Medical Cannabis and the Law in the UK.

Medical Cannabis in the UK: The Law, Prescriptions and Patient Rights

Cannabis remains a controlled drug in the UK, but certain cannabis-based products can legally be prescribed for medicinal use.

The law changed on 1 November 2018, when qualifying cannabis-based products for medicinal use in humans were moved to Schedule 2 of the Misuse of Drugs Regulations 2001.

This created a legal route for specialist doctors to prescribe appropriate products without obtaining an individual Home Office licence for each patient.

The change did not:

• legalise recreational cannabis;
• allow patients to grow cannabis plants;
• permit people to buy cannabis from unregulated suppliers; or
• make every cannabis or CBD product lawful.

Is Medical Cannabis Legal?

Yes, but only where the product is lawfully prescribed, supplied and possessed.

An unlicensed cannabis-based product for medicinal use can normally be initiated only by a doctor listed on the General Medical Council's Specialist Register.

The specialist must consider the patient's condition, previous treatment, available clinical evidence, potential benefits and possible risks.

A GP cannot normally initiate an unlicensed medical cannabis prescription. In some cases, ongoing prescribing may later be shared with another doctor under an appropriate specialist-led arrangement.

A patient who possesses the prescribed product in accordance with a valid prescription is not committing the ordinary offence of unlawful possession.

Is Recreational Cannabis Legal?

No. Cannabis remains a Class B controlled drug under the Misuse of Drugs Act 1971.

Without lawful authority, it is generally illegal to:

• possess cannabis;
• supply or offer to supply it;
• possess it with intent to supply;
• produce or cultivate cannabis;
• import or export it; or
• allow premises to be used for certain drug-related activities.

Claiming that cannabis is being used to manage pain, anxiety, insomnia or another medical condition does not by itself make possession lawful.

The person normally needs a valid prescription for the particular medicinal product in their possession.

What Is a Cannabis-Based Product for Medicinal Use?

For the Schedule 2 prescribing regime, the product must meet the statutory definition of a cannabis-based product for medicinal use in humans.

In broad terms, it must:

• contain cannabis, cannabis resin, cannabinol or a cannabinol derivative;
• be produced for medicinal use in humans; and
• be a medicinal product, substance or preparation intended for administration to a person.

Cannabis products that do not meet the definition may remain subject to the stricter Schedule 1 controls.

What Conditions Can Medical Cannabis Treat?

Cannabis-based medicines are not regarded as a general treatment for every condition.

Different products contain different active ingredients and different proportions of:

• cannabidiol, commonly known as CBD; and
• tetrahydrocannabinol, commonly known as THC.

NHS prescriptions are currently most likely to be considered for:

• certain rare and severe forms of epilepsy;
• nausea or vomiting caused by chemotherapy where other treatment has not worked or is unsuitable; and
• moderate to severe muscle stiffness and spasms caused by multiple sclerosis where other treatments have not been effective.

An appropriate private specialist may consider prescribing for other conditions, but a prescription must still be based on clinical judgment, the available evidence and the patient's individual circumstances.

Medical Cannabis for Epilepsy

Epidyolex is a purified cannabidiol medicine that may be prescribed as an additional treatment for certain severe epilepsy syndromes.

These include:

• Dravet syndrome;
• Lennox-Gastaut syndrome; and
• seizures associated with tuberous sclerosis complex in qualifying patients.

Epidyolex does not contain significant amounts of THC and does not normally produce the intoxicating effect associated with recreational cannabis.

Medical Cannabis for Chemotherapy

Nabilone may be prescribed to adults experiencing nausea or vomiting caused by chemotherapy where conventional anti-sickness medicines have not worked or are unsuitable.

Nabilone is a manufactured medicine that acts similarly to THC.

It is not the same as possessing or smoking herbal cannabis.

Medical Cannabis for Multiple Sclerosis

Nabiximols, commonly known by the brand name Sativex, is a cannabis-based mouth spray licensed for adults with moderate to severe muscle spasticity caused by multiple sclerosis.

It may be considered where other treatments have failed to provide sufficient relief, and the patient responds adequately during an initial treatment period.

Treatment should be initiated and supervised by a suitably experienced clinician.

What About Chronic Pain?

There is continuing research into cannabis-based products for pain, but the present evidence does not support describing medical cannabis as a proven general treatment for chronic pain.

NHS guidance states that the evidence is not currently strong enough to recommend cannabis-based medicines routinely for long-term pain.

They may sometimes be used:

• as part of a clinical trial;
• where treatment was already established under earlier arrangements; or
• following individual assessment by an appropriate private specialist.

Patients should be cautious about claims that cannabis will reliably treat back pain, arthritis, fibromyalgia or every form of neuropathic pain.

