Through the haze: Answering UK patient’s medical cannabis questions

What do you do if your GP doesn’t want to help you get a prescription?

Don’t worry if your GP doesn’t want to help you get a prescription because they aren’t legally able to; there is an alternative route through private cannabis clinics. GPs are currently unable to prescribe medical cannabis due to it being prescribed off licence, allowing only specialist doctors who have completed more training to prescribe. The National Institute for Clinical Excellence (NICE) decides what the NHS can prescribe, i.e. those medications that have passed clinical trials to be licenced to treat specific conditions. 

With medical cannabis becoming legalised only relatively recently, companies have only just started investing in the clinical research required to support NHS doctors’ ability to prescribe. However, clinical trials can take many years to complete. In the meantime, private cannabis clinics have opened to offer the service for those who can fund their treatment plan and medication costs independently. 

There is a campaign by the Cannabis Industry Council calling for the Home Office to give GPs medical cannabis prescribing powers. 

How do I get medical cannabis on the NHS?

To get medical cannabis on the NHS is rare. Public articles online indicate that there are only five patients receiving a medical cannabis prescription from the NHS. The Home Office has instructed the NHS to prescribe with a certain criteria. The conditions of the criteria are a barrier to access for many people who rely on the NHS for healthcare. 

A small number of terminally ill cancer patients have had their medical cannabis prescription costs reimbursed through Private Funding Requests, which funding bodies look at on a case-by-case basis. 

How easy is it to switch medical cannabis clinics?

Switching medical cannabis clinics is a relatively straightforward process. By following the steps below, you will have tied up all the loose ends with your last clinic and be confident that your new clinic has everything it needs to continue your treatment. 

• Request your consultation notes and prescription history from your previous clinic. 
• Request a discharge letter from your previous clinic before being accepted as a new one so they know you wish to end your treatment plan with them. 

• Use Releaf’s integrated NHS login feature to grant us instant access to your most recent SCR. The one you may have on file from applying to your previous clinic will now be outdated. 

If you would like more help switching from your existing medical cannabis clinic to Releaf, our patient support team is happy to assist. 

Is there a limit to how much medical cannabis a doctor can prescribe?

Technically no, there's not a higher limit on how much of a certain medicine a doctor will prescribe a patient, but clinics may set a limit for regulatory safeguarding measures. Doctors assess every patient uniquely using the same set of principles and decide whether a cannabis based treatment is a suitable option. 

Doctors will then advise selected products are used in specific doses a set number of times in a day to try and alleviate certain symptoms. After the first month, patients will have a follow-up appointment to make sure their treatment is providing maximum benefit, and minimal side effects. Following this, patients are monitored through check-ins with the clinical team every 120 days.

Patients require different prescription quantities based on their medical need; having a prescription for medical cannabis is not a licence to freely use as much cannabis as you like. 

Does having a medical cannabis prescription make it legal for me to grow my own at home?

No, having a legal prescription for medical cannabis does not give you the legal right to grow your own at home. Cannabis cultivation is an offence under Section 6(2) of the Misuse of Drugs Act 1971. It is an arrestable offence and can result in a custodial sentence. A defendant diagnosed with a medical condition is not a valid defence for breaking the law, but judges may take that into consideration during sentencing. 

It is important not to confuse all medical cannabis laws in every country as being the same, Releaf has put together a list of all the countries with medical cannabis here for you to learn about the differences. 

Once I have a prescription, can I put any cannabis in the tub?

No, when you are prescribed medical cannabis from a clinic, it's that specific medical cannabis that doctors prescribe to you. The doctor must know what varieties of medical cannabis you are taking, how much and how often in order to care for you appropriately. Through these details, the doctor can monitor your overall condition, symptom control and pain levels to know whether they are prescribing the correct dose and forms of medical cannabis. 

When patients introduce other unregulated cannabis products to their care plan without their doctor's knowledge, it can compromise the advice they give you. Your prescription label is valid for 28 days. If you need to increase your medication or change the variety, you should speak to your doctor at your next appointment. If your next appointment is too far away, call the patient support team, and they can assist you in booking an appointment sooner. 

Why is smoking medical cannabis still prohibited? 

Smoking medical cannabis is still prohibited because burning plant material creates known carcinogens in the smoke which cause harm to your respiratory system, lungs, cause cell damage and cause DNA mutations. Using a vaporiser reduces the amount of toxic byproducts, making it a far safer option for patients.

What happens if I am unhappy with the medical cannabis the clinic has sent me? 

You should tell your doctor during your next appointment if they have prescribed a product that does not alleviate your symptoms. Your doctor will be able to suggest other products that may be suitable for you or advise you to take a different dose. Clinics cannot issue refunds for prescription medications that aren’t to your liking once treatment has commenced. 

However, you should contact the patient support team and advise them of the problem if you are unhappy with the quality or if the product has a physical issue. You must give the batch number on the packaging label to help with further quality control. Patient support will be able to assess the situation and, if appropriate, will arrange to send a replacement product to you. 

Why does medical cannabis have to be irradiated?

