Early Attitudes and Prohibition

Before the 20th century, cannabis was widely used in Britain for medicinal purposes. In the 19th century, doctors prescribed cannabis-based tinctures for conditions such as pain, muscle spasms, and insomnia. Queen Victoria was reportedly given cannabis by her physician, Sir J. Russell Reynolds, to help with menstrual cramps.

However, attitudes toward cannabis changed in the early 20th century as concerns over drug use grew. In 1928, the UK classified cannabis as an illegal substance under the Dangerous Drugs Act, following international pressure from the League of Nations. Over the following decades, cannabis was increasingly associated with recreational drug use rather than medicine, and it remained illegal under the Misuse of Drugs Act 1971, which classified it as a Class B drug.

Growing Support for Medical Cannabis

By the late 20th and early 21st centuries, scientific research on cannabis and its medical benefits began to challenge existing legal frameworks. Studies suggested that cannabis-based medicines could help manage conditions such as epilepsy, multiple sclerosis (MS), chronic pain, and chemotherapy-induced nausea.

Public awareness of medical cannabis increased significantly due to high-profile cases of individuals using cannabis to treat severe health conditions. One such case was that of MS patient Elizabeth Brice, who campaigned for legal access to cannabis after finding it alleviated her symptoms. In response to increasing pressure, the UK government allowed limited research into cannabis-based medicines, leading to the development of Sativex, a cannabis-derived spray for MS patients, which was approved for use in the UK in 2010.

The Role of High-Profile Patient Cases

While Sativex was a step forward, it remained expensive and inaccessible to many patients. The real turning point in the UK medical cannabis debate came in 2018 with two high-profile cases: Billy Caldwell and Alfie Dingley.

Billy Caldwell, a young boy with severe epilepsy, had been using cannabis oil successfully to reduce his seizures. However, when his mother tried to bring his medication into the UK from Canada, it was confiscated by customs officials. Billy subsequently suffered a series of life-threatening seizures, drawing national media attention.

A similar case involved Alfie Dingley, another young epilepsy patient whose seizures significantly decreased with cannabis oil treatment. His family launched a campaign to gain legal access to medical cannabis, receiving widespread public support.

These cases forced the UK government to re-evaluate its position. In response to mounting public and political pressure, Home Secretary Sajid Javid announced a review of medical cannabis laws in June 2018.

Legalisation of Medical Cannabis in 2018

In November 2018, the UK government officially legalised medical cannabis. The Home Office reclassified cannabis-based products for medicinal use (CBPMs) from Schedule 1 (drugs with no medical use) to Schedule 2 (drugs with recognised medical benefits but still subject to strict regulation). This change meant that specialist doctors (not general practitioners) could prescribe cannabis-based medicines under certain circumstances.

However, the new legal framework was highly restrictive. Prescriptions could only be given for conditions where other treatments had failed, and patients needed approval from a specialist consultant. The National Institute for Health and Care Excellence (NICE) set strict guidelines, recommending medical cannabis only for severe epilepsy, chemotherapy-induced nausea, and spasticity in MS. Many other conditions, including chronic pain, were not covered by NHS prescriptions.

Limited Access and Barriers to Prescription

Despite the legal change, access to medical cannabis in the UK has remained difficult. Several barriers prevent widespread prescription and use:

1. Strict Prescription Guidelines

NICE’s guidelines are highly restrictive, meaning that even eligible patients struggle to get a prescription. Many doctors remain hesitant to prescribe medical cannabis due to a lack of training and concerns over legal liability.

2. NHS Reluctance

The NHS has been slow to embrace medical cannabis, largely due to concerns over cost and insufficient clinical trials. As a result, the vast majority of prescriptions for cannabis-based medicines come from private clinics, making them inaccessible for many patients due to high costs.

3. Cost of Private Prescriptions

Private clinics charge between £150 and £300 for an initial consultation, and monthly cannabis prescriptions can cost anywhere from £200 to over £1,000, depending on the dosage and type of product. These high costs force many patients to turn to the black market.

4. Limited Product Availability

Most cannabis-based medicines must be imported, which increases costs and delays. Unlike in countries such as Canada or Germany, the UK does not have a large domestic medical cannabis industry, further limiting supply.

5. Stigma and Lack of Doctor Training

Many doctors are reluctant to prescribe cannabis due to stigma and insufficient training on its medical uses. A 2019 survey by the British Medical Journal found that many healthcare professionals felt unprepared to prescribe cannabis-based treatments.

The Rise of Private Clinics

Due to NHS reluctance, private cannabis clinics have emerged as the primary source of medical cannabis prescriptions in the UK. Since 2019, several private clinics have opened, offering consultations and prescriptions for conditions such as chronic pain, anxiety, and PTSD.

These clinics have provided an option for patients unable to get NHS prescriptions, but the high costs remain a major barrier. Advocacy groups continue to push for greater NHS involvement in medical cannabis to make treatment more accessible.
The Future of Medical Cannabis in the UK

While the UK’s medical cannabis system is far from perfect, there are signs of progress. Campaigners, patients, and advocacy groups continue to push for broader access, and some politicians have expressed support for further reform.

1. Expanding NHS Access

There is ongoing pressure on the government and NICE to update guidelines and expand NHS access to medical cannabis. If more clinical trials demonstrate its effectiveness, NHS prescriptions may become more widely available.

2. Domestic Cannabis Production

The UK has one of the world’s largest legal cannabis cultivation industries, but most of it is for export. If domestic production for medical use increases, prices could fall, making cannabis treatments more affordable.

3. Legalisation of Recreational Cannabis?

Some campaigners argue that legalising recreational cannabis could help medical patients by improving access and reducing stigma. While the UK government has so far resisted full legalisation, shifts in public opinion and international trends could influence future policy changes.

Conclusion

The legalisation of medical cannabis in the UK in 2018 was a historic moment, but the system remains flawed. Strict guidelines, NHS reluctance, high costs, and limited doctor training have left many patients unable to access treatment. While private clinics offer an alternative, they are expensive, creating a two-tier system where only those who can afford it benefit.

The future of medical cannabis in the UK depends on continued advocacy, policy changes, and further research. As global attitudes towards cannabis evolve, the UK may eventually follow other countries in making medical cannabis more accessible and affordable. For now, many patients remain in limbo, struggling to obtain a treatment that is legal in name but not in practice.