Unfortunately, it's more of a grey area than a green one.
We note that the subject contained in this article represents illegal activity in certain jurisdictions. Whilst we do not condone any acts which are contrary to any such laws, we understand that readers in those jurisdictions which have decriminalised cannabis may find this article of interest.
It's the one-year anniversary of the United Kingdom's legalisation of cannabis-based medicinal products.
When medical cannabis legalisation first took effect in November 2018, it had been hotly anticipated by patients seeking alternate therapies for medical disorders such as epilepsy. However, while this seemed like a victory at the time, the new law has come with some serious restrictions.
According to the UK's National Health Service, medical marijuana is only likely to be prescribed to those with severe forms of epilepsy, or those suffering nausea from chemotherapy treatment. Even so, it would "only be considered when other treatments weren't suitable or hadn't helped." Such products may only be accessed with a doctor's prescription.
Another issue is that cannabis is still classified as a Schedule 2 drug, which means that patients are required to get the prescription written in specific detail, on pink paper, and from a licensed importing pharmacy and shipping company. Storing and cultivating the plant is prohibited in the UK, which forces patients into the position of having to order it from a different country.
According to a UK pharmacist, Paul Mavor, having medical cannabis importation conducted, "on a name-patient basis and not being able to store any stock in the country is really increasing suffering by not allowing access in a timely manner."
"It is essentially a prohibition-style access scheme because there is so many hurdles."
However, the barriers to access also extend to a lack of research and education, which resulted in the Royal College of Physicians and the British Paediatric Neurology Association rushing through the development of interim guidelines for medicinal cannabis. With little scientific data, restrictive guidelines were developed, which has led to less prescriptions for people who need them, which means there is consequently less evidence of their value.
So far, Epidiolex, Nabilone and Nabiximols (Sativex) are the only unlicensed cannabis-based medications that are currently being trialled in the UK and are available for doctors to prescribe.
The Chief Scientific Officer at Hanway Associates, Henry Fisher, explained that, "in practice, these prescriptions won't be available on the NHS".
"These products are referred to as 'unlicensed specials' – so there's been confusion and challenges with getting to grips with that regime."
"Doctors, for good reason, won't prescribe specials unless there is a very good reason for them to do so," Fisher said.
Prescribing in the private sector may be easier as money isn't a primary factor. One of the UK's main suppliers is Grow Biotech, which is involved in about three quarters of all medical cannabis imported into the UK. The company recently told The British Medical Journal that it had fulfilled roughly 80 prescriptions so far: all were for patients who came through private healthcare.
"Some NHS trusts might not have wanted to open the floodgates to funding medical cannabis," said Michael Barnes, a neurologist and cannabis expert.
"There's less constraints, but it's a problem because effectively a lot of the population won't be able to access it because of [its] cost."
The clinics, which charge about £250 for an initial consultation—and £150-£175 for follow-up appointments—take referrals from GPs and hospital consultants.
Restrictions on imports caused by the UK's regulatory regime meant that Germany-based company, Cannamedical, could profitably sell medicinal cannabis to pharmacies in Germany at €10 a gram but would have to ask for £30 a gram to achieve the same margin in the UK.
It's no wonder that estimates suggest as many as one million people who use cannabis for medical purposes are put at risk from buying cannabis on the criminal market.
But don't worry, things aren't all doom and gloom.
The National Institute for Health Care and Excellence will release new guidelines towards the end of 2019, which should help doctors make more informed decisions around cannabis prescription.
"We're hoping that individual doctors will prescribe, and see that once they've done it once, and it's worked, so it's a useful medicine," Barnes said.
"Then it will pick up: for example, in Germany, it took two or three years for the medical profession to catch up."
Hopefully, the new laws will allow for greater patient access, further research and increased advocacy for medical cannabis.
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