This week a man in Shetland has had his legal cannabis prescription confiscated and withheld by Police Scotland, and so The Hemp Community Podcast asks is medical cannabis really legal in the UK?
In this week's episode we discuss the state of the UK's medical cannabis sector and how we can do better by putting people before profit!
Want to have your say? Listen til the end to learn how you can get involved >>
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Episode 12 – Is medical cannabis REALLY legal in the UK?
Hi there and welcome to the Hemp Community Podcast. My name is Dan and in this episode we’re going to be talking about a particular cannabis conundrum; in a nutshell the Government assures us that cannabis is now legal for medical use but nobody seems to have any unless it’s through a private prescription and even then there appear to be significant hurdles and ongoing risks associated with accessing a supposedly lawful supply of cannabis.
For anyone new to the podcast, The Hemp Community is a social enterprise operating in Edinburgh, Scotland and our business exists for people, not for profit. We run a CBD shop and you’ll probably be aware that we also trade through our website hempcommunity.scot. The Hemp Community sells a range of cannabis products, specifically CBD rich oils and other related products, but the real work we do is answering questions and offering support for the process of using cannabinoids for health. As we’ve discussed in previous episodes most people using CBD are doing so to address or pre-empt a health concern. At the hemp community we teach people that using CBD is not just a chemical reaction nor is it the case of just finding the so-called “right product”; we want people to understand that using cannabinoids like CBD and THC is less like pharmacy and more like therapy. The twist is that those seeking cannabinoid therapy will learn that they are co-therapist and as they learn the ropes they’ll eventually take control of the process for themselves. My position is that the process is more important than the product, in the same way that when we appreciate art, we value the painting more than the paint, and of course we value the artist most of all.
In this episode we’re going to look at the product-focused, profit-driven medical cannabis industry in the UK. At the time of recording, nearly 4 years have elapsed since the Home Office adjusted the law to permit cannabis on prescription. In that time the private sector have picked up the ball and ran with it, leaving behind many who cannot afford to follow. Notably cannabis has not been embraced by the public health system, and as a result the general public remains either ignorant or misinformed about the legal status of cannabis products and more importantly how these products can be used by any of us to look after our bodies’ endocannabinoid system.
In case you don’t know, the endocannabinoid system is the part of you that makes and uses chemicals called cannabinoids, it can even use cannabinoids made by plants like cannabis. You have cannabinoid receptors throughout your body in almost every tissue, and their job is to keep the other systems in balance within themselves and between one another. Amongst other things, cannabinoids are used to regulate the nervous system, immune system, digestion, reproduction and even skin pigmentation. In theory a happy healthy endocannabinoid system makes for a happy, healthy person, and in fact most people probably have fairly well nourished endocannabinoid systems without needing an exogenous supply. Simply put; your endocannabinoid system looks after you and it’s your job to look after it. There are lots of practical things you can do to support endocannabinoid function; a diet full of omegas 3,6 and 9, lots of sunshine and socialising, regular exercise and even activities like singing and dancing are all associated with up-regulation of the endocannabinoid system. The elephant in the room is the cannabis plant; a rugged, flowering herb that produces prolific quantities and combinations of cannabinoids that our bodies can safely consume, utilise and recycle. As a bonus, cannabis plants produce nutritious seeds and culinary oils, it’s long fibres can be used in textiles, and cannabis plants can even be used to produce materials as diverse as concrerte, explosives and eco-friendly plastics.
In a sane world, cannabis would never have been made illegal in the first place. The enforcement of drug prohibition always leads to an epidemic of harm as end-users are pushed towards illicit markets that operate without a duty of care. The obvious example is alcohol prohibition in 1920’s America; a disastrous experiment that had major social and economic repercussions, and was even implicated in the deaths of thousands of people who consumed bootleg spirits and died from methanol poisoning. You may be interested to learn that during this period of alcohol prohibition, citizens who could afford the fees could acquire a prescription for alcoholic beverages in particular Scotch Whisky which was popularly if erroneously regarded as a cure-all for the middle class and disaffected. Supposedly Laphraoig Whisky adopted their now iconic pharmacy-green bottle and stark black and white label, which harmonised with the peaty and medicinal aromas in their single-malt. Wealthy patients could legally purchase and consume prescribed whisky, and I often wonder if the script said to consume the drink with a drop water or over ice. Under prohibition, criminal gangs control the bulk of the market and private practitioners can make easy money catering to the willing few with the available funds.
