Voices from the Field: What's Holding Back Medical Cannabis in the UK

Releaf speaks to five well placed medical cannabis industry professionals to find out what hurdles still remain in the way of cannabis clinics offering the service that completely meets the needs of patients. 

In the opinion of Robert Jappie (Fieldfisher)

Robert Jappie, partner at legal firm Fieldfisher is well known in pretty much every corner of the UK cannabis industry. He has been a longtime policy advocate previously working at drug policy reform charity Release, taking on activists challenges against the home office, defending cannabis businesses tangled up in court cases of CBD bureaucracy and generally knowing all the legal ins and outs of cannabis policy. We asked him about his musings on what improvements could be made to cannabis policy or services as things stand. 

What kind of improvements do you think need to be made to the service patients are getting at the moment?

“Customer Service plays a huge part in this sector. Patients, especially those who are cannabis-naïve, require ongoing support and attention. Getting a patient into the legal market is challenging in itself, but keeping them in it is even harder. It is essential that patients feel valued and able to ask questions, even after they have received their first prescription.” 

It’s a valid point; the medical cannabis sector is here to help patients transition from an illicit market with uncountable hidden dangers. Clinics need to be able to make patients feel more comfortable to get their medication from than the illicit market, the win-win situation. But what else could happen to improve patients rights? 

Do there need to be any further changes to the law? What are they? 

“More protection for patients in the workplace would be extremely helpful. As patient numbers increase, we are seeing more and more driving and employment issues arise. Some employers are supportive and understanding, but many are not and this needs to be addressed. Taking cannabis for medical purposes needs to be viewed in a positive light, and it should be recognised that medical cannabis is helping many people get back into work.” 

Over 2.5 million people of working age are currently out of the labour force due to a long term medical condition or health problem. Further to this some conditions have few effective treatments with 20-50% of patients being treatment resistant to conventional options. 41% of pain patients tol the British Pain Society that their pain prevents them from working. Cannabis could offer a valuable solution to helping people get back into work and taking greater control of their lives. 

What are your thoughts on the UK government allowing patients the right to grow at home. Would it be a sensible move to make?

“I think what a person does in the privacy of their own home is their business (provided no harm is caused to others). To my mind, there is no good reason to prevent patients from taking control of their treatment and this should include being able to grow at home within accepted parameters.”

The government has recently responded to a patient-led petition calling for the law to change, allowing patients prescribed a cannabis-based medicinal product to grow a small number of plants at home. The response was negative and the government reiterated their stance; 

“Cannabis cannot be cultivated except under a Home Office licence. The Home Office does not grant licences to grow cannabis for personal consumption and there are no plans to introduce this.”

Is there anything else that needs highlighting regarding patients rights when carrying their prescription?

“I'm seeing more and more erroneous interventions from the police in relation to medical cannabis patients. Medical Cannabis has been legal for nearly 5 years and it is astonishing that so many police officers still don’t know this. Countless police hours and resources (all taxpayer funded by the way) are being spent on these issues and it is a complete waste of time and money. Patients should be well protected from such police action, and it is essential that the police are educated in such matters.”

In the opinion of Sam Cannon (Beyond Green)

Sam Cannon is an enthusiastic business activist and entrepreneur that has worked with Formula E, Ministry of Sound, Fabric, and most recently with the government of Thailand developing software services in medical cannabis. Sam consults for a number of businesses in the UK and internationally. He is also a patient, with a diagnosis of ADHD, that provides him with both a business and patient perspective, and allows him to integrate the patient experience into business projects designed to help patients like him. 

Firstly, how is life as a patient that has been prescribed legal medical cannabis in the UK?

“We need better quality cannabis flowers at a more affordable price."

"It’s frustrating. I think we have made a good amount of progress. Customer service has got much better, the choice of products on the market has got better although it can be potluck. You will look at the potential products available that are affordable, which for most people is the £5-8 a gram mark. If it isn’t up to standard you are stuck with it. You can’t see and smell the product before you buy it and this is a real problem. There’s effectively not enough consumer rights. When you are on a budget it’s just impossible to rectify the issue. To a lot of people hearing the amounts that patients have to spend a month on their meds is alarming because people are so used to getting things for £9.95 on the NHS." 

"It would be great if patients could get a sample pack of all the strains a clinic has. It will allow patients to see what works for them and then continue with the strains that work best for them. I would really love to see clinics doing this." 

