Barriers to Cannabis-Based Medicine

A collage-style graphic titled ‘Barriers to Cannabis-Based Medicine’ combines vintage anti-cannabis propaganda clippings (including reference to the 1936 film, ‘Reefer Madness’ and warnings about ‘marihuana’), a botanical illustration of the cannabis plant, a greenhouse growing setup, and a modern image of a doctor holding a jar of cannabis—highlighting the contrast between historical stigma and contemporary medical use.

From 2016 to 2022, the United Kingdom dominated the global Medical Cannabis market and was consistently ranked as the world’s largest exporter. In 2021, the UK exported the equivalent of 213 tonnes of cannabis for medical and scientific purposes – more than half of the reported total globally. Most of this exported cannabis will have been used for pain management applications.

Yet access to cannabis-based medicine in the UK is only accessible to most patients through private clinics, resulting in a two-tier system: those who can afford private care and those who cannot.

The NHS usually only prescribe cannabis medicine for three very specific health conditions, and this limited scope has been described as ‘out of step’ with many other nations.

In this blog, we will explore why this discrepancy exists. Additionally, we’ll explore what is preventing those who purport to be using ‘street’ cannabis for medical reasons from accessing cannabis-based medicine through private clinics.

Barriers to NHS prescriptions

Cannabis-based medicine is typically only approved for NHS prescription for severe, treatment-resistant epilepsy, chemotherapy-induced nausea, and severe MS spasticity. NHS prescriptions of cannabis-based medicinal products for chronic pain are currently rare.

The National Institute for Health and Care Excellence (NICE), the public body in the UK that makes recommendations to the health and social care sectors, tend towards risk-aversion and requires a high standard of scientific evidence, and a rigorous cost vs benefit analysis for any recommendations to be made.

NICE states that most of the studies done on cannabis medicine for chronic pain are not rigorous enough, with small numbers of participants, short durations, and poor protocols, offering mixed results. And they’re right – many contributions to the study of cannabis-based medicine are far from rigorous, and numerous studies don’t split their participants into types of pain, which confuses the results.

We urgently need more high-quality research into medicinal cannabis’s efficacy for chronic pain and many other conditions. To understand why this research isn’t being widely conducted in the UK, we must first consider how cannabis has been classified.

Barriers to scientific research

Cannabis has traditionally been listed as a Schedule 1 drug, under the Misuse of Drugs Regulations 2001, which means it is considered to have ‘little or no therapeutic value’. Other Schedule 1 drugs include MDMA (ecstasy), LSD (acid) and psilocybin (magic mushrooms).

Schedule 1 drugs are strictly controlled, and before researchers can conduct trials using them, they must obtain a license from the Home Office, facing long waits and high licensing costs, as well as stricter handling and storage protocols, which place a higher burden on researchers.

The next category down, Schedule 2 drugs, such as morphine, fentanyl, amphetamines and ketamine, are those that have a high potential for misuse, but also have ‘legitimate medical purposes’. They are still heavily controlled and subject to prescribing restrictions, but are far easier to use in research.

Confusingly, cannabis is currently classified as both Schedule 1 and partly Schedule 2; The plant itself, raw plant material, is typically Schedule 1, and cannabis as an approved medicine is Schedule 2.

A table reiterating the information given in the text about how cannabis is scheduled for scientific research, as both 'Schedule 1' and 'Schedule 2'.

The reasons for this only partial move to classification as Schedule 2 are that UK regulators say there must be greater large-scale clinical trial evidence. There are also concerns around increased mental health risks, the potency of cannabis, its use among young people who have developing brains, and its potential for dependence.

The Royal Pharmaceutical Society, the professional leadership body for pharmacists and pharmaceutical scientists, have argued that by moving the cannabis plant itself to Schedule 2, many research barriers would be removed.

In July 2018, as part of a review into the scheduling of cannabis and evidence for its medical uses, the then Chief Medical Officer, Professor Dame Sally Davies, said that there is ‘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 in part and considered robust by some of the leading international scientific and regulatory bodies, as well as the World Health Organisation (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’.

Yet, eight years after the government review, much British cannabis research is snuffed out before it can begin, due to bureaucratic barriers. This lack of high-quality clinical evidence of cannabis medicine is then cited by organisations like NICE when they choose where funding for research goes and make recommendations to patients. Cannabis medicine in the UK is stuck in a loop, and that loop may be rooted in stigma.

