Medical use of cannabis

Under the Misuse of Drugs Act 1971, Cannabis is a controlled drug. The Act makes it illegal for people to possess, supply, produce, or import/export controlled drugs.

The Misuse of Drugs Regulations 2001 allows for the legitimate use of controlled drugs – substances are divided into five “schedules” which determine how they may be used.  Changes to these regulations in November 2018 have meant that unlicensed cannabis-based medicinal products can now be prescribed under certain circumstances.

Review of the scheduling of cannabis medicinal products

There was increased debate on the medical use of cannabis products in 2018.  Much of this focused on the cases of children with rare and severe forms of epilepsy, whose families reported that they had benefited from the use of cannabis products.

In a statement on 19 June 2018, the Home Secretary said that the position in the UK on this issue was not satisfactory.  He announced that the Government would review the scheduling of cannabis. There were two parts to the review:

• Part one was undertaken by the then Chief Medical Officer, Professor Dame Sally Davies, and looked at the evidence for the use of cannabis-based medicinal products. She reported that there was conclusive evidence of the therapeutic benefit of cannabis medicinal products for certain medical conditions and recommended that the whole class of cannabis-based medicinal products be moved out of Schedule 1; and
• Part two was undertaken by the Advisory Council on the Misuse of Drugs (ACMD) and provided advice on whether certain products should be rescheduled. Based on its short-term review, the ACMD advised that cannabis-derived medicinal products of the appropriate medical standard should not be subject to Schedule 1 requirements. Once a definition of a Cannabis-derived medicinal product has been developed, the ACMD advised that products meeting that definition should be moved into Schedule 2 of the Misuse of Drugs regulations.

A longer term ACMD review of the rescheduling of cannabis-based medicinal products was published in November 2020.  The report states that the scheduling of these products remains appropriate, but that the impacts of this change will be gradual and, therefore, further review is recommended in the future.  The ACMD highlighted the importance of establishing a patient registry for cannabis-based medical products, and the commissioning of further research in this area.

A change in the law

On 26 July 2018, the then Home Secretary announced that, following this advice from the Chief Medical Officer and the initial ACMD review, he had decided to reschedule cannabis derived medicinal products. 

In November 2018, the law changed to allow the prescribing of unlicensed cannabis based medicinal products in certain circumstances.  The Regulations included a definition of these products and set out that only doctors on the GMC specialist register could prescribe these. These doctors would predominately be prescribing unlicensed products since only two cannabis-based medicines have a marketing authorisation (often known as a ‘licence’) in the UK. 

There are two cannabis-based medicines that have received marketing authorisations for use in the UK.  Sativex is licensed for use in the treatment of spasticity in Multiple Sclerosis. Epidyolex is licensed for use in the treatment of seizures in children with Lennox-Gastaut syndrome, Dravet syndrome, and tuberous sclerosis complex. 

Prescriptions for cannabis-based medicinal products and concerns raised

It has been reported that there have been few prescriptions for unlicensed cannabis based medicinal products since the change in the law but only limited data on this is available.  Patient groups and families have expressed concerns about prescribing and have called for more action in this area.  Professional bodies and senior clinicians, however, have said there is a need for further evidence and have called for randomised controlled trials to look at the benefits and harms of these products.

A review into Barriers to accessing cannabis-based products for medicinal use on NHS prescription, was published by NHS England and NHS Improvement in August 2019. It found that clinicians were reluctant to prescribe unlicensed medicinal cannabis-based products to children with severe epilepsy, particularly in the absence of sufficient evidence to help them balance potential benefits against potential harms. The Review recommended further research, including at least one randomised control trial, to address the lack of evidence into the safety and effectiveness of cannabis-based medicinal products.  NHS England, NHS Improvement and the National Institute for Health Research have agreed support in principle for two randomised Controlled Trials on the use of cannabis products in the treatment of Epilepsy.

In November 2019, the National Institute for Health and Care Excellence (NICE) published guidance on prescribing cannabis-based medicinal products for people with intractable nausea and vomiting, chronic pain, spasticity and severe treatment-resistant epilepsy.

The Medical Cannabis (Access) Bill

The Medical Cannabis (Access) Bill was introduced by Jeff Smith MP, who came seventh in the Private Member’s Bill ballot for the 2021-22 Parliamentary session.  It has its Second Reading on 10 December 2021.

The Bill aims to improve access to cannabis products for medical purposes through two measures:

• Expanding the ability to prescribe unlicensed cannabis medical products to General Practitioners (GPs) who are on a register maintained by the General Medical Council; and
• Establishing a Commission for the assessment of cannabis based medicinal products.

In June, Mr Smith provided the following information on the Bill to the House Magazine, stating that the aim was remove some of the barriers which prevent patients accessing medical cannabis products:

My bill is aimed at breaking through the barriers stopping patients being able to be access medical cannabis. It’s a campaign that I’ve been involved in for some time, and although medical cannabis is legal, lots of patients aren’t able to get NHS prescriptions. “I’ve got constituents who are affected by this, as have many other MPs. One of my constituents, for example, is paying a fortune for a private prescription for his grandson, and it shouldn’t be like that. “It is a complicated issue, but I’m looking forward to working with ministers and officials on how we might solve the problem.

The Bill and associated documents are provided on the Parliamentary Bill page, Medical Cannabis (Access) Bill.