Why Are NHS Prescriptions Limited?

Making medical cannabis legally prescribable did not mean that every cannabis product was approved for routine NHS use.

Many cannabis-based medicinal products are unlicensed medicines. This means they have not received the usual marketing authorisation confirming quality, safety and effectiveness for a particular condition.

A specialist may need to consider:

• the quality of the clinical evidence;
• whether licensed treatments have already been tried;
• the product’s THC and CBD content;
• possible side effects and drug interactions;
• the patient’s physical and mental health;
• the quality and consistency of the proposed product;
• the risk of dependence or misuse;
• the need for continuing monitoring; and
• whether the expected benefit justifies the risks.

NHS commissioning arrangements, licensing status and cost may also affect access.

Can Medical Cannabis Be Prescribed Privately?

Private specialists may prescribe cannabis-based medicinal products where they consider treatment clinically appropriate.

The prescriber should be suitably qualified and have the expertise needed to manage thepatient'ss condition and treatment.

A private prescription does not make every cannabis product lawful. The medicine must be:

• the product specified in the prescription;
• obtained through a lawful pharmacy or authorised supply route;
• used by the person for whom it was prescribed; and
• taken in accordance with the prescribing instructions.

Patients should retain the dispensing label, original packaging and evidence of the prescription.

Private treatment can be expensive because consultation fees, monitoring, prescriptions and the medicine may not be funded by the NHS.

Can Patients Grow Their Own Cannabis?

No. A medical cannabis prescription does not permit a patient, carer or relative to cultivate cannabis plants at home.

Cultivation remains an offence unless it is carried out under specific Home Office authority.

Growing even a small number of plants for personal medical use can lead to:

• police investigation;
• seizure of the plants and equipment;
• arrest;
• prosecution; and
• confiscation proceedings in serious cases.

Difficulty obtaining or paying for a prescription does not create a general legal right to grow cannabis.

Can Prescribed Medical Cannabis Be Smoked?

No. The controlled-drug regulations prohibit the self-administration of a cannabis-based medicinal product by smoking, apart from limited research circumstances.

Prescribed products may instead be supplied in forms such as:

• oils;
• capsules;
• oral solutions;
• mouth sprays; or
• dried cannabis flower intended for use through an appropriate vaporising device.

Vaporising a prescribed product in accordance with medical instructions is legally and medically different from smoking it with tobacco or burning it in another way.

Patients should use the medicine only in the form and dosage prescribed.

What Is the Difference Between CBD Oil and Medical Cannabis?

Some CBD products are sold as foods or food supplements rather than medicines.

These products are not the same as prescribed cannabis-based medicinal products and cannot lawfully be advertised as treating or curing a medical condition unless they have the necessary medicines authorisation.

CBD itself is not generally controlled, but consumer CBD products may also contain controlled cannabinoids such as THC.

Whether a product is lawful can depend on:

• its ingredients;
• the amount and form of any controlled cannabinoid;
• whether it satisfies the controlled-drug exemption requirements;
• whether it has the necessary food authorisation; and
• the claims made when it is sold.

A product is not automatically legal merely because it is labelled "CBD", "hemp" or "THC-free".

Are Online Cannabis Products Safe?

Products sold through unregulated websites may contain different ingredients or strengths from those stated on the label.

Possible problems include:

• unexpected THC;
• incorrect CBD concentration;
• pesticides or other contaminants;
• residual solvents;
• heavy metals;
• microbiological contamination;
• interactions with other medicines; and
• unlawful importation or supply.

Buying a product online following a questionnaire is not necessarily equivalent to receiving a valid prescription from an appropriately regulated specialist.

Risks and Side Effects

Cannabis-based medicines can cause side effects and are not suitable for everyone.

Possible effects include:

• drowsiness;
• dizziness;
• reduced concentration;
• changes in mood or behaviour;
• changes in appetite;
• diarrhoea or other digestive problems;
• interactions with other medicines;
• dependence;
• anxiety or paranoia; and
• an increased risk of psychotic symptoms in susceptible individuals.

Risks commonly increase as the amount of THC increases.

The prescriber should consider matters including:

• a personal or family history of psychosis;
• substance dependence;
• pregnancy or breastfeeding;
• cardiovascular illness;
• liver function;
• other medicines being taken; and
• the patient’s need to drive or operate machinery.

Medical Cannabis and Driving

A prescription does not automatically make it safe or lawful to drive.

Two separate drug-driving offences may be relevant:

• driving while unfit through drugs; and
• driving with certain controlled drugs, including THC, above the specified blood limit.

A statutory medical defence may be available where:

• the controlled drug was prescribed or lawfully supplied for medical purposes;
• it was taken in accordance with the directions given; and
• the driver complied with the applicable legal requirements.