This is where comparison between cannabis and alcohol ends, because nobody who has so much as glanced at the available evidence would conclude that cannabis and alcohol share more than a few surface-level similarities. Although there are many useful alcohols put to work in a multitude of chemical and industrial applications. Despite an honourable mention for the alcohols that sterilise medical equipment, as a consumer product alcohol is overwhelmingly associated with harm to individuals, communities and society. A&E wards overflow at the weekends with waves of alcohol related injury and this is just the tip of the iceberg; the NHS spends billions every year treating physical and mental illness related to chronic, supposedly moderate alcohol consumption. Cannabis is nothing like alcohol; conversely there is evidence to suggest that cannabis users are less likely to need hospital treatment for injury or illness resulting from use of the drug, and it is possible to infer that the protective factor from the use of cannabis could prevent a number of medical interventions down the line, potentially saving the health service billions. Above and beyond it’s potential as a preventative medicine, cannabis is already safely used as a treatment for a wide variety of indications, often prescribed for pain, mood disorders and sleep by doctors all over the world. Perhaps most importantly, cannabis is well tolerated by most patients to the extent that they can legitimately enjoy using the drug with the beneficial and cumulative side-effects. Cannabis is understood to be safe and effective, and unlike the vast majority of medical treatments it is generally enjoyable.
The psychotropic experience of cannabis, the “high”, is only one aspect of what the plant has to offer, and yet it commands the attention of patients, practitioners and policy makers alike. It is the popular, though ill-informed perception of that “high” feeling that prohibitionists use to promote their ideology, seizing on the cannabis plant’s ability to entertain our minds as if this is something unusual and dangerous. As if feeling stoned is shameful and worthy of disgust. If you are a cannabis user, there is no reason to be ashamed or embarrassed about that choice. If you do something stupid while you’re high that’s on you, but using cannabis by itself doesn’t make you any less worthy and I would hope that it doesn’t effect your esteem. Responsibly used cannabis has long-term benefits including reducing risk of future healthcare needs, and it just so happens to be a delight to consume, one of life’s greatest and most repeatable pleasures; as I often say, cannabis is only illegal because it works.
Now we get to the detail; the legality of the products. Cannabis on prescription is legal in the UK, but the vast majority of cannabis consumed in this country is supplied by the black market. For example, in the last episode of the podcast “Cannabis by numbers”, we learned there are roughly 360,000 cannabis users in Scotland, and about 3000 of them are accessing cannabis on a private prescription. The implication here is that 99%+ of the cannabis consumers here are using products grown, sold and consumed without any medical or basic regulatory oversight. These few thousand medical cannabis prescriptions being fulfilled barely scratches the surface of consumer demand. You may be wondering if I am deliberately conflating the medical and recreational use of cannabis, and in this instance yes I am. Generally I’m not a fan of the phrase “recreational cannabis” because it ignores the fact that regardless of your intention, once consumed cannabinoids will be used by your endocannabinoid system to perform neuro-physiological and immune-regulatory tasks. Even if someone is just using cannabis for fun, they will still be benefitting from its protective factor, and indeed many so-called “recreational” users will reveal when pressed that their cannabis use offers them amongst other benefits, a reprieve from stress, good sleep and a way to avoid alcohol. Some surveys have even claimed that cannabis users have better sex lives! My point here is that focusing on the debate of prescribed versus un-prescribed cannabis products, we risk alienating the people who are using the products, and we end up with policy that reflects a narrow band of opinions. For what its worth, my opinion is that all cannabis is medicine, you just have to be flexible with your thinking.
Generations of people around the world have grown up with cannabis depicted as an enemy of health and well-being; as a culture we have been conditioned by propaganda that has attempted and broadly failed to stymie demand for cannabis. If you’ve ever wondered “why don’t scientists wade in with some proof” bear in mind the same political establishment that upholds cannabis prohibition also gets to decide what kinds of academic research into the plant is permitted. Historically research licenses for cannabis would only be given to projects that support the UK government’s chosen narrative; that cannabis is harmful and NOT a medicine. The obvious problem that we run into here is that if you only look for evidence of harm, you will only find evidence of harm. The absence of evidence of medical utility is used as a proof that there is no utility, when in fact the gap in knowledge is a conscious decision of government to protect the status quo.
