Access, referrals and prescriptions
1. How do I get a prescription for medical cannabis?
At the time of writing, the NHS is not prescribing medical cannabis, so patients must be prepared to pay for a private prescription. However, an NHS specialist is legally permitted to prescribe the medicine, so it always worth asking! See question 2 for more on this.
Find a clinic on the internet (a Google search for medical cannabis clinics will give you a range of choices, or have a look at our clinic directory) and fill in the details required – this usually includes information about your medical history.
When the clinic responds, they will provide next steps which will vary by provider. You may need to speak to your GP for a referral letter, or ask them to release your medical notes to the clinic. They may contact your GP on your behalf. Your records will be sent to the clinic’s consultant who will decide whether you are eligible for medical cannabis treatments. Clinics will not see you without the relevant medical records or a GP referral.
If you are eligible for medical cannabis treatment, you will be sent an appointment request via tele-health consultation (during restrictions due to Covid-19).
2. Can I get an NHS prescription for medical cannabis?
Currently, medical cannabis prescriptions are only available in the private sector. Limited guidance for doctors mean that no new NHS prescriptions for medical cannabis have been issued in last 18 months. Legally there is no barrier, but in practical terms this is almost impossible.
There are three exceptions. Sativex is a cannabis medicine licensed for use with spasticity in multiple sclerosis and can be prescribed on the NHS. Also, Epidyolex can now be prescribed on the NHS for certain childhood epilepsies (Dravet and Lennox-Gastaut syndromes) alongside another drug called Clobazam. Finally, a synthetic cannabis called Nabilone is also prescribable on the NHS for severe nausea and vomiting, usually during chemotherapy.
3. Who can prescribe medical cannabis in the UK?
Any doctor on GMC Specialist Register can prescribe medical cannabis. This is usually a hospital consultant. A GP can prescribe under shared care arrangements under the direction of a specialist.
You are more likely to be prescribed medical cannabis from a doctor working for a medical cannabis clinic as those doctors are more likely to have been trained in cannabis medicine.
4. How can I find a doctor who is supportive with medical cannabis?
Contact one of the cannabis specialist clinics now operating in the UK, or contact the Society, who can point you in the right direction.
5. Do I need a referral from my doctor?
In most cannabis clinics you can self-refer but they will need to contact your doctor to confirm your medical history.
6. My NHS doctor isn’t supportive – what can I do?
A medical cannabis clinic can still see you. GPs are obliged to provide a medical summary to your medical cannabis clinic so this should not be a barrier to treatment.
A GP can prescribe for follow-up under the direction of a specialist. This might be possible (although currently unlikely). The clinic can ask your GP if he/she would be willing to prescribe for follow up appointments.
NHS GPs are unlikely to prescribe medical cannabis (see question 2-cannabis on the NHS). Private GPs would need to have an FP-10 special prescribing pad to undertake shared care prescribing of medical cannabis and have the permission of their CQC licensed clinic to do so.
Understanding medical cannabis
1. What conditions can be treated by cannabis?
There are no barriers to medical cannabis treatment and any condition can be considered. However, most prescriptions are for chronic pain, anxiety, PTSD, epilepsy and muscle spasm (spasticity).
2. What is the endocannabinoid system?
This is the body’s own “cannabis” system. We all have cannabinoid nerve receptors in our brain and elsewhere in the body. We produce chemicals, called endocannabinoids, which lock on to those receptors and perform vital functions. This system is responsible for such things as pain control, mood control, anti-inflammation response, control of bodily movement, epilepsy, etc. The plant cannabinoids, called phytocannbinoids, help that system by also locking on to those receptors. This is why cannabis has so many potential uses.
3. What’s the difference between THC and CBD?
Both THC and CBD have medical properties.
THC is the cannabinoid that is the major part of recreational cannabis and in high doses can cause impairment. In lower doses it is a muscle relaxant, can help with sleep and many different causes of pain. It can also help with nausea and other chemotherapy related side effects.
CBD does not cause impairment. CBD is often used in anxiety, epilepsy and pain management also. There is much overlap between the two when controlling symptoms.
When you are assessed by a doctor they will determine the combination that is most likely to help your symptoms. Most doctors start with a higher CBD product with small amounts of THC and increase the dose slowly, but it will depend on your previous exposure to cannabis and your symptoms. If prescribed carefully, the side effects one commonly recognised with recreational cannabis and unopposed THC use are usually very minimal and well tolerated.
