Getting prescription cannabis meds in the UK legally: a beginner’s guide

Medicinal cannabis capsules in the UK containing 5mg THC and 10mg CBD (Image: Public Domain)

Cannabis-based medicines have been improving the health and quality of life of millions of people in many countries, for many decades, with very few harmful side effects. As a recent study noted: “Medical cannabis is increasingly used by Canadians, and patients around the world, to treat a broad range of medical conditions.”

If you live in the UK and you think that you might benefit from taking medical cannabis, you will be pleased to know that several legal pathways to obtaining this medicine have opened up since the law was changed in November of 2018. (I recently described one person’s experience with cannabis-based treatment in this Medium article: Prescription cannabis and quality of life: a case study from the UK.)

You can buy products containing CBD — one of the two main cannabis compounds with therapeutic properties— over the counter or online. However, any product that contains significant quantities of the other therapeutic compound — THC—requires a prescription.

Further complicating matters is the fact that the CBD market in the UK is a bit of a mess. As one expert has put it: “Given the murky legal status of the substance and the lack of current regulations within the industry, however, customers have been finding it tough to distinguish between reliable, high-quality products and lower-end products with little to no CBD.”

If you want to look into non-prescription CBD, I recommend the very helpful article from which that quote is taken. If you want to get medication that contains both CBD and THC, then keep reading as I describe one of the paths to achieving this: a private doctor’s prescription.

(Unfortunately, unless you believe that the rich should get better medical options than the poor, you won’t be pleased to know that the path of least resistance to legal UK use of medicinal cannabis is probably the most expensive. Nevertheless, I have laid out the steps below and at the end of the article, I will provide information about two alternative paths.)

Although we are approaching the third anniversary of the legalization of medical cannabis in the UK, it looks like only a handful of private medical clinics in the UK currently meet the legal requirements to prescribe cannabis-based medicine.

However, getting medicinal cannabis from one of these clinics is likely to be quicker, and is potentially more efficacious, than going through your GP and the NHS, but there are costs involved. The short version goes like this:

  1. Contact a cannabis clinic (see list below)
  2. Complete an initial assessment questionnaire
  3. Provide additional medical information
  4. Pay for and schedule a consultation (about £100)
  5. Go through the consultation process
  6. If approved, get a medical cannabis prescription
  7. Pay for and receive your medical cannabis (about £120 per month)

The Medical Cannabis Clinicians Society has compiled a list of medical cannabis clinics operating in the UK that are “CQC-registered.” This means they are monitored by the Care Quality Commission, the independent regulator of health and adult social care in England, which should ensure clinics meet appropriate standards and are accountable. Here’s a link to the MCCS CQC cannabis clinic list.

Step one is to contact a clinic. I am going to use Sapphire Medical for the purposes of this article but is likely that the other clinics operate in a similar manner (I have no personal or professional or financial relationship with Sapphire Medical, but I do know one of their patients).

Note that the physical location of the clinic need not be a factor in your selection given that video-based consultation is now widely available in the UK, and apparently meets government health guidelines, given its extensive use by NHS doctors during the pandemic.

Also note that at some point in this process you will need access to as many of your medical records as possible. These will be used to document your symptoms as well as previous diagnoses, treatments, and medication.

Step two is the completion of an assessment questionnaire which can probably be done online. Before engaging with you, the clinic will want to know that you are a good candidate for cannabis-based treatment, based on the way that this treatment is currently regulated (more on this later).

Basically, good candidates have serious, long-term health issues, including one or more of the following that negatively impact your quality of life: Anxiety Disorder, Chronic Pain, Multiple Sclerosis, Post-Traumatic Stress Disorder, Substance Use Disorder, Tourette’s Syndrome, Adult Epilepsy. Furthermore, at some point you will need to show that you have exhausted other therapies that have failed to resolve those issues.

Step three is the collection of any additional information that the clinic decides it needs to determine whether or not you are a good candidate for cannabis-based medication. You may get emails or phone calls asking for specifics about your conditions and past treatments. At some point, if you meet the clinic’s initial criteria, you should get an email saying you’re approved for a triage consultation.

Step four is to schedule and pay for a consultation (over Zoom or similar video-call system). Currently, you can expect this fee to be around £100. If the clinic does not say what the cost is, do not be shy about asking. This information should be freely available. Sapphire Medical publishes its costs online.

At this point, if the clinic has not already contacted your doctors to get your medical records it will do so, prior to going ahead with the consultation. (You can also supply records yourself if they are not with the NHS.)

Be sure to document and store of all your correspondence with the clinic (one patient told me that the clinic issues patients with an ID number this should be used in all clinic communications; if not, “they can lose track and get confused.”

Step five is the consultation with the doctor. Her task is to build a picture of your health problems, past and current conditions, treatments you have tried, and diagnoses you have received. It is important that you convey the extent to which your current health issues negatively impact your quality of life.

The doctor will probably explain the two main therapeutic cannabis ingredients, CBD and THC (see links below to read up on these). Many patients find a combination of these two ingredients to be effective without unpleasant side effects. Here’s an example of 10mg of CBD combined with 5mg of THC in capsule form.

Three methods of cannabis medicine delivery used in legal prescriptions: vape, oil drops, capsules

The doctor may also discuss the approved means of delivery for your medication, with the main choices available in the UK right now being vaping, oil drops, or capsules.

Step six is the ordering of your medication and this is triggered by approval of your request for medical cannabis. This approval can take a while because it is a committee decision, something that is stipulated by the current regulatory oversight, presumably due to the lack of depth in medical cannabis expertise in the UK at the moment. Furthermore, that committee may only meet once a week.