Successive generations of doctors, nurses and other frontline healthcare professionals in the NHS all trained and practiced in a context that was hostile towards cannabis; taught to distrust the plant. The people in positions of power within these institutions have never learned about the physiological mechanisms that facilitate the effects of cannabis, nor have they ever considered a positive case for cannabis. The very existence of the endocannabinoid system should be regarded as a landmark in medical history, but for decision-makers, it represents an extremely inconvenient truth; the endocannabinoid system exists and therefore cannabis is in some weird way a medicine. Government policy however, takes precedence over the facts and for decades policy remained unchanged in the face of cannabis’ obvious medical potential and well-documented history of use throughout human civilisation even in the modern era.
2018 is the year the UK’s medical cannabis policy changed; the home secretary at the time was Sajid Javid who changed the law to recognise the medical utility of medical cannabis. The irony is that even as this law came into place the UK was already the world’s largest exporter of medical cannabis products. In fact, the UK has been exporting medical cannabis since 2011 when the Home Office issued an exclusive license to the well known company GW Pharmaceuticals, who produce and sell a range of patented isolate-based cannabinoid preparations, including their flagship oils Sativex and Epidiolex. In the nineteen nineties the government gave GW their research license and by 2011 the Home Office decided there was enough evidence to allow GW to export their cannabis medicines, while simultaneously claiming that cannabis had no medical utility. I’m curious to know what type of evidence was presented to win such favourable treatment from the Home Office, and call me cynical, but I wonder if that evidence came in the form of a paper bag full of cash or if ministers now take card? Either way, by the time medical cannabis became legal in 2018, the UK was already a well-established presence in the international medical cannabis market. Nonetheless, it is still borderline impossible to access cannabis on the NHS and the process of acquiring a private prescription leaves much to be desired.
As with anything in life, there are positives and negatives that we can see in the private medical cannabis sector. In the UK, we are accustomed to free healthcare at the point of need, so for many people the idea of paying for an appointment and a prescription takes a little getting used to. Thanks to changes in the law, the process of acquiring a medical cannabis prescription in the UK has become more streamlined and as the private clinics have grown the cost of a consultation has decreased over time. Most services charge between fifty and a hundred pounds for an appointment, and the prices of the products vary depending on category, potency, quantity, branding and vendor. Some prescriptions cost less than a hundred pounds, although some can run into the thousands; a steep recurring cost for a medicine that grows in dirt. At a particular disadvantage in this system are the families of children with intractable epilepsy; for whom the medical cannabis law was changed in 2018. Many of these children, whose seizures are successfully controlled by medical cannabis oils, are having to pay for these prescriptions privately, and they meet additional barriers and expenses because the UK private clinics only cater to adults; there is no private paediatric medical cannabis clinic in the UK, so many of these children are being treated by doctors in other countries. Families continue to fret over money while politicians solicit donations from pharmaceutical lobbies. It’s cruel and its deliberate; the government has known this was an issue even before the pandemic took the limelight.
There are many stories of patients very content with the level of service they get from the private sector; some qualify for subsidies and can access cheaper cannabis medicine as a result. Almost every patient I’ve spoken to relays that one of the most important aspects of their experience is being taken seriously by a medical professional. Instead of being fobbed off with a copy&paste reply about the supposed harms of cannabis, patients feel reassured that their doctor actually understands. This is especially important for people who are already cannabis users, i.e. cannabis users who are moving from the black market to a legal prescription. This type of cannabis patient often has an established relationship with the plant, and while they can be shy they are normally a bit better at articulating their cannabis preferences. Whether or not the doctor listens is another question.
One patient laughed as they told me how their initial prescription lasted a week, rather than the month that the clinician intended; this particular user is used to consuming larger quantities of cannabis than their doctor had experience of, and after their prescribed meds ran out they had to wait a couple of weeks for an appointment and new prescription. At the least they got to say “I told you so”. During the interim the black market stepped in and filled the gap. This individual still accesses their legal prescription because it works out cheaper than the llegal market, but they also report that the quality is proportionate to the savings and they continue to acquire cannabis from illicit sources occasionally because pharmaceutical grade products often lack the flavours, aromas and enjoyable effects of old-fashioned weed. The difference in perceived quality is largely due to production processes; pharmaceutical companies produce en masse and blast their crops with gamma radiation to sterilise the buds. The unfortunate side-effect of this is that many of the terpenes of the plant are lost. The product will then sit in plastic packaging for weeks or months as it is moved from one storage location to another and eventually into the hands of patients. It is worth noting that none of these products are made in the UK; the afore mentioned GW Pharmaceuticals does not typically serve the domestic market. Most of the legally prescribed cannabis in the UK comes from producers in countries like the Netherlands, Canada and Israel; domestic production is still tightly regulated despite enormous demand.