4. Can the CBD I get over-the-counter work just as well?
Over-the-counter CBD is usually derived from hemp.
Hemp is a cannabis strain that has been grown for centuries for its strong stem that is used for paper and building materials, for example. It is also used for hemp seed oil production, which is a very healthy oil which can be used in cooking.
However, hemp contains high levels of CBD and very little other cannabinoids and few of the other components, like terpenes and flavonoids. It is thought by many that these other components are essential for the full medical benefit of the plant (the entourage effect).
So, over-the-counter CBD might be useful for some conditions but less likely to help than the prescribed medicine. Also note the over-the-counter CBD products cannot make any medical claims for their products and they are not subject to such stringent controls as a medical product.
It is sometimes difficult to know what to take and in what dose. Look at some websites to see good quality products such as CBDShopy, Mellow.store and SavageCabbage.co.uk.
5. What is the entourage effect?
Medical cannabis not only contains cannabinoids, but also other chemicals called terpenes (which give smell) and flavonoids (which give colour).
There are over 130 cannabinoids, in addition to CBD and THC, as well as over 100 terpenes and flavonoids. It is thought that the full plant with all those components in various proportions give a better medical effect than the individual parts.
That is the entourage effect and explains why the full plant prescriptions may be better than the over-the-counter hemp CBD products.
6. What’s difference between recreational and medical cannabis?
Generally, recreational cannabis is high in THC and low in CBD – opposite to most of the initial medical cannabis prescriptions. Also, recreational cannabis comes with no guarantees of safety and quality and may well be contaminated with other chemicals like heavy metals and pesticides. Usually, you will not know what’s in recreational cannabis and one batch is likely to be different from the next.
7. Why is cannabis unsuitable for randomised controlled trials?
The cannabis plant contains 147 cannabinoids and over 100 terpenes and flavonoids, as well
other plant chemicals such as chlorophyll and waxes. These are not “contaminants” but an
integral part of the plant and many of these components have medicinal value. As an example,
there are at least nine cannabinoids and terpenes that are known to have anti-convulsant
properties. The basis of the double-blind, placebo-controlled trial is to compare a single
compound, usually pharmaceutical, product with a placebo. Occasionally, a multi-compound
medicine can undergo such studies, such as Sativex which is a combination of THC and CBD.
However, it is not possible to conduct such studies for full-spectrum cannabis because of the
complexity of the medicine and of course the difficulty of an adequate placebo. Comparison of
isolate cannabinoids is possible (such as the Epidyolex studies, as Epidyolex is “nearly” an isolate
(it contains a small amount of THC)).
Medical cannabis and UK law
1. Can I grow my own cannabis for myself or my loved one?
You are not legally allowed to do this.
We don’t encourage anyone to break the law. The
MCCS believe that regulated, GMP quality cannabis provided under expert care and with monitored dosage is the right way to access medical cannabis.
GMP (Good Manufacturing Practice) means that the products are high quality, consistent and free from any contaminants. Only GMP products can be prescribed in the UK.
2. What if I get stopped by police or arrested with medical cannabis?
It is, of course, possible to be stopped in possession of cannabis. You will need to show that you have been legally prescribed the product. It’s a good idea to carry your prescription with you. If you have over-the-counter CBD then it should be sufficient to say that it is a legal product, but keep the container with you.
Consuming and dosing medical cannabis
1. How is medical cannabis taken or administrated?
There are many ways to take medical cannabis. Oils can be taken under-the-tongue, or there are capsules, topical creams or dried flower for vaping. Smoking is not allowed. Most prescriptions are for oil and dried flower.
Your doctor will discuss the best way to consume medical cannabis for your symptoms.
2. When might someone choose whether to vape or ingest medical cannabis?
Vaping is usually for “breakthrough” pain when a quick result is needed, as vaping effects come on quickly (in minutes) but last only about 2 to 3 hours.
Oil provides better background relief all day long when taken 2 to 3 times daily. Your doctor will advise what is best for you.
3. How long does the cannabis effect last and how long to start working?
It depends on what form you take it in. Vaping will mean a quicker effect (in minutes) and last about 2 to three hours or so. Taking an oil will take longer to have an effect (maybe 60-120 minutes) but lasts longer (maybe 6 hours or so). Everyone is very variable, but this is an average.