Medical cannabis flowers come in two forms. Non-irradiated and irradiated. Irradiation involves using gamma or beta waves to sterilise the medication. Irradiating products extend their packaging stability and shelf life. Doctors will prescribe only irradiated medical cannabis flowers to patients with a compromised immune system as a safeguarding measure. 

Irradiated flowers are the safest flower products because the irradiation process ensures no potentially harmful biological contamination, such as mould or bacteria, can harm the patient. Patients who are undergoing chemotherapy or radiotherapy treatment, have had a transplant or are taking immunosuppressive medication for an autoimmune disease will fall into this category. 

Why do medical cannabis flowers have to be dried to 10% humidity?

Medical cannabis flowers must have a water content of 10% or lower, according to the EU monograph for medical cannabis flowers. A low humidity ensures minimal chance for moulds, yeast and bacteria to grow whilst the product is stored before reaching patients. You may want to introduce a Bovida humidity pack once you have opened the container and broken the seal if you find that the low moisture level is impacting the quality of how the medical cannabis flowers vaporise.

Introducing the humidity pack will stabilise the container environment to 62% relative humidity, which some patients find improves how the flowers vaporise. With a higher humidity level it will improve the flavour and larger volumes of vapour. Some patients have reported that without the extra humidity added back in, the vapour tastes burnt, can cause greater levels of throat irritation and induce a dry cough which is considered an unpleasant side effect. 

What’s the difference between medical cannabis and street cannabis?

The difference between medical cannabis and street cannabis is the way it is produced and accessed. There is a greater level of quality control with medical cannabis, where it is grown in a regulated environment and carefully controlled to precise conditions for optimum plant health and cannabinoid production. Plants are harvested at the correct time, which is determined through testing for cannabinoids THC and CBD, including the terpene levels. 

Medical cannabis goes through multiple screening processes before it reaches a patient. Only people prescribed cannabis can have it without breaking the law, and only specialist doctors can prescribe it. Once a doctor has written a prescription, a pharmacy must dispense it. Cannabis produced under regulated conditions for a medical market is produced to be a consistent product, each batch providing the same level of quality ongoing care. 

Cannabis that has been grown without the same stringent levels of control cannot be trusted in the same way because there are no assurances that it is clean of harmful contaminants such as pesticides, heavy metals and mould. 

Patients do not have to worry that someone has contaminated their medicine because at every stage in the process checks are made to ensure that doesn’t happen. Unlike the situation with grit weed we covered. Take a look at the more of the hidden dangers of unregulated cannabis here. 

Is medical cannabis synthetic or genetically modified?

Most cannabis medications are made from naturally occurring phytocannabinoids, but there are some products that are synthetic and man-made in a lab. Medical cannabis is more broadly defined as cannabis-based medicinal products for use in humans (CBMPs). CBMPs include products that contain any kind of cannabinoids derived from natural plant sources or that have been synthesised in a lab. 

The synthetic cannabinoid medicines less frequently prescribed include Dronabinol and Nabilone. 

The majority of CBMPs prescribed by private cannabis clinics are naturally produced, with flower products being the most popular, followed by oil tinctures. Capsules, vape pens, and lozenges are also available, and new products such as inhalers and patches dispense naturally derived cannabinoid extracts. Learn about all of the available products here. 

These medications aren’t licenced for specific conditions, but doctors may prescribe them because the evidence suggests they are in the best interest of the patient. There are several licenced cannabis based medicines, some are natural, but there are also synthetic cannabinoids available on prescription. 

Jazz/GW Pharmaceuticals make the natural ones and include Sativex, a 1:1 THC:CBD oil mouth spray suspended in ethanol for use in patients with Multiple Sclerosis (MS). Epidiolex is a CBD tincture in sesame oil with strawberry flavouring for use in children with Lennox Gusset Syndrome, a severe form of epilepsy. 

Are the cheaper strains of medical cannabis good quality?

Yes, the cheaper strains of medical cannabis are good quality. Quality refers to the purity and cleanliness of the product that contains the active medicine. All cannabis-based products for medicinal use in humans are screened in the same way, so even if they are produced in different conditions (indoors, greenhouse, outside) they must pass the same level of testing scrutiny. There may be differences in the grading of flowers which can be reflected in the price, but the price will not always be a fair indication of how high or low the grade of the flower or even the terpene levels are. All medical cannabis products are of the highest pharmaceutical quality. 

A quick round up

The facts about medical cannabis in the UK demonstrate how well regulated, and therefore how safe, the industry is. From the quality of products to the level of care from the medical professionals, every treatment plan is tailored to the needs of each patient. 

Private cannabis clinics are the fastest way to become a legal patient due to stricter prescribing rules within the NHS. There is a cost involved in medical cannabis but it is becoming more affordable as patient numbers increase. Switching clinics is also very easy. 

Medical cannabis products come in all shapes and sizes, providing patients and doctors with a variety of treatment options. Safety is of the highest importance and regulatory safeguarding by the government and clinics has been put in place to ensure the highest quality of care. Regulated medical cannabis products used under the care of a specialist doctor are the safest treatment option for patients who need cannabinoid therapy in the UK . 

Hopefully this will provide you with the information you require to check your eligibility and book an appointment with one of our specialist doctors.