ByĀ Chelsea Coates,Ā BBC London
- Medical whole cannabis was legalised in 2018 after a campaign to make it available to children with severe epilepsy
- Private clinics are seeing a rise in patients, but the drug has only been prescribed to a handful of people on the NHS
- Campaigners are calling for it to be more widely available to give patients more treatment options
- But the government says more evidence of the drugās benefits is needed
Private cannabis clinics are seeing a rise in patients as people choose the drug to treat chronic pain and mental health conditions.
One medical cannabis clinic in Westminster, Mamedica, said it had seen the number of patients increase by more than 10 times in 2023, rising from 250 to 2,750.
CEO Jon Robson said this was down to a ālarge number of patients who are transitioning to us not just from the illicit market, but because they havenāt found the treatments that the NHS can provide to be sufficient for their conditionsā.
The majority of patients at the clinic take medical cannabis for psychiatric conditions, such as anxiety and depression, with 40% taking the drug to treat chronic pain.
In a statement, the Department for Health and Social Care said that ālicensed cannabis-based medicines are routinely funded by the NHS where there is clear evidence of their quality, safety and effectivenessā.
But it added that āmost products on the market are unlicensed medicines, and clinical guidelines from the National Institute for Health and Care Excellence (NICE) demonstrate a clear need for more research to support routine prescribing and funding decisions on the NHSā.
One patient taking the drug for chronic pain is Julie Gould, from Wimbledon in south London.
The 64-year-old started using medical cannabis in 2020 after being diagnosed with multiple sclerosis (MS) in her 30s.
āIāve got permanent damage. My walkingās affected, my bowel, my bladder is affected,ā she says, comparing one of her symptoms to someone āhammering your brain with an ice-pickā.
She used paracetamol and ibuprofen to relieve the pain until her neurologist prescribed her with amitriptyline, a pain medication also used as an antidepressant.
But the drug aggravated the symptoms of another condition ā restless legs syndrome (RLS), which causes an āunpleasant crawling or creeping sensationā in the legs.
Ms Gould wants the drug to be āheavily subsidisedā, adding that itās become ātoo expensive for most peopleā, especially if they need to take it more regularly to manage their symptoms.
āIt should be heavily subsidisedā
āI can remember going to my GP, saying: āI donāt think Iām going to make it through. I havenāt slept for two days and I really canāt cope with this.
āI remember bursting into tears in front of her and she looked at me and said, āas we get older we all get aches and painsā.ā
Ms Gould started taking medical cannabis oil after getting a prescription through a private clinic and says it āinstantly stopsā the nerve pain she experiences.
āIn my view, itās just a miraculous drug,ā she says, adding that it helped her through withdrawals after she was put on a new medication for her RLS.
She now only uses the medicine occasionally, but is concerned about how she would afford it if her symptoms got worse.
āIn 2020, 100ml of the oil I used cost about Ā£150 ā now that same 100ml is Ā£350,ā she says.
Sativex, a cannabis-based spray used to treat MS muscle spasms, is licensed for prescription on the NHS, but the MS Society says there is an āunacceptable postcode lotteryā for the drug.
NHS England says it already offers several cannabis-based treatments that have been approved by the MHRA but āmany doctors and professional bodies rightly remain concerned about the limited evidence available concerning the safety and efficacy of unlicensed productsā.
In a statement, it said āmanufacturers are encouraged to engage with the UK medicines licensing process, which can help provide specialist doctors with the confidence to use the products, in the same way they use any other licensed medicines that are recommended for use on the NHS.ā
Who can take medical cannabis?
Before 2018, medical cannabis products could not be legally prescribed in the UK.
This is because they were classified as Schedule One drugs, meaning that they were judged as having no therapeutic value.
After a successful campaign to allow access to medical cannabis for children with severe epilepsy, medical cannabis was legalised.
This allows NHS or private specialist doctors to prescribe the drug ā but only if other treatments have not been effective.
But an investigation by the BBC in 2023 found that fewer than five NHS patients had been prescribed with the drug so far.
One reason for this is that not all medical cannabis products are licensed.
First, they need to go through clinical trials that are costly and complicated because of the many compounds in the cannabis plant.
There are a few licensed medical cannabis products, but they do not contain the whole plant.
They can only be prescribed on the NHS for severe epilepsy, for nausea from chemotherapy or for muscle spasms caused by multiple sclerosis.
Specialist NHS doctors can still prescribe unlicensed products if they think the patient will benefit, but they have to ask NHS England to pay for individual cases and are often turned down.
Private specialists can also prescribe unlicensed products, but this often comes at a high cost for patients.
āThereās still a lot of stigmaā
Epidemiologist Michael Lynskey leads research on the T21 Project, the UKās biggest non-profit observational study of patients taking medical cannabis.