The source of your medicine will be one of the approved cannabis pharmacies in the UK. It is early days for all of them and you may encounter limitations and delays as they are working to expand the sourcing and processing of ingredients.

Step seven is when you use your payment card to pay for your medical cannabis and get a date for its delivery, which will probably be by courier. (As a reminder, a clinic like Sapphire estimates the cost to be £137 per month, inclusive of appointments and medicine.)

Be sure to keep all of your correspondence throughout this process and make notes on any commitments around delivery logistics. Do not hesitate to call the clinic if there are any delays.

At this point you might be asking yourself why this process is so complicated and expensive and lengthy. The answer is itself complicated, but a lot of it is down to the fact that all this new to the UK. However, things could be moving much faster, and probably would be, if more people in positions of power within the government and medical governance had more enthusiasm for cannabis as a medicine and fewer objections rooted in myths and prejudices about cannabis.

That said, let’s look at what you encounter if you turn to the NHS for cannabis-based medicine.

Since the end of 2018 it is has been possible to get cannabis legally prescribed by a doctor in the UK. This is noted on the NHS website, quoted here as of August 2021: “some cannabis-based products are available on prescription as medicinal cannabis.”

That very general statement encompasses both the process described in the previous section and the NHS approach to dispensing cannabis. However, in the very next sentence the NHS goes on to say: “These [cannabis-based products] are only likely to benefit a very small number of patients.”

At first glance, this sounds like a pretty dumb statement given the indisputable reality that millions of people around the world benefit from medicinal cannabis every day. You have to read the next sentence to understand what is being said: “Very few people in England are likely to get a prescription for medical cannabis.”

Why does the NHS think this? Because the NHS finds it itself in a position where it can only legally prescribe medical cannabis for the following conditions:

  1. children and adults with rare, severe forms of epilepsy
  2. adults with vomiting or nausea caused by chemotherapy
  3. people with muscle stiffness and spasms caused by multiple sclerosis (MS)

This article is not the place for a discussion of why the NHS is in this situation, but the effects appear to be stifling. According to this article in The Pharmaceutical Journal, in 2019 the NHS provided “just 18 prescriptions for cannabis-based medical products.” The article states that the Care Quality Commission found: “Only 6.5% of the total number of cannabis-based medical products prescribed in 2019 were prescribed through the NHS.”

If I find more recent stats I will post them here, but if you Google these words — nhs prescriptions for cannabis — you will find a lot of stories about families pleading with the UK government to allow the NHS do prescribe more cannabis for their loved ones.

An alternative to paying full price for a private medicinal cannabis consultation and supply might be Project Twenty21, a project that “allows eligible patients to access medical cannabis treatment at a capped price, and have their treatment tracked by Drug Science.”

The Drug Science website actually has a very helpful video on this page that generally describes a lot of the process steps listed above. You will have to dig a little deeper on the site to find out how the project itself operates.

Why go this route of sharing your personal medical experience? Well, the social benefits are potentially significant. Drug Science will use the data from Project Twenty21: “to provide evidence for NHS funding of medical cannabis treatment.”

And that brings me back to my own motivation for laying out the process of “going private” to get medicinal cannabis. Regardless of how people in the UK get their cannabis-based medicine, the more folks that do so, and share their experiences, the harder it will be for the authorities to continue to deny that cannabis-based medicine offers many tangible benefits to a wide range of patients.

If the UK government does make cannabis widely available via the NHS on a comparable cost basis to drugs like statins, beta-blockers, and opioids, then the benefits to the country will be huge. For example, beyond the patient benefits, the burden of care for people who look after other people will also be lightened.

My hope, shared by many others, is that we can all add to the mounting evidence of the efficacy and safety of cannabis as a medicine, evidence that will eventually force the UK government to expand the ability of the NHS to prescribe cannabis-based medication.

In my opinion this is a very realistic goal. Remember, it has been almost 25 years since the State of California, a state with an annual gross Domestic Product almost as large as that of the UK, decided the following:

“seriously ill Californians have the right to obtain and use marijuana for medical purposes where that medical use is deemed appropriate and has been recommended by a physician who has determined that the person’s health would benefit from the use of marijuana in the treatment of cancer, anorexia, AIDS, chronic pain, spasticity, glaucoma, arthritis, migraine, or any other illness for which marijuana provides relief.”

Disclaimer: The author of this article has no financial interest in any of the companies mentioned and does not consume cannabis in any form for any purpose.

About THC and CBD: Every responsible document about medicinal uses of the cannabis plant will tell you that this is a very complex topic, and a controversial one. So it is hard to find an objective, simplified account of the various compounds found in the cannabis plant (referred to as cannabinoids). This one from the Medical Cannabis Clinicians Society is pretty good and the MCCS website has more good information:

“Both THC and CBD have medical properties. THC is the cannabinoid that is the major part of recreational cannabis and in high doses can cause impairment. In lower doses it is a muscle relaxant, can help with sleep and many different causes of pain. It can also help with nausea and other chemotherapy related side effects. CBD does not cause impairment. CBD is often used in anxiety, epilepsy and pain management also. There is much overlap between the two when controlling symptoms.”

Links for more information: these sites will help you navigate the medicinal cannabis landscape in the UK.

Independent research around risk, tech, gender, ethics, healthcare, and public policy. Long history of learning, writing, and speaking. Based in Coventry, UK.