4. What dose should I take?
Your doctor will advise on the dose. Generally, you will be started on a low dose – say about 10mgs of CBD and build up slowly to the average dose of CBD of 60-100mgs daily (usually in 2/3 divided doses).
Children with epilepsy can need to go higher – up to about 10-12mgs/kg. If the doctor wants to add in THC then again it starts low (even as low as 1mg THC) and builds up slowly.
It is unusual for people to need more than 150 mgs CBD or 30mgs THC daily in oil form or 1-2grams per day in dried flower form (for vaping).
5. Can a carer or support worker give someone medical cannabis treatment?
Yes, this can often be arranged by speaking to the service where an individual is living.
However, although it’s all legal, some local regulations by care agencies or residential homes may prevent those services from giving the medicine. If you are having difficulties, please consider speaking to your prescribing doctor who may be able to provide support.
6. What is the best way to inhale from a dry herb vaporiser?
Step One: Once the oven has reached vaping temperature, take a steady and controlled breath on the mouthpiece. If you inhale too hard and too fast, you'll actually suck out all the hot air from the oven and your herbs will not vaporize efficiently.
Step Two: Once you've inhaled from your vape, in the same breath, take in some fresh air as deeply as possible. This final deep breath opens up your lungs and exposes more of it to your vapour. The clean air also acts as a plunger and pushes the cannabinoid vapour to the bottom of your lungs.
Step Three: Exhale in one smooth motion.
Credit to: https://www.vapeelevate.co.uk/
Safety and side effects
1. Is medical cannabis suitable for everyone?
Like any medicine, not everyone is suitable for medical cannabis treatment. People with active schizophrenia, for example, may not be suitable as well as some people with heart rhythm problems. Medical cannabis doesn’t mix very well with some other medicines that you might be on.
Your doctor will check out whether it is suitable for you before prescribing.
2. What are the side effects of medical cannabis?
CBD is generally very safe, but can give some people stomach upsets, diarrhoea, dizziness and tiredness.
THC has more side effects and these can include dizziness, disorientation, drowsiness and dry mouth, as some examples.
However, your doctor will start you on a low dose and increase it gradually so that side effects are minimised. Serious side effects, like a psychotic episode, should be avoided by careful screening of whether you are suitable for treatment in the first place.
3. Can you overdose on cannabis?
You can take more than prescribed, but fortunately no one has died directly from an overdose of cannabis – unlike some medicines like opioids. Overdosing can be unpleasant and can give, for example, palpitations, sweating, dizziness, disorientation and even, in very rare cases, psychotic reactions but these will pass after a few hours. A very large overdose can be serious and If you are concerned, go to A&E and tell them what you have taken.
4. Does THC effect the developing brain?
Some reports have said that THC can damage the developing brain in children and adolescents. There is no evidence of this in the low doses generally used in cannabis medicine. There are some reports of such problems in high THC recreational cannabis users, but those reports are also controversial. In the low THC doses used in medical practice that risk is very small indeed.
5. Can I take cannabis while pregnant or breastfeeding?
No woman should really take any medicine whilst pregnant or breastfeeding. However, occasionally taking some medicine is essential for a medical condition. If your condition necessitates continuing on cannabis (such as epilepsy) then be reassured that there are no definite “syndromes” associated with cannabis. High THC recreational cannabis may cause low birthweight, but the evidence for any other problems in the newborn child is not clear. Avoid if possible.
6. Can I give my cannabis to someone else or my pet?
No, the medicine is for you alone. In some countries it is legal to give cannabis products to pets, for example for anxiety in dogs, but in the UK it is illegal.
7. What should I look for in a product so I know it’s safe?
Properly prescribed medical cannabis treatment by a specialist ensures that you will receive safe products. Prescribed medical cannabis treatment will be EU GMP standard and thus meets high quality standards of consistency. It comes with a certificate of analysis so you can be confident it contains exactly what is required. Your doctor will only prescribe safe products that are suitable for you.
8. Why is there MCT (medium chain triglyceride) oil in my product?
This is a carrier oil, which helps to enhance the availability of the cannabis after consumption. MCT oil is arguably the most effective option, however some brands will try other sources, such as olive oil. Be aware of the carrier oil as some people may be allergic to some oils, like peanut oil.
