Medical use of cannabis

Cannabis-based medicines are available in various forms and can be used to relieve the symptoms of several different health conditions.

Under the Misuse of Drugs Act 1971, cannabis is controlled as a class B drug. It is illegal to possess, produce, supply, import or export cannabis in the UK. The Misuse of Drugs Regulations 2001 allow for the legitimate use of some controlled drugs for medical, dental or veterinary purposes.

In November 2018, these regulations were updated to allow cannabis-based medicines to be prescribed to patients by specialist doctors. In November 2024, the government said that it had no plans to make further changes to this arrangement.

Cannabis-based medicines in the UK

To date, two cannabis-based medicines, Sativex (nabiximols) and Epidyolex (highly purified cannabidiol, ‘CBD’), have received a UK marketing authorisation (product licence), allowing them to be prescribed in the UK. One synthetic cannabinoid, nabilone, also has a marketing authorisation.

Doctors on the General Medical Council’s Specialist Register can also prescribe unlicensed cannabis-based medicines, where they think this would benefit an individual patient.

NICE and SMC approval for use in the NHS

The National Institute for Health and Care Excellence (NICE) assesses the clinical and cost-effectiveness of new treatments for use in the NHS under its technology appraisal process. NICE recommendations about new treatments must be implemented by the NHS in England and Wales, and they are usually also implemented in Northern Ireland. In Scotland, the Scottish Medicines Consortium (SMC) publishes recommendations about the use of medicines in the NHS.

NICE and the SMC have recommended Epidyolex (cannabidiol) as an option for treating seizures caused by two rare forms of epilepsy (Lennox-Gastaut syndrome and Dravet syndrome) and for seizures caused by the rare genetic disorder tuberous sclerosis complex (TSC).

Local funding decisions for cannabis-based medicines

In non-binding general guidance on cannabis-based medicines, NICE has also recommended that:

• Nabilone can be used to treat adults with nausea and vomiting caused by chemotherapy treatment, if other treatments have not worked.
• Sativex can be used to treat spasticity (muscle stiffness and spasms) in adult patients with multiple sclerosis, if other treatments have not worked.

Funding for these medicines is a decision for local integrated care boards in England, NHS health boards in Wales and Scotland, and the Health and Social Care Board in Northern Ireland.

NHS doctors who wish to prescribe these medicines to treat other conditions (‘off label’ use) or to prescribe unlicensed cannabis-based medicines must make an application for exceptional funding. In England, these are known as individual funding requests.

Cannabis-based medicines can also be prescribed privately.

Access to cannabis-based medicines

Patient groups and researchers have reported that patients face barriers in accessing cannabis-based medicines. They argue that these barriers have persisted since the law has been changed.

Only limited data on prescription numbers is available. The government has reported that there were around 5,000 NHS prescriptions for licensed cannabis-based medicines in the community in 2023. However, this figure does not include prescriptions issued in hospital settings, or privately.

Review of access to cannabis-based medicines

In 2018, the then Health Secretary, Matt Hancock, announced that he had commissioned a review of the barriers to accessing cannabis-based medicines in the NHS. The review focused on access to cannabis-based medicines for children with severe epilepsy. Its report was published in 2019 (PDF).

The review found that patients had high expectations about access to cannabis-based medicines, but that doctors were concerned about a lack of evidence about their effectiveness and safety. It recommended that a network of specialist doctors should be established to help generate new evidence about these medicines, that doctors and pharmacists should be reminded about guidance and education about cannabis-based medicines, and that more information should be provided to patients.

NHS England said that it has worked with other organisations to implement the report’s recommendations “to ensure that clinicians feel supported to prescribe a cannabis-based medicinal product” when appropriate.

Improving the evidence base for cannabis-based medicines

In October 2024, the government said that it was committed to research that will improve the evidence base for cannabis-based medicines, acknowledging that, “until the evidence base improves, prescribers will remain reticent in prescribing and no decision can be made by the NHS on routine funding”.

It noted that two clinical trials of cannabis-based medicines for the treatment of difficult-to-treat epilepsies have been funded by NHS England and the National Institute for Health and Care Research (NIHR).