Stigma

You’re probably familiar with media stereotypes associated with cannabis users, such as the sloth-like pothead/stoner; typically, males in their teens to forties, who are lethargic, apathetic, unmotivated, withdrawn from others and lacking ambition.

A fancy-dress costume being sold online, representing 'The Dude' from the Big Lebowski, wearing a beige dressing gown, dark shades, a grey t-shirt and black shorts.

Perhaps Jeff Bridges’s unkempt, dressing-gown-clad character, ‘The Dude’, in the 1998 film ‘The Big Lebowski’, comes to mind, or the artist Afroman’s song ‘Because I Got High’, detailing the many tasks he failed to do in a day because of his cannabis consumption. It’s an old stereotype, and not entirely without some basis in reality. Sedation is, after all, a key feature of the drug!

However, the genesis of much stigma can be found in prohibition-era America, where a series of propaganda films, including ‘Reefer Madness’ (1936), were released, incorrectly attributing cannabis consumption to a series of frenzied, violent crimes.

It was at this time that the notion of cannabis as a ‘gateway drug’, a soft entry into harder, more socially destructive drugs, entered public consciousness. While cannabis use is typically associated with later use of other drugs, correlation does not equal causation, and the data show that most cannabis users do not progress to harder drugs.

The current consensus is that risk factors for all drugs are multifactorial, involving genetics, impulsivity, psychiatric disorders, childhood trauma and peer networks. Cannabis use is considered more a marker of risk than the ‘gateway’ to harder drugs.

Almost sixty years ago, US President Richard Nixon declared a ‘war on drugs’, a campaign of prohibition and criminalisation said to be rooted in xenophobic aims. Trillions of pounds have been spent on ‘the war on drugs’ globally, and the criminalisation of those who use drugs. The UK’s Misuse of Drugs Act (1971) was introduced to ‘prevent and control the use and supply of illicit drugs.’ Yet, by every conceivable metric, drugs have won the war.

Drug deaths are at an all-time high, the number of adults in drug and alcohol services has increased by 6% on the previous year, people have greater access to illicit drugs than ever before, and there is no evidence that criminalising people who use drugs helps them or society.

The widespread prohibition of cannabis for the past century may be a mere blip on the drug’s millennia-long medicinal history, but it offers useful context for assumptions about cannabis use in the present day. The negative stereotypes associated with cannabis affect the way users of cannabis-based medicine are treated, with the assumption being that they don’t have a genuine medical reason for using cannabis and simply want to get high.

Ironically, counter to the stereotype, consumption of cannabis-based medicine often enables those with disabling chronic health conditions to engage in tasks they would otherwise struggle to do, making them more productive.

A small 2022 study published in the International Journal of Neuropsychopharmacology looked at non-medical cannabis users, who used it about 4 times a week. The researchers found no link between the frequency of cannabis use and chronic apathy or reduced capacity for pleasure.

A photograph of an older person with short fair hair, wearing a vertically striped shirt and beige trousers, clutching their left knee in discomfort. Centrally, a black text box contains the words, 'Medical cannabis users are generally older, as rates of disability increase with age' in white text.

Users of cannabis-based medicine are an eclectic bunch, with a variety of lifestyles and motivations. Recent research has found that medical cannabis users are generally older, as rates of disability increase with age.

Medicinal users typically consume cannabis more frequently and have lower states of anxiety than recreational cannabis users.

The same study found medical users were more likely to cite sleep management and symptom relief as their motivations for use, whereas recreational users tend to cite enjoyment, experimentation, celebration and altered perception more.

Harm-reduction

The lag in British scientific research into cannabis for chronic pain and psychiatric conditions, specifically, may be contributing to social harms that disproportionately affect Disabled people.

In 2021, according to ONS data, 4,859 people died from drug poisoning (all forms of drugs) in England and Wales, the highest figure since records began in 1993. Of those who died as a result of these drug poisonings, many were Disabled people; at least two-thirds had a mental health condition, and almost 30% had received a legally prescribed, long-term prescription for pain management.