Founded by London-based charity Drug Science in 2019, the programme now has more than 4,600 patients nationwide.
It enables patients to access medical cannabis clinics at a discounted price and collects their data to provide evidence on the effects of the drug.
Prof Lynskey says the number of people signing up to the project has been ārelatively constantā and there has been an increase in people looking to be prescribed cannabis in the UK overall, especially with patients over 65.
About a third of UK patients try the drug to treat psychiatric conditions such as anxiety or PTSD, but the charity says this is still an āemergent fieldā.
The UK medical cannabis market is the second largest in Europe and is expected to be worth Ā£300m in 2025, according to market researchers Prohibition Partners.
Prof Lynskey says it is āunfortunateā that some people are āexcludedā due to the cost of cannabis from private clinics, especially as many of those living with chronic conditions are ānot working or not working full time and struggling financiallyā.
Even if the drug is made more accessible on the NHS, he says that attitudes towards medical cannabis may take longer to change.
āThereās still a lot of stigma in the general population against it and that includes actually a lot of doctors, who either donāt know itās legal or donāt believe it should be,ā Prof Lynskey says.
āYou donāt tell peopleā
For Stephen ā not his real name ā his employer or colleagues finding out that he takes medical cannabis is āone of his biggest fearsā.
āYou donāt tell people. Itās a secret,ā the 52-year-old software developer from London says.
He tried the drug for the first time in 2022 after receiving a prescription from a private clinic through the T21 Project.
Like most other patients, he had to prove he had already been prescribed at least two other treatments that had been ineffective and now has checkups with a private GP every three weeks to review his treatment.
It costs Ā£60 a session and a further Ā£80 to Ā£180 for the supply of medical cannabis oil.
āIām very lucky I am able to afford this, Iām in a good job, but there will be many people who really struggle to pay for it,ā he told the BBC.
Stephen is among a growing number of people who are turning to medical cannabis to treat their mental health.
The T21 Project says that 42% of patients on the programme take the medicine for psychiatric conditions ā making them the second largest group behind chronic pain patients.
After he attempted to take his own life in his late teens, Stephen was diagnosed with what was then called ābipolar depressionā and prescribed a series of antidepressants on and off until the age of 49.
āIt sort of turned me into a zombie,ā he says, adding that the SSRIs he was prescribed āseemed to increaseā his anxiety.
āAt one stage I was also prescribed benzodiazepines for my anxiety, which I got very, very addicted to. And then spent a good two years trying to wean myself off that.ā
He was finally diagnosed with autism, PTSD and anxiety disorder after two years on the waiting list.
He began taking medical cannabis oil shortly afterwards and said it had been ātransformativeā, helping him to cope with the āhectic environmentā at work.
āItās also had the weird effect of helping me be more empathetic with family members,ā he added.
He says that while he understands medical cannabis will not work for everyone, he wants people with complex mental health needs to have access to a wider range of treatments.
āI wouldnāt necessarily claim that it would work for everybody, because I think thatās always a dangerous claim, but I think, you know, itās always good for there to be options.ā
Despite this, he still says the fear of being found out for using the legal drug āterrifiesā him.
āThereās such a stigma attached to it because of the status of recreational use.ā
Some campaigners also argue that this stigma is a major roadblock on the path to making medical cannabis more accessible for those who could benefit, especially in minority communities.
Katrina Ffrench is the founder of UNJUST, a not-for-profit organisation that campaigns against discriminatory practices in policing and the criminal legal system.
She argues that while itās āfantasticā that people can access medical cannabis on the NHS, āso much moreā needs to be done.
āWhat we do see is the ongoing criminalisation of predominantly black communities around the use of cannabis and that itās incredibly difficult to then encourage communities to seek cannabis as a medicine when theyāre criminalised for its use in other spheres, so thereās a lot of mixed messaging.ā
āLack of clinical evidenceā
In a statement, the Department for Health and Social Care said there was a need for more research on the effects of medical cannabis before any changes could be made to how it is prescribed on the NHS:
āUntil the evidence base improves, prescribers will remain reticent to prescribe and no decision can be made by the NHS on routine funding.
āThat is why we continue to call on the manufacturers of these unlicensed products to conduct research and are ourselves working closely with regulatory, research and NHS partners to establish clinical trials to test the safety and efficacy of these products.ā
The National Institute for Health and Care Excellence (NICE) is responsible for deciding what drugs are available on the NHS.
The body said its clinical guideline reflected āthe overall lack of clinical and cost-effectiveness evidenceā for cannabis-based medicinal products and encouraged specialist doctors to consider the ārelative risks and benefits in choosing treatmentsā.
It also added that it was āimportant to point out that even had NICE recommended widespread use of these products, it would not necessarily mean that they would become routinely available on the NHSā as the majority of cannabis-based products are unlicensed.