Keeping patients safe: Clarifying legal and clinical claims in medical cannabis advocacy

‘Smoking vs Vaping Prescribed Cannabis Flower’ raises important questions about law enforcement, patient autonomy, and access to cannabis-based medicines, but it also includes several claims that, in our view, risk misrepresenting the realities of legislation and clinical obligation. 

In a field like medical cannabis where the rules are still evolving, and misunderstanding can carry real life consequences (often for those who are most vulnerable in society) fact-checking isn’t just helpful: it’s essential. 

This blog explores some of the legal and clinical interpretations shared by Seed Our Future’s report, not to discredit their advocacy or undermine their work, but to ensure patients receive clear, safe, and reliable information. 

Legal justifications: Is smoking prescribed cannabis actually illegal?

While Seed Our Future do include a disclaimer on page one that their report should not be taken as legal advice, their opening statement reads:

“Although the smoking of prescribed medical cannabis flower is not recommended by clinics or consultants in the UK as smoking is not considered a normal medical route, even though cannabis has been smoked for medical use for several millennia, it does not constitute a criminal offence to do so, as the use of any controlled drug is not legislated for within the Misuse of Drugs Act 1971.”

However, this statement, and its placement within the report, is potentially dangerous. Later, they do respond to this same piece of legislation, however, when they do so, we believe their interpretation of the law could be described as imaginative.

So, what does the law actually say?

On the 1st of November 2018, the day medical cannabis was legalised in the UK, The Misuse of Drugs Act 1971 was amended to account for the use of cannabis-based medicines.

In this amendment, the following clause was also written into law:
“(3) A person shall not self-administer a cannabis-based product for medicinal use in humans by the smoking of the product (other than for research purposes in accordance with regulation 13)”

This directly contradicts the information given by Seed Our Future in their opening statement.

And while there are tens of thousands of individuals in the UK accessing cannabis-based medicines, millions more are eligible for these treatments but are yet to access them. This information could not only land them in hot water, but, also potentially, in handcuffs. 

Imaginative interpretations: Smoking cannabis counts as ‘personal research’

Later in the report, Seed Our Future return to this, and make the convoluted claim that patients smoking their prescribed cannabis could argue they’re conducting ‘personal research’ if they’re doing so in a home, or premises, they legally own. 

However, we believe this claim could lead to false confidence, and ultimately, legal consequences.

While it’s true that there are grey areas in the MDR legislation, the term ‘personal research’ is not recognised by law, and although it's an inventive loophole, it undermines the intricacies involved in cannabis-based research. 

In fact, the MDR states research purposes must be in accordance with Regulation 13 - which specifically relates to research conducted by approved, licensed facilities - not informal, personal experiments. 

Reframing this narrative has the potential to mislead patients into thinking they’re legally protected when they are not, disguising a legal gray area as an out-and-out patient right. 

Incorrect information: Smoking and vaping are the same

The second paragraph in this 18-page report reads:

“Many patients unwittingly ‘smoke’ their medication via the use of their vaporisers by exceeding a temperature of 200 degrees centigrade, a point at which combustion starts, as most available products exceed this temperature. Combustion is the same as smoking in that the temperature emits visible vapour and or smoke.”

Again, this is inaccurate, and, we feel, misleading. 

While it’s true that the optimal temperature to heat most cannabinoids in order for them to activate and unleash their therapeutic potential falls between 180 and 210 degrees Celsius, when cannabis is smoked, temperatures range between 400 and 900 degrees Celsius. 

To claim those using vaporisers ‘smoke’ cannabis implies combustion and vaporisation are the equivalent of one and the other once vapour or smoke appears. However, in reality, combustion occurs when a substance is burnt, resulting in smoke, ash, and toxic chemicals. On the other hand, when cannabis is vaped it is heated (ideally until it’s boiling point) and not burnt. 

While there is no definitive answer as to what temperature cannabis begins to ‘combust’ because of the amount of variables involved (such as density and moisture content), it is misleading, and irresponsible, to suggest that vaporising cannabis at higher temperatures constitutes the same as smoking. 

Misleading comparisons: Smoking cannabis is ‘less harmful’ than smoking tobacco

Following this line of thinking - that smoking and vaping are essentially equivalent - the report then goes on to explore the harms associated with smoking cannabis, comparing them to the harms associated with smoking tobacco. 

