Introduction to medical cannabis

What is medicinal cannabis?

Cannabis use as a medicine is extensive and mostly lost to history. We do know that ancient civilisations such as the Greeks, Romans, Egyptians, Babylonians and Imperial China have records showing it was a medicinal, spiritual and industrial crop that had high importance.

In the Victorian era, Dr O'Shaunessy researched the use of cannabis as a medicine in India, leading to the Queen's physician treating many of her medical complaints with cannabis tincture. It is reported that Queen Victoria also used cannabis to help with birthing pains during child labour. Cannabis was legally used medically and recreationally in Britain until 1928, when the League of Nations Dangerous Drugs Act added cannabis at the suggestion of the Egyptian delegate, who compared hashish to opiates.

The heyday of cannabis medicine was around the end of the nineteenth century when it was used for many symptoms in several forms. The excitement of the introduction of hypodermic syringes and injectable opiates reduced cannabis usage somewhat, in addition to newer synthetic drugs. However, in retrospect, some of these new drugs have proved ineffective in some people and have dangers inherent in their use. Unfortunately, the current state of our War on (some) Drugs legislative policies has prevented its legal use and restricted any research efforts that brave scientists have attempted.

Cannabis was part of the British Formulary until it was made a controlled substance in 1971 when the Misuse of Drugs Act was introduced. Even though not many doctors were prescribing cannabis products at this time due to no products being available, the act saw an end to any potential for legal prescribing.

After many years of campaigning by patients and activists, a light at the end of the tunnel started to be seen. Police forces across the UK began backing patient-run cannabis social clubs that also gained the support of MPs and Members of the House of Lords. When corporate groups started showing interest off the back of this grassroots campaigning, more traction was made with PR agencies creating news bubbles, creating public interest on a scale that has not been achieved in UK cannabis campaign history.

In 2018 everything came to a head when children suffering from childhood epilepsy were thrown into the spotlight, creating a poignant leverage point that capitulated the push and tipped policymakers over the edge, forcing them to legislate for legal access.

"There is now, however, conclusive evidence of the therapeutic benefit of cannabis-based medicinal products for certain medical conditions and reasonable evidence of therapeutic benefit in several other medical conditions. This evidence has been reviewed in whole or part, and considered robust, by some of the leading international scientific and regulatory bodies, as well as the World Health Organization (WHO).As Schedule 1 drugs by definition have little or no therapeutic potential, it is therefore now clear that from a scientific point of view keeping cannabis based medicinal products in Schedule 1 is very difficult to defend. Moreover, I believe that it would not make sense to move cannabis and its derivatives out of Schedule 1 whilst leaving synthetic cannabinoids, which the evidence suggests have potentially greater therapeutic benefit and less potential for harm, in Schedule 1. I therefore recommend that the whole class of cannabis based medicinal products be moved out of Schedule 1."
Dame Sally Davis, 2018

Following this statement, an amendment to the Misuse of Drugs Act 1971 was made to allow the medical prescribing of cannabis-based medicinal products. The government's official line has changed from "cannabis has no medicinal value" to "there is now conclusive evidence cannabis has medicinal value". Specialist consultants and not GPs can prescribe Cannabis Based Medicinal Products (CBMP), but not through the NHS.

Britain now joins many nations with medical cannabis implemented by the state government. Canada has full recreational cannabis with strict regulations, but the US has still not changed policy. The USA has 23 states with recreational cannabis laws and 38 with medical cannabis laws. There are 11 states where you can grow your medical cannabis at home and in total 24 states allow home growing of some kind. States that legalised medical cannabis without the right to grow do not seem to add home growing after the law has been passed, often due to the law being crafted by corporate groups rather than written for patient rights.

Cannabis can treat a wide range of medical diagnoses and symptoms to relieve pain and inflammation, promote healing, regulate the immune system, aid appetite and sleep, and reduce nausea in chemotherapy. There is evidence that shows cannabis compounds have antitumor properties, but this is still an area of study that requires a great deal of money and research to conclude just how and what kinds of cancer cannabis may be able to treat effectively. Cannabis is helpful for diabetes, epilepsy, gastrointestinal disorders such as Crohn's Disease and Ulcerative Colitis, and autoimmune diseases like arthritis. It is an effective anti-spasmodic and antitumor agent for Multiple Sclerosis (MS) and Parkinson's.

Because the NHS is restricted from prescribing cannabis and CBMP's, it has meant the only passage of access to legal cannabis is through private prescriptions. Around 20 cannabis clinics now prescribe cannabis to patients in the UK. Patients are required to have a medical condition that they have tried two other forms of medication unsuccessfully before they can be prescribed cannabis. Between 2018 and 2022, less than 20,000 patients paid for a private cannabis prescription, about a tenth of the number of patients accessing legal medical cannabis in Germany in the same time frame. Public studies show 60% of the UK population is eligible for medical cannabis prescriptions under current legislation. Patients report this lack of uptake to be due to the prohibitive cost, poor slow service, and low-quality products that do not compare to the black market and grey market cannabis social club cannabis patients have already been accessing.

Cannabis-based medicinal products are primarily limited to flower and diluted cannabis oil in tincture bottles - not because this is all that is allowed; it is mainly down to specialist doctors, clinics and special off licence medicines importers not having enough experience or knowledge of CBMP or what products patients are finding most useful. Fortunately, alternatives to clinics are surfacing, such as the dispensary model, where patients pay a monthly subscription fee and get an all-inclusive service. Taking a patient-based approach to the service offers a chance for patients to get the prescription products they require in a way that suits them.

Updated June 2023 - Greg de Hoedt, Releaf.