The defence does not protect a person who drives while impaired.

Patients must not drive where the medicine affects:

• concentration;
• coordination;
• reaction time;
• alertness;
• vision; or
• judgment.

Patients should carry evidence of their prescription, but documentation does not guarantee that no investigation or roadside test will take place.

Medical Cannabis at Work

A lawful prescription does not necessarily mean that an employee can use medical cannabis in every workplace or while performing every duty.

Safety-sensitive work may require particular assessment, including:

• driving;
• operating machinery;
• working at height;
• clinical work;
• working with vulnerable people; or
• performing duties where reduced alertness creates a significant risk.

An employer should consider the employee's medical circumstances, health and safety duties and possible reasonable adjustments where disability law applies.

An employee should not conceal a side effect that could create a serious workplace risk.

Travelling With Medical Cannabis

A UK prescription does not guarantee that medical cannabis may legally be taken into another country.

Some countries prohibit cannabis-based medicines completely, even where the traveller has a lawful UK prescription.

Before travelling, the patient should:

• check the law of the destination country;
• check the rules of any country through which they will travel;
• contact the relevant embassy where necessary;
• carry the medicine in its original labelled packaging;
• carry a copy of the prescription or a clinician's letter; and
• confirm whether an import licence or other authorisation is required.

When entering or leaving the UK, prescribed controlled medicine should normally be carried personally rather than placed in unaccompanied luggage or posted separately.

A traveller can generally carry up to three months' supply of qualifying Schedule 2 to 4 controlled medicine into the UK if it was lawfully prescribed, but additional requirements may apply.

Possession Without a Prescription

Possession of cannabis without lawful authority may result in:

• an out-of-court disposal where appropriate;
• arrest and investigation;
• prosecution;
• a fine;
• a criminal record; or
• imprisonment in more serious cases.

The outcome may depend on:

• the quantity;
• the circumstances of possession;
• previous offending;
• whether children were present;
• whether there is evidence of supply; and
• whether cultivation or commercial production is involved.

The maximum penalty for possession of a Class B drug is five years' imprisonment, an unlimited fine or both.

Supply, production and possession with intent to supply carry substantially higher maximum penalties.

Medical Need Is Not Automatically a Defence

A court may take a person's health and motivation into account when deciding how a case should be dealt with.

However, self-medicating with unlawfully obtained or home-grown cannabis does not normally provide a complete defence to possession, production or cultivation.

A person who believes that cannabis-based treatment may be appropriate should speak to their doctor and ask whether referral to a suitable specialist is clinically justified.

What if Prescribed Cannabis Is Seized?

A patient should provide the police with evidence showing:

• their identity;
• the dispensing label;
• the original packaging;
• the name of the prescribing clinician or clinic;
• the lawful pharmacy that supplied the medicine; and
• the current prescription where available.

The patient should not transfer medicine into an unlabelled container or carry more than has been lawfully supplied.

Legal advice may be appropriate where prescribed medicine is retained, destroyed or treated as unlawfully possessed despite evidence of a valid prescription.

A Developing Area of Medicine

Cannabis contains numerous compounds, and different products may have very different effects.

It is therefore inaccurate to describe cannabis generally as either a "wonder drug" or a substance with no possible medical use.

There is established evidence supporting particular cannabis-based medicines for a limited number of conditions.

For many other conditions, the evidence remains:

• uncertain;
• incomplete;
• based on small studies;
• dependent on a particular product or dose; or
• insufficient to support routine NHS treatment.

Future research may lead to additional licensed treatments, but medical claims should be assessed by reference to the individual product, dosage, condition and quality of evidence.

Getting Legal Advice

A criminal law solicitor can advise a person accused of:

• possessing cannabis;
• supplying or possessing cannabis with intent to supply;
• producing or cultivating cannabis;
• unlawfully importing a controlled product;
• drug driving; or
• breaching controlled-drug licensing rules.

Legal advice may also be required where prescribed medical cannabis has been seized or where there is a dispute about whether a product was lawfully prescribed or supplied.

A solicitor cannot arrange medical treatment, but can advise on the distinction between lawful prescribed possession and offences under controlled-drug legislation.

Finding a Criminal Law Solicitor

Use the search facility at the top of this page to find a solicitor experienced in controlled-drug offences, cannabis cultivation, drug driving or cases involving prescribed medical cannabis.

Disclaimer

Solicitors.com is not a firm of solicitors. This page provides general information only and does not constitute legal or medical advice. Readers should seek advice from a suitably qualified solicitor, specialist doctor, pharmacist or other appropriately regulated professional about their individual circumstances.

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