There is a gulf in the difference between the traditional way patients have acquired their cannabis before the law changes. With a more tactile experience being able to see and smell the flowers before selecting which ones you were going to buy allowed you to identify what you think will most likely work for you based on previous experience. To me, this identifies a deeper level of education for patients about what terpenes are in which strains and what kind of effects that can influence. 

How have you found being a patient out in public? Is there still a stigma?

"Yes there is still a stigma, even from people who know it is a medicine, it’s hard for them to shake years of anti-cannabis propaganda. Seeing more places open that allow people to use cannabis will be better. We have seen people rejected from venues for having their prescription in their bags. But the cafe’s that are opening up are great, there are just too few of them. They need to be in every town and city realistically. The social aspect is necessary." 

"We need more social clubs, membership organisations that patients can join and use to feel like they aren’t out of place when they are medicating in a public space. Patients deserve to have a place where there aren’t going to be any complaints made about them.They can be away from kids, they can have access to the services they need and it makes it more adult for everyone." 

Cannabis Social Clubs are finding their way into the wording of the national legislature in multiple countries. The model introduces a way for patients to safely take their cannabis in public without it causing alarm or distress to anyone that still has a negative view of cannabis use or does not like the idea of children seeing it taken. They also provide an opportunity for patients to socialise with other patients. Having a chronic health condition can be very debilitating and often lead to patients not leaving the house very often. Knowing you can visit a place that does not have a stigma around cannabis as a medicine or people with a disability is often very beneficial to their mental health. 

Do you think there is sufficient patient access to cannabis-based treatments?

"Yes and no. There are plenty of clinics but patients aren’t being connected to the services enough which patient cafes on the high street will help by signposting. We need more public awareness campaigns too. We can’t advertise the product but we can advertise the service and the stories that patients have lived." 

"We need clinics to be braver with their outreach. It’s really great to see Releaf challenging the stigma. I see Releaf popping up more than anyone at the moment and it’s down to several things I think. You are putting yourself out there and aren’t afraid of being noticed. But also, being part of the conversations that are taking place and you have patients with experience as part of the staff so you know what is needed to attract patients and provide a good service." 

Seeing more people with real world cannabis and patient experience in the UK will certainly make an improvement to the quality of services in the UK. There are lots of tight regulatory compliance that need to be adhered to, more so than most other countries. It means companies have to be creative about the way they market their services so people know they exist. 

What else do you think would improve patients rights and access?

"We would benefit from technology like cannabis inhalers. Not everyone wants to vape or likes the experience so there definitely need to be newer solutions for people to find the most suitable delivery method for them. Devices that control the dose in a carefully metered way are definitely in demand. It would also be great to see more tailored capsules made up for people so they can get the dose and cannabinoid ratio that suits them, rather than just one size fits all. I wouldn't mind seeing pastels or gummies on the market that came through the post in my prescription every month." 

Product choice in the medical cannabis market is increasing over time. Due to the way the supply chain works it isn’t as simple as just making the product and putting it on sale. Devices need to be regulated just as much as the medicines in them, which is costly and takes many years to design, test and develop before it is ready for market. Patient feedback about the products they would like to see is always helpful to clinics like Releaf to receive as it allows us to make sure that the service we are providing meets the right needs - so don’t be shy. Your suggestion could influence the market for everyone!

In the opinion of Alkyoni Athanasiou-Fragkouli (Drug Science)

Alkyoni Athanasiou-Fragkouli is a neuroscientist and Research Officer for Drug Science overseeing one of the largest observational studies on medical cannabis in the UK. Alkyoni has a passion for patient advocacy, speaking publicly about patient access issues and presenting findings from Drug Science’s T21 study. 

What could the government do to improve patients rights when it comes to medical cannabis access?

"Medical cannabis should be accessible on the NHS. In fact, T21 was set up by Drug Science with the ultimate goal of influencing policy change by collecting real world evidence on the effectiveness and safety of prescribed cannabis. Ultimately, T21 seeks to shape future healthcare guidelines and make medical cannabis a viable treatment option for those who could benefit from it." 

"Recently the NHS has reimbursed the cost of two UK patient's private medicinal cannabis treatment. It would be great to see some clear guidelines on this process so that eligible patients can apply with the help of their clinic. Moreover, cannabis based medicinal products such as Sativex and Epidyolex are only available in some NHS trusts despite being fully licensed for specific conditions."

