Experts Explain: Medical cannabis advertising and promotion in the UK

Our Chief Legal and Compliance Officer Rupa Shah has spent the majority of her career at the intersection of law, compliance, and marketing in highly regulated industries. 

Using the skills she gained during her 13 years at the Advertising Standards Authority and the Committee of Advertising Practice, or CAP, Rupa has a unique perspective and invaluable experience navigating regulatory compliance, policy, enforcement, and, ultimately her favourite: the gray areas in complex, evolving industries like medical cannabis. 

So, we sat down with Rupa to discuss the complexities, challenges, and compliance involved in advertising medical cannabis in the UK, from what she loves to what she loathes, to give an inside perspective of what it’s like to sit on the board of the UK’s fastest growing medical cannabis clinic. 

Could you please start by giving us a rundown of your day-to-day responsibilities at Releaf?

"Of course! As Chief Legal and Compliance Officer at Releaf, I oversee regulatory strategy, advertising, compliance and patient communications. So it's making sure that we're not just following the letter of the law - it's about setting industry standards and ensuring all of our marketing is responsible and compliant.

If I was to summarise my day, I would say that in the mornings, I tend to be pushing things through the review process. So, I’ll look at marketing content, social media, posts, any patient comms, press materials, etc, to ensure all of that is legally sound won't land us in trouble with the regulators.

Then around midday, I move onto broader legal matters, responding to any regulatory inquiries or just refining our internal compliance processes and frameworks. Towards the end of the day, I tend to have more meetings, I might be meeting with the board and briefing them on any legal updates, communicating or briefing our external legal team, or tackling any internal policies, updates, crafting new policies, or working with our CTO Ollie, to develop our patient portal. 

As well as working at Releaf full-time, I also currently sit on the promotional marketing and direct response panel at CAP, so there I can help shape industry guidance, particularly to do with promotional marketing, direct marketing and compliance matters. I also run my own business Hashtag Ad, that helps brands, creators, agencies, and everyone in the influencer marketing sphere to stay abreast of what the rules and regulations are around influencer marketing."

Looking back ten years ago, did you ever think you’d end up working in the medical cannabis industry, let alone as Releaf’s Chief Legal and Compliance Officer?

"This is a great question! So, ten years ago in 2015 medical cannabis hadn’t been legalised yet, so no, I didn't envisage working for a medical cannabis clinic, because it wasn't even legal. 

But if you were to tell me back then I'd now be working in an industry that’s in a constant tug of war between medicine, politics, and public perception, I probably would have laughed, but then decided that would be an amazing challenge and something I would enjoy. 

My background in compliance and advertising regulation fits really well with what I'm doing right now. The challenge and the appeal is navigating an industry where a relatively recent change in law is driving growth, but the existing regulatory framework restricts the public’s access to information that would ordinarily be disseminated through conventional marketing."

In your professional opinion, how difficult is it to advertise medical cannabis in the UK? 

"I'm sure I've said at some point that I thought, in a way, this would be the easiest job in the world because I'd just be saying no to everything. But actually, although it's difficult, it isn't impossible. 

There is scope for Releaf to be able to advertise, but it’s limited. Because we're dealing with a prescription only medicine, that means the traditional advertising rules that I'm really used to from working with the ASA don't often apply. We're in another zone now because we offer prescription-only medicines, and the rules actively prohibit most forms of direct medicine promotion. 

That means: we can't make certain explicit health claims, we can't push specific cultivars or products, and we can't promote patient testimonials that go beyond what the evidence suggests medical cannabis can do. 

So there are these restrictions, we're very aware of them, and we follow them, but we know that even our educational content, our blogs, our amazing educational database, even that could be scrutinised, because technically, that could potentially contain promotional material. 

So while it's difficult, it's also about knowing how to work within those boundaries. 

So at Releaf, we're making sure that we're focused on factual, legally compliant educational material. That's our focus. It's content and it's education. So we just want to help patients understand their options without crossing into really overt promotional material.

A big focus for Releaf’s marketing is Releaf’s clinic:  it’s amazing doctors, the amazing patient service that we offer, and how receptive we are. All of that service led aspect to Releaf is what we have to focus on in marketing, and we’re lucky, because we really are amazing!"

How do UK regulations compare to other countries when it comes to marketing medical cannabis compliantly?

"We sit in a bit of a strange middle ground compared to lots of other territories. I think in  America and in Canada, where cannabis is either fully legal or regulated with a bit of flexibility, clinics there can openly advertise their services, but they can also list their available strains or flowers. They can engage in marketing that is just entirely illegal here. So there's a stark contrast just there. 