9. Can patients take cannabis based medical products when already being prescribed other medications?
In the majority of cases, the answers is yes. However, there are some important interactions to note. Research is limited, but in vitro studies indicate that THC and CBD have limited ability to inhibit the activity of CYP450 enzymes. One study showed that a patient consuming cannabis had an increased response to Warfarin. An increase the metabolism of theophylline and chlorpromazine has been shown, and levels of clobazam sometimes increase in children. Liver enzymes sometimes increase in concomitant administration of sodium valproate. Pending additional studies, patients taking THC should avoid drugs that alter the activity of CYP3A4 and CYP2C9. Any drug interactions should be reported via the MHRA's Yellow Card scheme.
10. Are there any medical conditions for which medical cannabis should not be prescribed?
It is important than individuals living with the following conditions and symptoms should not be prescribed certain types of cannabis cased medical products. This includes psychosis or schizophrenia (THC), Mania (THC), Cannabis use disorder (THC), Pregnancy /breastfeeding. Caution should also be taken around post MI, post Stroke, any cardiac arrhythmia and cirrhosis.
The cost of medical cannabis
1. What will I pay for a medical cannabis prescription?
You will pay for the cost of treatments - an average of £500 per month for your products. Families of children with epilepsy will see costs from £1000+ per month but costs are coming down.
You will also pay the cost of import, which can be around £150 per prescription. However, now bulk importation of medical cannabis products are permitted, we see prices reducing as this cost is split between multiple patients.
You will also pay the costs of the pharmacy as well as the cost of any consultation – face to face or telehealth – with your consultant – usually around £200 for the first consult and less for follow-up visits, which need to be monthly at first but if you are stable then can then be less frequent.
2. Is it possible to get cheaper medical cannabis?
Prices are coming down and are currently around half the price they were during January 2020 and it will continue to decline in cost.
If you have a qualifying condition, then access via Project Twenty21 may be an option for you. Treatment will available at be a capped cost but will restrict a doctor to prescribe only certain products. It is only available at the moment for those with pain conditions, MS, Tourette's, psychiatric conditions like anxiety and PTSD and substance use disorder. There is information about Project Twenty21 on the Drug Science website.
3. Will I have to fundraise to pay for my treatment?
Some families, particularly those with children with severe epilepsy, fundraise for medical cannabis treatments as their costs can be very high.
4. Will my health insurance company pay for medical cannabis treatments?
The MCCS has asked health insurance companies if they will pay for legally prescribed medical cannabis products and we will update this information when we have an answer. At the time of writing, we do not know of any health insurance companies currently paying for private medical cannabis prescriptions.
Work, driving and holidays
1. What happens if I am drug tested by my employer while being prescribed medical cannabis?
If your employer tests employees for drugs like THC then it is possible that you will be positive for a THC test on a prescribed or recreational product. You can test positive even if you are not impaired as THC is detected for some days after you have taken it.
It is best to tell your employer that you are on medicinal cannabis and talk to them about the situation. Your doctor may also be able to help and explain matters.
Some professions will not allow any detectable THC even if you are not impaired – such as pilots, railway signaller etc.
CBD is not intoxicating and should not cause problems on testing but be aware that some CBD prescriptions and over-the-counter CBD can have a little THC which, whilst being a very low and non-intoxicating dose, can cause positive urine or saliva or hair test results.
Be honest and discuss with your employer and if need be, get support from your doctor or Union.
2. Can I drive while taking medical cannabis?
No one should drive whilst impaired.
THC can cause impairment for driving whilst the intoxicating effect is still present, so avoid driving (or other hazards such as operating machinery) whilst “under the influence”.
There is a legal limit for THC (2 micrograms per litre). There are problems with this measure as THC can be detected in the blood for days after the acute effect has worn off (depends on dose and other factors). This is because THC is stored in fat cells and will come out of those cells over several days after the dose. So, it is possible to be over the legal limit even though you have no “intoxicating” effects left. It’s a good idea to carry a copy of your prescription at all times.
CBD does not impair driving.
3. Can I go abroad on holiday with my cannabis?
It depends where you are going.
Always check the legal situation in the country you are visiting. Some countries allow medicinal cannabis and some even recreational cannabis. Some allow CBD but others do not.
Check initially on Wikipedia for “legality of cannabis” but always check with the embassy of the country.
Also be aware if you are transferring flights in another country. Some countries do not allow cannabis in any form even if just in transit through the airport. Dubai, for example, is one such common transit hub.
4. Can I get medical cannabis during coronavirus lockdown?
Yes – most clinics are carrying out telemedicine consultations during lockdown.