While we cannot know which drugs were implicated in these drug poisonings, or whether these were accidental overdoses, suicides, or drugs combined with more toxic substances, Disabled people are disproportionately affected by drug poisoning. We also know that people with chronic pain are twice as likely to die by suicide.

As we’ve explored in our series of blogs on chronic pain, the condition can be very tricky to manage, as most pharmaceuticals used for pain management come with risks and side effects. Few chronic pain patients can achieve a state of ‘no pain’, even with potent pain-killing pharmaceuticals.

The medication options for those with chronic pain are imperfect and limited, and painkillers like codeine and fentanyl come with issues such as tolerance and risk of accidental overdose. Even over-the-counter painkillers can cause ‘rebound headaches’ if used too frequently.

Recent research from King’s College revealed that the number of opioid deaths in England and Wales over recent years is more than 50% higher than government data had previously suggested, due to systemic errors and a lack of specificity in coroner reports. Policymakers have been using this inadequate data to make decisions about drug and health policy. The researchers found that 39,232 people died because of opioid use between 2011 and 2022.

For the same period, there were a reported 281 cannabis-related deaths in England and Wales. This means that people are almost 160 times more likely to die from using opioids than from using cannabis.

Overlaying a cream coloured background, a graphic of a purple brain sits centrally, with connections represented through a busy network of dots and lines around it. Under the brain, the information in the body of text about cannabis's safety profile is reiterated in black text.

Cannabis has a good safety profile compared to other drugs – while not impossible, it is much harder to overdose on it because the brain regions that control breathing and heart function have very few cannabinoid receptors.

These stark statistics about drug-related deaths raise big questions about how we, as a society, are failing at harm reduction. Improved access to prescription cannabis may prevent accidental overdoses and suicides, but until the gold standard of scientific research is conducted, and until patchy cannabis provision is resolved, we won’t know.

Both the United Nations (UN) and the World Health Organisation (WHO) recommend models of drug decriminalisation and harm reduction strategies.

Barriers to private prescription

Now to consider the barriers preventing the estimated 1.77 million people across the UK who use ‘street’ cannabis from utilising private clinics for prescription cannabis. These cannabis users face criminalisation and stigma and must interact with drug dealers rather than clinicians.

Most ‘street’ cannabis these days is grown to be as potent as possible, which increases the risk of harms like psychosis. Whereas, carefully cultivated, regulated cannabis is not designed to get the user ‘high’, it is selected for its medicinal properties.

Cost is the greatest barrier for many; cannabis-based medicine is not cheap. Some private clinics offer an ‘Access scheme’, with reductions for those on means-tested benefits, those receiving PIP, UK Veterans, and other groups. There are also organisations, such as Grow, that support patients on lower incomes with accessing affordable cannabis-based medicine.

We don’t know exactly how many patients of the 40 private cannabis clinics operating in the UK are turned away for not meeting eligibility criteria, but there are major concerns that, in private healthcare settings, the financial incentives to prescribe liberally are compromising patient safety.

These private clinics may be filling a gap in healthcare needs, but there are concerns that they are not being adequately scrutinised when it comes to health conditions such as depression, with very tenuous evidence supporting cannabis use for symptom management.

Conclusion

During Prime Minister’s questions on 14 Jan 2026, the Prime Minister was asked about the two-tier system currently preventing children with uncontrolled, life-threatening epilepsy from accessing paediatric medical cannabis through the NHS. Some families are currently spending £2000 a month to manage their children’s seizures.

The Prime Minister responded, ‘NHS England and NICE recently agreed funding for two world-first clinical trials relating to the use of cannabis-based products'. This could help make medicines more routinely available in the NHS. Whether this research extends beyond epilepsy remains to be seen.

Cannabis-based medicine is not a cure-all, nor is it without associated harms; it is not the right treatment for many people. However, cannabis does have numerous medical applications, and it boasts a good safety profile when compared to other pain management options.

Many people who may benefit from it are currently being prevented from exploring this option, and many people are seeking out pain management through more dangerous means, including high-potency 'street' cannabis, with a far higher risk of psychosis.

In our next blog in this series, we’ll share a guide to navigating specific situations as a medical cannabis user, such as work, driving, interacting with police, and using your medication while in public spaces.

Written by Arianne at Equal Lives