I think America is a really good example to compare us, because in some ways, with lots of UK products and advertising we follow what happens in America. Although we're often a couple of years behind, when it comes to medical cannabis, that's not necessarily the case. 

In general, we're a little bit more bureaucratic than a lot of Europe as well. We hear a lot about Germany, and there are events that go on in Germany regarding medical cannabis where it's a bit more open. They do have strict medical cannabis laws in Germany, but their prescribing process is just a lot more straightforward, which means access is very different, as well as overall knowledge and understanding of these treatments. While they do have advertising regulations, they're just not as strict as those in the UK, so that's why Germany's developed in a different way. 

The most relevant comparison is in Australia, where legalisation happened at a similar time, but progress is much faster, and I think that's to do with prescribing, and the fact that GPs in Australia can prescribe medical cannabis to their patients. It's meant that understanding stigma, all of these challenges that we're still facing here in the UK has been overcome much faster in Australia, because that's such a big thing, isn't it? Trust in your healthcare provider."

How do you ensure Releaf’s content, whether that's the website, social advertising, promotional materials or press releases, remains compliant?

"So, there are a lot of steps involved. We've been building, ever since I started, quite a strict internal compliance framework. It's strict, but it's transparent as well. So for example, if the regulators need to understand what we're doing, we can be very clear and open about what our processes are.

We have a pre-approval process internally, which means that marketing content goes through compliance checks, and our public facing posts - things like social media, are regularly checked and scrutinised against the guidelines we’ve set out. 

All the marketing team, all of Patient Support, and anyone else who communicates product information to patients, have training so they know what they can and can't say, and we don't really leave room for interpretation because when it comes to legal risk, it has to be quite clear. 

I also conduct regular audits to routinely review our content. Of course, we also have training so we make sure when staff are onboarded they understand exactly what their responsibilities are, what the key rules are, what you can and can't say about medical cannabis and our clinic and, outline our general Releaf approach to advertising."

What legislations and regulations does Releaf have to follow to ensure the above?

"There are a lot of rules and regulations we follow at Releaf, but I’ll explain some of the key ones:

The main one is Misuse of Drugs Regulations 2001, which determines who can prescribe and dispense cannabis based medicines. It's not one that comes to mind when I'm thinking about advertising, but it's one that was important when we're putting together the framework of  Releaf.

Secondly, there's the Human Medicines Regulations of 2012 and that is key. So the HMR prohibits the advertising of prescription only medicines. So that's the reason we have this challenge of trying to explain what Releaf do within the constraints of not being able to talk about our medicines. Outside of that, there’s MHRA guidance as well when it comes to healthcare advertising and prescription-only medicines, and we also have to follow CQC requirements concerning safety and care standards. 

Then, in addition, the ASA and CQC also have rules. These repeat the fact that you can't advertise prescription only medicines, but the ASA do have some quite handy guidance that explains what advertising means and the difference between editorial and advertising, for example." 

Since joining Releaf in 2023, what has been the most challenging hurdle or barrier so far for marketing?

"I think it has to be about public perception, because in the industries I've worked with previously (namely finance, alcohol and gambling), the understanding of what the product is is already there. People understand what gambling is, or they understand what alcohol is, and you know how to consume it, whereas we have that massive challenge in the first place with medical cannabis.

So it is this public perception versus the regulatory reality that I think is our biggest challenge. Patients still don't fully understand that medical cannabis is legal, and that means that the regulators are hypersensitive about any communications that could be seen as promoting it. So, we have to strike this balance between education and compliance, ensuring patients can access factual information without it looking like promotional marketing. And that's a huge challenge."

If you could change one thing about UK medical cannabis regulation, what would it be and why?

"Oh, there's a fair few things I’d change!

But, firstly I have to emphasise: I understand the purpose of the rules about not promoting prescription only medicine, as we all know, you can go to America and be bombarded with medicine ads, with reems of small print, and we don't want that situation here. 

But if you're going to have that type of rule, then the supporting framework and the guidance and the ability for a clinic like Releaf to ask questions of the regulator should be there. They should have the functionality for us to say: ‘well, what do you think of this?’ and that’s something we are struggling to have with the regulators, that open dialogue. 

I think having more open channels and communications with the regulators would be amazing, and I think for all the policymakers and the government, this proactive approach would work well."

And finally, what is your hope for the future of medical cannabis in the UK?

"My hope for the future of medical cannabis in the UK is to finally move beyond the outdated stigma we currently face and to treat medical cannabis like any other prescription medicine, where patients, doctors, and regulators focus on clinical outcomes rather than playing political games.

But to get there, we need to have clearer regulations, we need better NHS access and solidify an entire industry that upholds high ethical standards. Ultimately, my hope is that more clinics move towards the approach that Releaf are taking."