International Day of Education: Medical cannabis

To participate in this day of observance and celebration of education, we thought it would be fitting to give you a crash course in medical cannabis. So, in this article we will go back to the basics, exploring the science and the law, and explain how to access medical cannabis treatments in the UK. 

So strap in, school is now in session.

Back to basics: Medical cannabis 101

What is medical cannabis?

Medical cannabis is an umbrella term used for a range of cannabis-based medicines that have been prescribed by a specialist consultant or clinician to treat a specific patient’s health condition or associated symptoms. 

Medical cannabis can be prescribed in dried flower, oil, edible, or topical form to patients who are struggling to manage their health conditions with conventionally prescribed treatments or medicines. 

Although the cannabis plant has been used in traditional medicine practices for thousands of years, now in the UK, medical cannabis is a regulated pharmaceutical product. Medical cannabis treatments are produced in a standardised, controlled environment and are tested to ensure their quality, efficacy, and safety. 

What is the difference between medical cannabis and recreational weed?

Medical cannabis, especially in flower form, is often mistaken for illegal, recreational cannabis, which is also known as weed, pot, grass, or marijuana.

In the UK, cannabis is only legal if it has been prescribed by an authorised healthcare professional for a medicinal or therapeutic purpose. Using cannabis for recreational reasons is strictly illegal in the UK, and smoking cannabis (regardless of whether it has been prescribed for a medical purpose or not) is a criminal offence.

Unless legally prescribed, in the UK, cannabis is considered a Class B controlled drug under Schedule 2 of the Misuse of Drugs Act 1971. If cannabis is sourced illegally, it is illegal - regardless of whether the individual holds a valid prescription for medical cannabis or not.

What can medical cannabis be used to treat?

Medical cannabis can be used to treat and manage a wide range of health conditions and has shown to be beneficial in managing or improving some of their associated symptoms like pain, anxiety, and disturbed sleep. 

Cannabis-based medicines are suitable treatments for a number of neurological conditions including epilepsy, as well as autoimmune inflammatory illnesses like multiple sclerosis, gastroenterological illnesses such as Irritable Bowel Syndrome (IBS), psychiatric conditions including PTSD, and so much more. 

This is because cannabis compounds are extremely versatile and intuitive when they enter the body, and depending on their dosage and concentration, they can act fast to target different receptors and restore harmony in the body.

Currently, evidence supports medical cannabis having the ability to reduce pain, anxiety, inflammation, seizure frequency, spasticity, vomiting, and nausea and relieve insomnia for some patients. 

How effective is medical cannabis?

Like any other pharmaceutical or medicine, medical cannabis is not a ‘one size fits all’ treatment plan, or a ‘cure all’ remedy and is not a suitable option for everyone. 

The efficacy, or benefits, of medical cannabis vary from patient to patient, depending on a number of factors. This includes the health condition the patient is treating, their medical history and personal lifestyle factors, other medications they are taking at the same time, and the dosage and concentration of their medical cannabis treatment.

At Releaf, our patients have regular check in appointments with our consultants to ensure their treatment plan is working for them effectively. Releaf’s medical cannabis treatment plans are tailored to the individual, and during these consultations adaptations or adjustments can be made to ensure they are getting the best possible results. 

The science simplified: Medical cannabis treatments

How does medical cannabis work?

Medical cannabis, and cannabis based medicines, are made up of cannabis compounds. There are three major types of compound that affect the way cannabis influences or interacts with the body. These are: cannabinoids (like THC and CBD), terpenes (like Mycrene) and flavonoids (like cannaflavins).

When cannabis is consumed, it interacts with the endocannabinoid system. The endocannabinoid system is a complex network of receptors, signal messengers (endocannabinoids), and enzymes that is ultimately responsible for restoring homeostasis or balance within the body. 

Upon entry to the body, cannabinoids mimic endocannabinoids and interact with their receptors (called cannabinoid receptors) to influence the messages they would typically send, and boost, or change the biological response that is normally triggered. Because of their existence all over the body, collectively cannabinoid receptors can influence mood, memory, pain, inflammation, appetite and so much more. 

The flavonoids, terpenes, and cannabinoids in medical cannabis work together in a synergistic fashion, boosting or influencing each of their individual effects and qualities, to give the most beneficial possible result for patients. This is called the entourage effect. 

How quickly does medical cannabis work?

Medical cannabis works at different speeds depending on how it is used or applied, in what concentration and dosage it is used in, and what it is being used to treat. 

Different cannabis-based products and medicines use different routes of administration, and therefore, absorb into the bloodstream and body in different ways. Medical cannabis that is ingested, in edible form, passes through the digestive system and therefore takes around 45 minutes to be absorbed properly, whilst tinctures bypass this, and filter into the bloodstream in a matter of minutes after being absorbed through the lining of the mouth.

Higher doses or concentrations of CBD or THC in medical cannabis are more likely to be felt faster, but those treating long-term conditions with medical cannabis treatments may have built up a higher tolerance, and so, it may take longer for results to become noticeable. 

Is medical cannabis safe?

Medical cannabis treatments are generally well tolerated when they are administered in suitable doses to suitable patients. There are also a number of reports whose findings suggest medical cannabis is a safer, and equally effective, alternative to certain other prescription medications like opioid painkillers. 

Prior to the legalisation of medical cannabis in 2018, the Chief Medical Officer for England, Professor Dame Sally Davies, reviewed medical cannabis research, evidence, and findings from around the world regarding the efficacy and safety of cannabis-based treatments. 

