Long before Dr Jennifer Forbes could prescribe medical cannabis, her patients were already teaching her about it.

While working in community addiction services, she began asking people more closely about their cannabis use. Many described using it to manage the physical and psychological effects of withdrawal, prompting her to consider its possible therapeutic role.

“Many reported it helped withdrawal symptoms such as muscle pains and sleep,” she says. “This interested me particularly as a possible aid to opiate reduction and an alternative to benzodiazepines.”

From general practice to addiction medicine

Dr Forbes did not set out to work in addiction medicine. After qualifying from the University of Dundee, she began training in anaesthetics before realising that general practice was a better fit. She also spent a year with a community mental health team in Melbourne, Australia.

Back in the UK, while working as a locum and raising her family, she took on some sessions at the Edinburgh Homeless Practice. She initially found the prospect daunting, but soon discovered how much she enjoyed the work. The experience changed the direction of her career, leading to 17 years in community addiction services, including time as a Clinical Lead.

Her work brought her into contact with people experiencing complex combinations of mental ill health, chronic pain, substance dependence and social disadvantage. It also gave her a perspective on cannabis that differs from that of many clinicians entering the field.

The change in the law prompted her to make medical cannabis part of her professional development plan. She began reading about the subject and asking patients more detailed questions about their experiences. “Many of my patients used cannabis, but I hadn’t thought of it as a possible treatment option until it became legal to prescribe in 2018,” she explains.

Her interest increased after she attended an educational event where experienced consultants shared their own prescribing experiences and the positive outcomes they had seen in patients. Their stories, together with what she learned about the safety profile of medical cannabis, convinced her that this was a credible area of medicine worth exploring further.

Balancing therapeutic potential with possible harm

Dr Forbes’ experience has made her acutely aware of the complexity surrounding cannabis use. From the outset, she had reservations. “I was concerned about prescribing cannabis flower and potentially promoting vaping, particularly given the issues for the younger population and my background and experience in addictions,” she says.

As an active prescriber, that concern now sits alongside the positive outcomes she hears from patients and informs how she thinks about risk, product choice and appropriate clinical boundaries. “The domination of inhaled products as opposed to oral products, and the recreational names, was certainly surprising,” she says.  “Patients have taught me a lot about different products, and I consider product type and potency as well as quantity for safe effective treatment.”

Her clinical background also helps her recognise situations that may require particularly careful conversations. “Hearing positive feedback from the majority of patients is incredibly rewarding,” she says, “but managing expectations of heavy cannabis users can be difficult, and discussing cannabis use disorder in the private virtual clinic setting can be particularly challenging.”

Finding a route into prescribing

Although Dr Forbes developed an interest in the field soon after the 2018 legal change, entering it professionally was not straightforward. “I was very disappointed to learn that as a GP I wouldn’t be able to initiate treatment and quickly discovered this was a significant barrier to gaining employment in the sector.”

Her experience in addiction-service leadership, together with professional connections in pain medicine, helped her secure a prescribing role in 2022.  Entering the sector also introduced Dr Forbes to the realities of working with fast-developing start-up clinics. Looking back, she says she wishes she had known more about “the financial risks associated with start-ups and the many ‘experts’ I would need to understand and learn from.”

Her early experiences taught her to look closely at a clinic’s culture, clinical governance and approach to risk. Her advice to clinicians interested in entering the sector is practical: “Research the clinics and approach one that aligns with your risk-management and patient-safety ideals.”

Dr Forbes is now a GP prescriber, co-founder of Borders Pain Clinic, Medical Director for an online clinic and an Executive Member of the Medical Cannabis Clinicians Society, bringing experience in addiction, mental health and chronic pain to the developing field.

Encouraging informed caution

Dr Forbes understands why many clinicians remain hesitant, pointing to the limited number of randomised controlled trials, uncertainty about how to assess real-world evidence, and understandable concerns about prescribing unlicensed controlled medicines.

She does not think clinicians should ignore those concerns. Instead, she says “I would encourage any interested clinicians to read around the subject and consider the safety profile of medical cannabis compared with many routine medications.”

Her approach is shaped by what patients tell her, but also by her experience of the risks. She believes it is possible to recognise the benefits of medical cannabis while remaining alert to potential problems, especially when chronic pain, dependence and heavy cannabis use overlap.

Looking ahead

What gives Dr Forbes the most hope is hearing from patients who feel treatment has made a difference. She believes these experiences will help more people understand medical cannabis and consider it as a treatment option. “I feel this would be helped by some form of legalisation and a move to prescribing more oral products that avoid the potential harms of vaping,” she says.

Her preferred direction for the sector reflects the balance that has defined her career: widening access to potentially helpful treatment while taking questions of dependence, delivery method and patient safety seriously.

Away from clinical work Dr Forbes is also an accomplished runner who has represented Scottish Masters athletics. 

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