This is a helpful suggestion to a pressing issue that so many people are waiting for a solution to. There is a long history of medical cannabis prescribing being a postcode lottery situation with some local NHS trusts allowing prescriptions like Sativex to be funded and others refusing even though it is a licenced CBPM. Children with epilepsy are suffering without the right to cannabis medicine on the NHS. Reporting indicates that approximately 5-7 patients out of 30,000 have had their medical cannabis prescriptions reimbursed by the NHS

Are there any legal issues that patients are facing that could have something done about them?

"The legal landscape regarding medical cannabis in the UK is constantly evolving, however patients still face challenges. One of the most significant issues that patients face is in regards to driving while receiving medical cannabis treatment. At the moment there is no specific legal limit on the amount of THC (the psychoactive component of cannabis) that can be in a driver's system, unlike the strict limits in place for alcohol." 

"The challenge lies in accurately measuring impairment because THC can remain in a person's system long after the impairing effects have worn off, especially for regular users. This means that someone who uses medical cannabis legally and responsibly could still test positive for THC long after the impairing effects have dissipated, potentially leading to legal complications, such as being charged with driving under the influence. Patients shouldn’t be stopped from driving if they are not impaired." 

"Additionally, the use of medical cannabis can sometimes lead to housing issues due to outdated regulations and stigma. It is important to note that if an individual is using medical cannabis to manage a disability or a chronic health condition, they might be protected under the Equality Act (2010) if they face discrimination due to their cannabis use. Employers and service providers could potentially be required to make reasonable adjustments to accommodate an individual's medical cannabis use if it is related to a disability. Patients facing housing issues due to their medical cannabis use can contact Release or Mackrell Solicitors for support."

Awareness that the police need more awareness and training that medical cannabis is legal and how to deal with it in a standardised way that does not infringe the patient's rights. As the number of patients steadily rises so too is the rate of negative incidents patients are reporting on social media sites. Clinics need to be supportive of patients who are wrongfully having their medicine withheld from them. Releaf has created a medical cannabis card for patients prescribed through our service. The card holds all the details of your prescription and prescribing history for cannabis in order to satisfy the policy concerns that you may be carrying illicit cannabis.

Is there something you think could happen overnight to speed up improvements to patient access?

"GPs should be allowed to prescribe, this is a change that could happen overnight that would have a substantial effect on patient access. At the moment only specialist consultants can initiate a medical cannabis prescription. Allowing GPS to initiate prescriptions would open up access to medicinal cannabis and would bring down costs. This is already happening on the islands of Guernsey and Jersey."

"In the long term, the government should invest in research to further understand the benefits and risks of medical cannabis, leading to more informed policies. Public education campaigns could help dispel myths and provide accurate information about medical cannabis, empowering patients and healthcare providers to make informed decisions." 

In the opinions of Professor David Nutt DM, FRCP, FRCPsych, FSB, FMedSci (Drug Science)

Professor David Nutt is a world renowned English neuropsychopharmacologist and the Edmond J. Safra Professor of Neuropsychopharmacology and director of the Neuropsychopharmacology Unit in the Division of Brain Sciences. He is part of the medical faculty at Imperial College specialising in the research of drugs that affect the brain and conditions such as addiction, anxiety, and sleep. His work with Drug Science has led to the T-21 study collecting data from legal medical cannabis patients to use real world data to help shape the conversation and policy surrounding medical cannabis. 

What do you think could be done to improve medical cannabis patients rights?

Allow GPs to initiate prescribing…

It’s a simple request, but one that would have one of the most dramatic impacts on patient access, increased availability and bring about a broader awareness and acceptance for medical cannabis.  

Rundown: How UK medical cannabis patients rights could be improved

Taking a look back at the suggestions we have had from our four guests gives an insight into the kind of improvements that could be made to make patients' lives and pathways to access easier and more hospitable. Customer service has got better but could still improve, more workplace protection, looking into allowing patients to grow their own, training for the police, better quality products and at more affordable prices, tester packs to trial strains, NHS prescriptions, more social spaces for patient socialising in public, more outreach from clinics to connect with patients and new delivery devices like inhalers. There’s also the pressing issue that GPs need to be able to prescribe and considerations that the eligibility criteria should not require patients to have tried two medications. More conditions should be prescribed to, government funding for universities to study cannabis, and updating driving laws to allow patients to have THC in their system if prescribed. Despite the desire to improve the services and treatment of patients, the industry is celebrating medical cannabis in the UK and the gains that it has made and with that in mind it seems hopeful that with time, more improvements can be achieved.