The UK may have legalized medical cannabis in 2018, but that doesn\’t mean patients can access it. According to a recent report in The Guardian, just two patients are receiving medical cannabis through the National Healthcare Service (NHS). Both received special emergency interim licenses from the Home Office. Outside the public system, there are perhaps 313 private prescriptions for unlicensed cannabis-based medicines. But these numbers come from a country of 66 million.

With only 315 prescriptions and the vast majority private, something seems amiss in the UK. Is a lack of public awareness to blame, or a system incompatible to the complexities of plant-based medicines? It turns out the UK public is well aware of the therapeutic value, but the fear-mongering policies of the past linger throughout the system.

Public Perception of Medical Cannabis in the UK Not the Issue

In 2018, YouGov commissioned a poll exploring attitudes towards cannabis, for both recreational and medicinal purposes. The organization released the results several months before legalization.

The final report found an astounding 75 percent also supported the ability of physicians to prescribe medical cannabis. However, as the publication noted, black-and-white questions like \”To what extent would you support or oppose the legalization of cannabis in the UK?\” tended to cover up these subtler opinions. For example, 43 percent supported legalization, with 41 percent opposed to it.

Other pre-legalization polls discovered that roughly 13 percent of people in the UK were already planning to ask their physician about medical cannabis once it was legalized. Combined with the 76 percent of people who reportedly were open to a cannabis prescription from their doctor, it seems that public opinion about the medicinal applications is positive.

Public perceptions and use of cannabidiol (CBD), the non-psychoactive hemp-derived cannabinoid, have also shifted. According to a report by the Center for Medicinal Cannabis (CMC), \”CBD has now gone mainstream in the UK.\” The CMC estimates that between four to six million people in the country have tried this cannabinoid for therapeutic purposes. Much like CBD paved the way for positive public perceptions of cannabis in the US, it is likely to do the same in the UK.

Despite Lack of Prescriptions, Patients Still Seeking Access

Following legalization, a few rough estimates have circled about the use of illicit, black market cannabis for medicinal applications. As the CMC explained, most early reports estimated between 50,000 to 1.1 million UK residents were currently using cannabis for therapeutic relief. However, the data behind these reports were somewhat unreliable.

In 2019, the CMC launched a new nationwide survey, which collected more than 10,000 responses. This revised poll was finally \”representative of the general population in Britain.\” This online poll asked pertinent questions about the current use of medical cannabis, frequency of use, and comfort level seeking cannabis through illicit channels.

 The results suggest that as many as 1.4 million people in the UK use medical cannabis, purchased through the black market, to treat various conditions. Furthermore, patients come from all cohorts of society and spend approximately £100 per month on treatment. As the CMC explained, \”We found that respondents were concerned over such illegal activity, quality and supply chains, and would prefer more transparency and regulation when obtaining their medicine.\”

Problems Lie With Those in Power and an Incompatible System

With perceptions about medical cannabis at an all-time high, and a significant portion of patients desperate enough to seek medical cannabis on the black market, it seems the discrepancy between legislation and ease of accessibility must lie within the system.

At the time of writing, there were three licensed cannabis-based medicines, all pharmaceuticals: Epidiolex, nabilone, and Sativex. The only approved applications are multiple sclerosis and intractable epilepsy. Physicians may still legally prescribe unlicensed medical cannabis (such as medical cannabis oil), but this must be the last resort. There is no coverage of these expenses through the NHS.

Cannabis, which is hundreds of natural compounds including terpenes and cannabinoids, is often considered too complex to fit within the traditional single-molecule clinical trial format. Therefore, regulators and the NHS continue to deny access to non-pharmaceutically produced cannabis because they claim limited evidence, limited medical education, and unreliable supply.

As the polling numbers show, people in the UK are increasingly aware of the potential of medical cannabis and are open to its idea within the traditional medical system. But while public pressure may have passed the initial legislation, those in power seem wary of actually making cannabis accessible. They demand results from traditional clinical trial models or, worse, still live in fear about the risks of a formerly illicit substance.

A telling example of this misunderstanding about medical cannabis comes from a recent report in The Guardian. Hannah Deacon, one of the country\’s most vocal cannabis advocates, wrote to every member of parliament about the \”abject despondency\” parents feel about the current state of the medical cannabis program. Thus far, she has received a single reply from a politician who told her that \”cannabis use was detrimental to the mental and physical health of communities.\” 

Deacon, the mother to one of the two children prescribed cannabis oil through the NHS, now watches her son bike to school, instead of suffering up to 500 life-threatening seizures a month. Needless to say, the politician\’s complete lack of awareness about the medical properties of cannabis did little to satisfy her complaints.

Clearly, the fear-mongering about cannabis continues to affect the mindset and awareness of the politicians, regulators, and others in power. This fear limits physicians\’ ability to prescribe, the system to improve accessibility, and politicians’ will to get involved. The UK may have legalized medical cannabis, but have failed to understand it under a modern lens.

With medical cannabis programs successfully rolling out in other countries, the UK struggles to get off the ground almost two years later. If the public is desperate enough to turn to the black market to get the medicine they need, the current system fails to a remarkable degree.

As Steve Rolles, senior policy analyst for the Transform Drug Policy Foundation, told the Guardian, \”Unless some kind of bespoke regulatory framework can be found that reduces barriers to access, the more risky scenario of unregulated self-medication with illegally sourced supplies will continue.\” Medical cannabis may be theoretically legal in the UK, but the ramifications of decades of cannabis alarmism continue to haunt the rollout.