Medical cannabis in the UK – a step backwards for drug policy?

On 1 November 2018, the UK legalised medical cannabis, making the 1.4 million people who sourced the drug illegally for medical purposes eligible for prescription.

18 months after legalisation the government records show no new prescriptions on the NHS, begging the question – was this a step backwards for drug policy?

Reasons for legalisation

Historically, cannabis has always been used for medicinal purposes, acclaimed for its alleviation of chronic pain. Only recently has its medicinal value been restored in countries such as Australia, Croatia, Israel, Germany and 33 US states where the sale of cannabis is government regulated.

The UK, by comparison, has been rather slow to jump on the weed bandwagon. 

It wasn’t until the 2018 campaign of epileptic sufferer Alfie Dingley, that the UK revised its position. Returning to the UK after residing in the Netherlands for five months (a country that welcomed cannabis legalisation in 1976), the family were prevented from importing the cannabis oils that were successfully treating Alfie’s epileptic seizures.

After nine months of campaigning for Alfie’s life-altering medicines to be legal, Home Secretary Sajid Javid announced the legalisation of cannabis for medicinal uses and Alfie Dingley received the first NHS prescription for cannabis on 7 November 2018.

Six months later Dingley’s mother, Hannah Deacon, penned an article for The BMJ voicing her concerns that the regulations amending the law had been inefficient:

“Many other children in similar situations have not been able to get these medicines despite now being legal. Why are families still not getting prescriptions? Why was the law changed if access was not to be forthcoming?”

Barriers to prescription

Despite its legalisation, there remains a huge mismatch between the supply and demand of cannabis for medicinal use.

A freedom of information request to the NHS business services authority confirmed there were no new prescriptions of oil in England between its legalisation and the end of February this year. 

The zero NHS and 313 private prescriptions which have been issued since the legalisation back in 2018 are figures which fail to correspond to the 1.4 million people annually reported to source the drug illicitly for medical treatment.

Within this lies a graver wealth disparity; private prescriptions, while evidently easier to get a hold of, cost patients around £2000. Wealthier families are at an advantage in being able to access medical cannabis while poorer families remain tempted by the lower cost of street cannabis, and the criminal consequences it hails. 

The UK has missed a vital step in fully legalising the drug – at the expense of users who cannot afford government prices for a prescription. 

More appropriate legislation would acknowledge the 1.4 million users and decriminalize the drug for medicinal purposes, allowing those who cannot afford the private prescription fees freedom to access their medication without the fear of a criminal record.

Although, economically speaking, this is not a favourable option for the government.

Legalisation diverts the profit from the hands of illicit dealers and gangs into government funds, through taxation on prescriptions. It allows them to regulate the price and control profit while ensuring nobody is detained for using the drug medicinally. 

Decriminalisation, on the other hand, grants the same freedom to users without giving the government control of the cannabis economy. While massively alleviating stresses on the justice system associated with stop and searches, detention, and prison overcrowding, decriminalisation generates no new profit for the government, which immediately constitutes it unviable.  

Instead, the 2018 cannabis law restricts users by allowing them to use their drug only if supplied by the government.

Harm and complexities of prescription

However, the legalisation of the drug brought with it many barriers to prescription due to the supposed harmful repercussions.

Adverse effects such as the risk of dependence, while relatively low (9% for recreational users of street cannabis), is enough to deter doctors from prescribing the drug.

Doctors also worry that medical cannabis may be sought after for recreational purposes, though the accessibility of illicit street cannabis means this is unlikely to be the case.

Furthermore, the current National Institute for Health and Care Excellence (NICE) guidelines recommend the prescription of cannabis-based products for the treatment of three main conditions:

  • Sativex for spasticity of adults with multiple sclerosis (MS);
  • Nabilone for chemotherapy-induced nausea and vomiting;
  • and Epidyolex for severe treatment-resistant epilepsy.

Limited clinical evidence exists for the effectiveness of cannabis in treating symptoms of Tourette’s, post-traumatic stress disorder, ADHD, anxiety and depression among many others, despite it being used effectively, albeit, illegally to treat these conditions.

A step in the wrong direction

The legalisation of medical cannabis is good. The way the government has implemented, or rather, not implemented, this legislation is bad.

After former chief advisor to the government, David Nutt, announced that the UK’s drug policy has done nothing but regress in the past decade, it seems as though this law was entirely performative, supported by the lack of prescriptions since its enactment. 

Instead the UK should look to other countries, such as Canada, for inspiration.

In 2018 Canada became the largest country in the world to fully legalise cannabis for both medical and recreational purpose. It legalised the drug for medicinal use in 2001, more than a decade earlier than its British counterpart, and the legislation was met with huge success – 2019 recorded 360,000 people registered as medical marijuana clients.

Canada’s policy, while ground-breaking, is not radical and came about after it prioritised the protection of public health, the protection of young people, and the reduction in criminality associated with the illegal market. A compassionate UK government would do the same. 

While at first the government’s new stance on cannabis seemed optimistic for future drug policy reform, its reality has proved the redundancy of its legalisation.

One might hope that the legalisation of cannabis for medicinal purposes would lead naturally to two future outcomes:

  1. The decriminalization of all types of cannabis whether medicinal or otherwise – a policy undertaken in Portugal, Uruguay and Canada, among others, proven to be effective in alleviating stresses on the justice system and decreasing prison populations in these countries.
  1. Following this, the legalisation of the drug, as is the case in California and Canada, would remove the supply of cannabis from the hands of the criminal underworld and leave it to the government to safely supply, regulate and tax.
  1. The review of other currently illegal substances with proven medicinal treatments, for example, psychedelics such as LSD have been used to effectively treat symptoms of post-traumatic stress disorder, particularly in ex-soldiers. The Class A status of these drugs make it almost impossible to conduct clinical trials that prove their medical value.

After its 50-year-old rhetoric that drugs are harmful, criminal and dangerous, it is no surprise that the government is reluctant to release evidence hailing the benefits of illegal drugs.

Unfortunately, regulation of drugs will, if ever, be slow-paced and halting rather than a smooth transition from ‘just say no’, to free cannabis via the NHS.

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