As well as reviewing clinical evidence regarding the medicinal and therapeutic effects of medical cannabis, the consequences and possible risks of cannabis use (such as an increased risk of developing cannabis use disorder, or developing respiratory issues) were also evaluated. 

Ultimately, it was decided that, provided medical cannabis treatments are tailored to the individual, and supervised or administered under the guidance of qualified healthcare professionals, the benefits of medical cannabis outweigh the risks. 

Does medical cannabis have any side effects?

Although there are a plethora of benefits associated with medical cannabis, like any pharmaceutical treatment - there are some potential side effects associated with cannabis-based treatments.

Most of the side effects associated with medical cannabis are deemed as mild, and the most commonly experienced include experiencing a dry mouth, red eyes, or feeling dizzy, fatigued, nauseous or experiencing diarrhoea. 

However, there are more serious side effects, including an increased risk of impaired cognitive function or risk of developing cannabis use disorder. This is why it is always important that medical cannabis treatments are supervised and monitored for safety and efficacy by qualified healthcare professionals. 

Laws and regulations: prescribed cannabis in the UK

When was medical cannabis legalised in the UK?

In October 2018, UK Home Secretary Sajid Javid announced that medical cannabis and cannabis based medicines would be officially legalised in the UK and would be made available on prescription for suitable patients as of November 1st 2018. 

The announcement came following high-profile campaigns and appeals from the families of epileptic children such as Billy Caldwell and Alfie Dingley, who had demonstrated incredibly life-changing results when treated with cannabis-based medicines abroad. 

The decision to legalise medical cannabis in the UK was backed by the Advisory Council on the Misuse of Drugs, and recommended by Professor Dame Sally Davies following the positive results of her evidential review in the summer of 2018. 

Is it legal to grow medical cannabis in the UK?

Medical cannabis can only be legally grown (or cultivated), manufactured, processed, sold, imported or exported in the UK by those with a licence. In the UK, a controlled drug domestic licence is required to grow medical cannabis. 

To get a licence that allows them to cultivate, applicants have to be able to prove to the government that they are able to rent, or own, a property that is suitable for growing cannabis safely, and will be able to implement and follow the strict standard operating procedures involved in the legal manufacturing of cannabis.

If you are found to be growing or selling cannabis without a licence in the UK, you could face up to 14 years in prison. 

Is medical cannabis covered by the NHS?

When working for the NHS, specialist consultants who are able to prescribe cannabis based medicines are typically only permitted to prescribe licensed medicines that have been approved by the National Institute for Health and Care Excellence (NICE). 

There are only three licensed cannabis-based medicines approved by NICE in the UK. 

These are: 

• Sativex: can be prescribed to patients with multiple sclerosis to treat spasticity symptoms like muscle spasms and stiffness.

• Epidyolex: recommended by NICE as an appropriate option for treating seizures associated with Dravet Syndrome and Lennox-Gastaut syndrome.

• Nabilone: considered as an appropriate add-on treatment for adults experiencing chemotherapy-induced nausea and vomiting.

Because doctors working for the NHS are restricted in terms of the cannabis-based medicines they can issue prescriptions for because of their strict guidelines, the vast majority of medical cannabis patients access their medication through private cannabis clinics. 

Although currently patients are paying out of their own pocket for cannabis-based treatments in the UK, in 2023 there were a number of patients who managed to successfully secure a reimbursement from the NHS for their treatment. 

Who can legally prescribe medical cannabis in the UK?

In the UK, patients are required to have tried at least two conventional prescription medicines that have proven unsuccessful in managing their needs before being considered for medical cannabis.

Initial prescriptions (i.e. the first ever prescription) for cannabis-based medicines or medicinal cannabis must be issued by a consultant featured on the General Medical Council’s Specialist Register according to UK law, after the patient's suitability has been assessed. 

The specialist consultant’s prescribing decisions are then reviewed and approved by a multidisciplinary team of clinicians including other expert consultants, as well as pharmacists, nurses, and other healthcare professionals involved in the individual patient’s care. 

How to access medical cannabis in the UK 

What conditions qualify for medical cannabis treatments in the UK?

There are a number of conditions that qualify for medical cannabis treatments in the UK if other conventionally prescribed medications have failed to successfully manage their symptoms. 

This includes, but is not limited to: 

• Anxiety 
• ADHD
• Arthritis
• Cancer pain/symptom management
• COPD
• Chronic pain
• Cluster headaches
• CRPS
• Dementia
• Depression
• Ehler’s Danlos Syndrome
• Endometriosis
• Epilepsy
• Fibromyalgia
• IBS and IBD
• Insomnia
• Lower back pain
• Menopause
• Meralgia paresthetica
• Migraines 
• Multiple sclerosis
• Neuropathic pain
• Peripheral neuropathy
• PTSD
• Sciatica
• Trigeminal neuralgia
• Other headaches
  

How can I get medical cannabis in the UK?

If you are wondering if medical cannabis treatments may be a suitable option for you, why not fill in Releaf’s free online eligibility checker?

Our user-friendly platform allows prospective patients to assess their eligibility by filling out a quick questionnaire and submitting their health record, or Summary Care Record. Our team of expert clinicians will review your suitability for cannabis-based treatments based on this information, and if appropriate, invite you to schedule in an appointment with one of our specialist consultants at a time that suits you. 

During this initial consultation, one of our specialists will discuss medical cannabis treatments and how they may be able to benefit you as an individual, or be incorporated into your daily routine and care plan. Then, if appropriate, our clinician will issue you a prescription for cannabis-based treatments, and guide you through how to order and administer your medical cannabis.