your local chemist and pick up a bottle of cannabis tincture fairly easily. It was prescribed for a range of illnesses and symptoms and was seen as a reliable and safe option for patients.

Before this, one part of the Cannabis sativa L. family tree, hemp, had been a titan in UK industry and defence. The only plant to ever receive a royal decree involving its production, with Henry VIII famously ordering all British farmers to grow it for naval purposes. It was only once the backlash against its psychotropic kin, marijuana/cannabis, began that we saw a decline in the cultivation of hemp and a move towards all things cotton.

How has the legislation surrounding medical cannabis evolved in the UK?

This prohibition was the status quo for a good 90 years. It was only after a series of high-profile cases involving severely epileptic children, culminating in the Billy Caldwell and Alfie Dingley cases, that the tide began to shift. The embattled plea's from these families and their advocates were heard, and the government realised that it was time for a change, leading to medical cannabis' eventual legalisation in 2018. 

Who is eligible for medical cannabis prescriptions through the NHS?

Not many. To quote the NHS themselves:

"Very few people in England are likely to get an NHS prescription for medical cannabis."

But why?

There are a few reasons, but one of the main issues is that NHS specialists are only legally allowed to prescribe three cannabis-based medicines. Medicines are split into two groups - licensed and unlicensed.

Both options have been proven to be safe for patients. The difference is that licensed medications have gone through more rigorous clinical trials and have been approved by the Medicine and Healthcare products Regulatory Agency (MHRA).

Private cannabis clinics can prescribe unlicensed CBPMs, like dried cannabis flower and some of the medical cannabis oil options.

Qualifying conditions for an NHS medical cannabis prescriptions

Currently, The NHS is only willing to consider cannabis-based prescriptions for:

• Children and adults suffering from rare, intense types of epilepsy
• Adults with chemotherapy-induced vomiting or nausea
• Patients dealing with muscle stiffness and spasms due to multiple sclerosis (MS)

It's not only the fact that the NHS is only willing to prescribe medical cannabis for a limited number of conditions that have patients opting for private medical cannabis prescriptions. Even if you do tick the above boxes, you may still not get your prescription.

Prescription process and eligibility criteria

Medicinal options derived from cannabis can only be prescribed within the NHS by a specialist doctor based in a hospital or under the direct supervision of a specialist. The same is true (specialist-only prescriptions) for private clinics, but the criteria for obtaining a private prescription are much more open. On top of this, there is simply a lack of qualified prescribers working within the NHS. This can leave vulnerable patients with very few options.

Since medical cannabis was introduced, the number of prescriptions provided through the NHS has been minuscule, and a lot of that potentially is due to the reluctance of specialists to take on the responsibility of prescribing medical cannabis, but there are other issues at play.

Professor Mike Barnes, one of the two NHS prescribing specialists, recently had to come out of retirement just to make sure there was still a pathway for children with severe epilepsy to receive a cannabis prescription through the NHS. 

What conditions outside of the NHS prescription criteria can medical cannabis potentially help?

One of the more often asked questions is, "Why doesn't the NHS offer medical cannabis prescriptions for more conditions?" - and a valid question it is.

The simplest answer is that the NHS needs to see cold, hard evidence and confirmation from clinical trials before prescribing any medicine for a specific health concern. And thanks to the almost century-long ban on all things cannabis-based, there simply hasn't historically been a lot of governmental funding available for researching the plant.

Thankfully, the last 15 years or so have seen a push from the private sector, and we are already seeing real results in terms of clinical trials for a host of conditions.

Private clinics may be the answer

Specialists working with private clinics have the legal ability to prescribe for a far larger list of health-related issues than the NHS, which includes, but is not limited to:

• Psychiatric - Anxiety, depression, OCD, PTSD
• Chronic Pain - Arthritis, back pain, migraines, fibromyalgia
• Gastroenterological - Ulcerative colitis, Crohn's disease, IBS
• Neurological - Parkinson's Disease, Alzheimer's disease, ADHD, epilepsy
• Sleeping Disorders - Insomnia, narcolepsy, restless legs syndrome
• Cancer - Chemotherapy-induced vomiting, cancer pain management, cancer-related anxiety

What does the future hold for the NHS and medical cannabis access?

We don't know exactly, but that constant push from families, advocacy groups, and now also government ministers isn't slowing down.

In late 2023, several MPs from both sides of the political spectrum banded together to call for a change in restrictive medical cannabis policies. In a letter penned to the Prime Minister, they requested that the government re-evaluate their current prescribing policies and allow a more direct pathway for children with severe, treatment-resistant epilepsy access to medical cannabis through the NHS.

As with most things' government-related, we don't expect any rapid movements - but, at the very least, it's a sign that the views surrounding cannabis as medicine are shifting at the highest levels of government. Hopefully, in the not-too-distant future, the changes being promoted become a legal reality.

If you are struggling to find the relief you need from conventional prescription medication, it might be worth exploring cannabis-based medicines.

Releaf has a team of prescribing clinicians experienced in offering the best cannabis-based prescription advice. Check out our free eligibility checker to find out if you might qualify for medical cannabis treatment in less than 30 seconds!

FAQs

Is there a NHS cananbis card scheme?

There is no NHS cannabis card. However, the Releaf Medical Cannabis Card is designed to help patients access medical cannabis legally in the UK. Our card serves as a way to verify that an individual has been prescribed medical cannabis by a qualified doctor, aligning with guidelines outlined by the UK government. The Releaf Medical Cannabis Card provides patients with an evidence-based, regulatory-compliant tool to support their treatment needs, ensuring they can prove their legal right to possess and use medical cannabis without fear of legal repercussions.

Are there any specific conditions for which the NHS is more likely to prescribe medical cannabis?

At the time of writing, the NHS is only willing to provide medical cannabis prescriptions for three specific health issues.

• Two rare forms of epilepsy (Dravet's Syndrome and Lennox-Gastaut Syndrome)
• Chemotherapy-induced nausea and vomiting
• Muscle spasticity caused by MS

What are the steps involved in applying for a medical cannabis prescription via the NHS?

The first step is to reach out to your GP, but only if you suffer from one of the three NHS qualifying conditions. Your GP will be able to give you a referral to see an NHS specialist, who can then review your case and decide whether to prescribe medical cannabis or not.

How does the NHS assess the eligibility of patients for medical cannabis treatments?

The NHS assesses eligibility based on two main criteria:

1. The patient must be suffering from a qualifying condition
2. Other treatment options must have been exhausted or found to be ineffective for the patient's specific case

What options are available if a patient is not eligible for medical cannabis on the NHS?

Private cannabis clinics, like Releaf, may be able to help. Private clinics can provide patients with access to medical cannabis prescriptions for a much larger scope of health concerns than the NHS.