The UK’s medical cannabis policy is informed by the opinions, experiences and practices of pharmaceutical companies. Currently the handful of operators in the private sector enjoy a type of regulatory capture; policy written with them in mind and very little room for competitors to access the market. Policy discussions invariably end up getting bogged down in details such as what defines a trace percentage of THC, or some other such triviality. These types of details serve as a convenient foothold for pharmaceutical reps who are used to dealing with spreadsheets, percentages and milligrams. Meanwhile in the real world, cannabis is a weird messy plant that works perfectly well without strict guidelines tying it down; in fact received wisdom would suggest that it works better when it’s free.
Freedom to choose is one of the many arguments in support of legalising cannabis; because cannabis effects everyone differently, patients should be able to choose what product they use and how much they consume. Cannabinoid tolerance is a strange and imprecise science; a dose that would floor some users might be a little pick-me-up to others. At the Hemp Community we always suggest to start off with a low dose and gradually increase over time; as you gather experience you will learn what feels right for you and your endocannabinoid system. There are thousands of CBD products already available over the counter in the UK, and that’s before we even start to think about mixing and matching products with different cannabinoid profiles. Any products that contain THC above a trace amount are considered controlled substances and as such are only available on a private prescription, but as I mentioned earlier in the podcast the specific product you are prescribed may well depend on the clinic’s relationship with its suppliers. I’ve lost track of how many customers have been prescribed something that is clearly a bad match for them; sometimes too low in THC but more often too high. Some patients feel pressured to buy more expensive products and I’ve even heard of patients having to argue with their doctor over the brands they are being offered. Distressingly, there is a sense among some of those accessing legal medical cannabis that the clinics exist merely to capitalise on a captive-market of vulnerable users, and indeed these clinics are commercial operations; they are in it to profit. Even a prescription that is too strong for comfort won’t do any lasting harm, and every new appointment is another current in the revenue stream.
I would also like to add that the majority of stories that I’ve heard about medical cannabis in the UK are positive; the times are changing and there has been some progress, but the legal market is still nowhere near fulfilling the demand for cannabis. Currently, legal cannabis patients represent less than 1% of cannabis users, and the most obvious barrier to the remaining 99% is financial. Let there be no doubt that there are probably millions of people in Scotland who could replace more harmful substances and practices with a little bit of cannabis. Think of all the painkillers, sleeping tablets and anti-depressants that could be avoided if we taught people how to nourish their endocannabinoid systems. Imagine living in a society where cannabis is seen as a public health opportunity and not a threat.
Unfortunately, we are nowhere near that particular state of affairs in the UK, in fact it’s still common for news stories to emerge detailing medical cannabis patients who have had their cannabis confiscated by police. As a result, most medical cannabis patients routinely carry private medical documents including prescriptions and letters signed by their consultants just in case the police have questions about the smell, but it is still perfectly possible for an officer to take away a patients’ medicine. Just today I read about an incident of exactly that happening in Shetland; a clearly labelled and documented, supposedly legal cannabis product removed from a legitimate cannabis patient. Part of the reason for this may well be the discretion of individual officers, I mean lets consider the mathematics here; if 99% of cannabis is illegal what’s to say that this prescription and packaging aren’t counterfeit. Perhaps its best not to take the risk and just confiscate the cannabis before there’s any trouble. We are dangerously far from the mainstream acceptance of medical cannabis, never mind un-prescribed or homegrown weed.
So back to the original question, is medical cannabis REALLY legal in the UK? Well, sort of; cannabis is legal if you can afford the paperwork but even then the cops might take it off you. Meanwhile the NHS doesn’t seem to have any plans to start using cannabis in hospitals, and so the illegal market is still the de facto supplier of the country’s weed. Whatever the providence, whether you are using cannabis from a clinic or a street dealer, you are not safe from the law.
The only way to neutralise the harm from cannabis is to legalise the plant and keep it simple; if it’s legal for one it’s legal for all and it should be easy for anyone to purchase, consume, grow or sell. Make it easy for small businesses to access the market; we already have similar systems that allow boutique distilleries and breweries with modest oversight. Tax the crop but take it easy; if the prices start going up people will go back to the illegal markets. It’s time to grow up and start taking cannabis seriously.
thanks for listening to this weeks episode, if you’d like to get in touch or you’d like to share your story, send an email to email@example.com. Alternatively head over to the website and contact us there! Until next time!