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The Long Road to Legalisation: Tracing the History of Medical Cannabis Law in the UK

The use of cannabis for medical purposes has been a controversial issue in the UK for many years. Although cannabis is classified as a Schedule 1 illegal drug, there has been growing pressure from patients, doctors and campaigners to legalise medical cannabis. In recent years there have been some changes to UK law regarding medical cannabis, however the situation remains complex. This article will provide an overview of the current UK laws concerning medical cannabis.

Cannabis Classification: Cannabis is classified as a Class B drug under the Misuse of Drugs Act 1971. Drugs in this class are defined as having some medicinal benefit, but for which there is believed to be some risk of harm or dependence. The possession and supply of cannabis is therefore generally illegal in the UK. Despite calls from some for cannabis to be reclassified or legalised, successive UK governments have resisted making changes to the 1971 law.

Early Campaigns for Legalisation: Campaign groups have argued in favour of legalising medical cannabis in the UK since the 1990s. They claimed some conditions like chronic pain, multiple sclerosis and epilepsy can be treated with cannabis. These groups also argued cannabis has fewer side effects than opioid painkillers. However there was little scientific evidence at the time to support the medical benefit claims of cannabis. Governments insisted more research was needed before changing the law.

Shift in Government Stance: In June 2018, the case of Billy Caldwell brought medical cannabis into the spotlight. Caldwell is a young boy with severe, life-threatening epilepsy which led to as many as 100 seizures per day. His mother had been treating him with cannabis oil sourced from Canada, with significant success in preventing seizures. However upon their return to the UK, the medicine was confiscated at customs. Following a sustained high profile campaign, Home Secretary Sajid Javid announced that some cannabis-based medicines would be re-scheduled and made available for prescription on the NHS. This marked a major U-turn in government policy.

Current Legal Situation: The latest regulations and guidelines permit some cannabis-based medical products to be legally prescribed in the UK. To qualify, the medicines have to meet strict standards regarding ingredients, dosage, labelling and consistency of supply. The only approved product meeting these criteria is Epidyolex, used to treat some forms of epilepsy. It went through extensive clinical trials and gained EU-wide regulatory approval. However, approval for this one product does not constitute a blanket legalisation of medical cannabis. Neither does it oblige doctors to prescribe it if they don’t deem it clinically appropriate. The British Paediatric Neurology Association guidelines say Epidyolex should only be prescribed to patients where other treatments have proven ineffective. So in effect, medical cannabis remains illegal in the UK aside from this one exception. Campaigners argue the rules are still far too restrictive for the many patients who could benefit.

Barriers to Wider Adoption: One of the main barriers is that many medical cannabis products did not go through rigorous clinical testing of the kind needed for medical approval in the UK. There are issues around unregulated doses, stability and reliability as well as understanding side effects. The UK medical community remains hesitant about prescribing unlicensed cannabis products. Another hurdle is that medical cannabis is not approved by National Institute of Health and Care Excellence (NICE) which provides national healthcare guidance. Cost is also a factor for the NHS with estimates that widespread medical cannabis provision could amount to billions per year. There are also complex considerations around social equality of access and potential over-use or diversion of cannabis products. Thus despite high profile cases and public sympathy, significant challenges remain for medical cannabis to become more widely adopted and prescribed in the UK.

Recent Developments: In 2019 it was announced that some specialist NHS doctors could legally prescribe medical cannabis. Guidelines were drawn up permitting consultants (not GPs) to prescribe cannabis if there is clear evidence of patient benefit. However these NHS prescriptions have been extremely limited so far, with estimated numbers in the low hundreds. Many patients still rely on private clinics which charge fees, or continue accessing illegal sources. In 2021 The Health and Social Care Committee published a report criticising the lack of progress in increasing availability of medical cannabis. It called for better guidance, reduced costs, expanded research and evaluation of how policies have worked abroad. While indicating some political will for change, the UK government is likely to remain cautious given the complex legislative, ethical and societal issues involved around cannabis.

Conclusion: medical cannabis UK law has shifted marginally but remains extremely restrictive. One licensed cannabis-based drug can now be legally accessed but this barely scratches the surface of potential demand. Patients wishing to use cannabis medicinally still face significant barriers and most resort to illegal access. There are reasonable arguments on both sides of this issue and strong ethical considerations. Changes to UK law are likely to remain slow and incremental. There is need for vastly expanded medical research to convince policymakers of the benefits relative to the risks. Only then might medical cannabis move substantially towards mainstream acceptance and legalisation.