In this section, they cite a number of sources, including the Advisory Council on the Misuse of Drugs (ACMD) claiming: 

“The council therefore considers that smoking cannabis, even when mixed with tobacco, is less likely to harm lungs than if tobacco is used alone”. 

This statement is not only taken out of context, we feel it's irrelevant. While the ACMD recognise that smoking cannabis appears less harmful than smoking tobacco - this is an incredibly low benchmark. 

Tobacco is recognised around the world as one of the leading causes of preventable fatalities. It is sold as a recreational product, and is one of the most harmful substances legally available. In addition, it is not prescribed by any healthcare professional as a medicinal product because it has zero therapeutic value. 

Cannabis, on the other hand, can be prescribed as a medicine. It has been shown to have therapeutic potentials that can ease and aid a number of life-limiting conditions and their associated symptoms. 

We feel, comparing the two is like comparing apples to oranges. 

When it comes to the administration of a prescribed medication, the things that should be considered are: what delivery method is the safest, most effective, and best supported by current clinical evidence - not what is less harmful than an unrelated, recreational product. 

Seed Our Future’s right to respond. 

When writing this blog, we did get in touch with Seed Our Future, and the author of this report Guy Coxall, to give him the right to respond.

Guy said:

'The report, ‘Smoking Vs Vaping Prescribed Cannabis Flower’ was written in response to a growing number of patients being harassed by the police for smoking their medication in circumstances where their device has failed. Having supported these patients, the police have been unable to identify a criminal offence in which to bring charges against these patients, except in the case of driving. A Schedule 2 prescribed medication is legal to possess and doesn’t become a Schedule 1 drug because of the way it’s administered.

Regulation 16A(3) is exactly that, a regulation and it doesn’t pertain to a criminal offence with sentencing guidelines.

Whether it’s an emergency situation (needing to medicate when device fails) or a situation of patients preferring to smoke, or adapting to using a vaporiser, a proportion of patients do and will smoke their medication as has always been the case. The report is not designed to encourage smoking but to provide a detailed assessment of the current situation, the legislative implications and potential defences for those patients who do find themselves in these situations.

The legal disclaimer on the front page clearly states that the report is not to be considered legal advice.

I stand by the content of the report and will continue to develop reports and support patients with complex issues. A number of clinics and consultants are sympathetic to patient’s needs and do not remove their treatment if informed. Placing patients needs first is the duty of every clinic and every consultant so long as the harms are negligible. 

Removing a patient’s medication where all other medications have failed and thus throwing them to the illicit market is disproportionate, cruel, unethical and discriminatory and is based on political and ideological motivations, not the science.'

Final thoughts from Releaf’s Chief Medical Officer: Graham Woodward

“In such a highly regulated space, even small misunderstandings can lead to confusion or harm - and that’s why we feel it is important to respond with the shared goal of keeping patients well-informed, supported, and above all, safe. 

While we understand that devices can, and do, occasionally fail, no patient should feel penalised for navigating a one-off emergency, and managing their symptoms. I would like to reassure patients that, at Releaf, they will not be discharged from our clinic if they encounter an emergency situation and their vaporiser runs out of battery, or breaks, as it has been implied. 

That being said, continuously ignoring prescribing guidelines is something we have to act on. It is not unjust or unethical, it is our duty of care. Prescribing medical cannabis comes with clinical and legal responsibilities - and if a patient chooses to ignore safe guidelines, medical cannabis clinics have every right - and realistically an obligation - to act.

However, we have worked hard to avoid these issues entirely, so patients aren’t left in a circumstance in which they have to break the law, to simply manage their health.

As well as prescribing medical cannabis flower, we also prescribe cannabis oil to be taken orally, and have recently secured a partnership with SOMAÍ Pharmaceuticals which has also allowed us to add vape cartridges to our formulary. 

Every patient who is prescribed these vape cartridges is provided with a free battery powered device so they can get started - removing the need to purchase a dry-herb vaporiser. These devices, or ‘pens’ have an extremely long battery life, negating the need for regular charging, and back up batteries can be purchased for just £14.99 through our Releaf store for extra piece of mind. 

For those who do already own a dry-herb vaporiser, we’d recommend incorporating regular charging into their routine, or carrying a battery pack or powerbank. These are universal, and in the modern world are incredibly useful - most people already own one, in fact, and so it’s another useful solution for peace of mind.”