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Medical cannabis (and cannabis oils)

“Medical cannabis” is a broad term for any sort of cannabis-based medicine used to relieve symptoms.

Many cannabis-based products are available to buy online, but their quality and content is not known. They may be illegal and potentially dangerous.

Some products that might claim to be medical cannabis, such as “CBD oil” or hemp oil, are available to buy legally as food supplements from health stores. But there’s no guarantee these are of good quality or provide any health benefits.

And some cannabis-based products are available on prescription as medicinal cannabis. These are only likely to benefit a very small number of patients.

Can I get a prescription for medical cannabis?

Very few people in England are likely to get a prescription for medical cannabis.

Currently, it is only likely to be prescribed for the following conditions:

  • children and adults with rare, severe forms of epilepsy
  • adults with vomiting or nausea caused by chemotherapy
  • people with muscle stiffness and spasms caused by multiple sclerosis (MS)

It would only be considered when other treatments were not suitable or had not helped.

Epidyolex for children and adults with epilepsy

Epidyolex is a highly purified liquid containing CBD (cannabidiol).

CBD is a chemical substance found in cannabis that has medical benefits.

It will not get you high, because it does not contain THC (tetrahydrocannabinol), the chemical in cannabis that makes you high.

Epidyolex can be prescribed for patients with Lennox-Gastaut syndrome and Dravet syndrome (both rare forms of epilepsy).

Nabilone for chemotherapy patients

Many people having chemotherapy will have periods where they feel sick or vomit.

Nabilone can be prescribed by a specialist to help relieve these symptoms, but only when other treatments have not helped or are not suitable.

Nabilone is a medicine, taken as a capsule, that has been developed to act in a similar way to THC (the chemical in cannabis that makes you high). You may have heard it described as a “manmade form of cannabis”.

Nabiximols (Sativex) for MS

Nabiximols (Sativex) is a cannabis-based medicine that is sprayed into the mouth.

It is licensed in the UK for people with MS-related muscle spasticity that has not got better with other treatments.

Long-term pain

There is some evidence medical cannabis can help certain types of pain, though this evidence is not yet strong enough to recommend it for pain relief.

What about products available to buy?

Some cannabis-based products are available to buy over the internet without a prescription.

It’s likely most of these products – even those called “CBD oils” – will be illegal to possess or supply. There’s a good chance they will contain THC, and may not be safe to use.

Health stores sell certain types of “pure CBD”. However, there’s no guarantee these products will be of good quality.

They tend to only contain very small amounts of CBD, so it’s not clear what effect they would have.

Is medical cannabis safe?

The risks of using cannabis products containing THC (the chemical that gets you high) are not currently clear. That’s why clinical trials are needed before they can be used.

“Pure” products that only contain CBD, such as Epidyolex, do not carry these unknown risks linked with THC.

But in reality, most products will contain a certain amount of THC.

The main risks of THC cannabis products are:

  • psychosis – there is evidence that regular cannabis use increases your risk of developing a psychotic illness such as schizophrenia
  • dependency on the medicine – although scientists believe this risk is probably small when its use is controlled and monitored by a specialist doctor

Generally, the more THC the product contains, the greater these risks are.

Cannabis bought illegally off the street, where the quality, ingredients and strength are not known, is the most dangerous form to use.

What are the side effects?

After taking medical cannabis, it’s possible to develop any of the following side effects:

  • decreased appetite
  • diarrhoea
  • feeling sick
  • greater weakness
  • a behavioural or mood change
  • dizziness
  • feeling very tired
  • feeling high
  • hallucinations
  • suicidal thoughts

If you experience any side effects from medical cannabis, report these to your medical team. You can also report them through the Yellow Card Scheme.

CBD and THC can affect how other medicines work. Always discuss possible interactions with a specialist.

CBD can also affect how your liver works, so doctors would need to monitor you regularly.

How do I get a prescription?

You cannot get cannabis-based medicine from a GP – it can only be prescribed by a specialist hospital doctor.

And it is only likely to be prescribed for a small number of patients.

A hospital specialist might consider prescribing medical cannabis if:

  • your child has one of the rare forms of epilepsy that might be helped by medical cannabis
  • you have spasticity from MS and treatments for this are not helping
  • you have vomiting or feel sick from chemotherapy and anti-sickness treatments are not helping

The specialist will discuss with you all the other treatment options first, before considering a cannabis-based product.

A prescription for medical cannabis would only be given when it was believed to be in your best interests, and when other treatments had not worked or were not suitable.

It’s expected this would only apply to a very small number of people in England.

If the above does not apply to you, do not ask a GP for a referral for medical cannabis.

Will the laws on cannabis be relaxed?

The government has no intention of legalising the use of cannabis for recreational (non-medical) use.

Possessing cannabis is illegal, whatever you’re using it for. That includes medical use unless it has been prescribed for you.

More information

Page last reviewed: 01 November 2018
Next review due: 01 November 2021

Information from the NHS website on medical cannabis

2021 is giving us over-the-counter medical cannabis

Low-dose CBD cannabis oil can be sold in pharmacies from next year.

From early 2021 you’ll technically be allowed to buy low-dose cannabis oil from pharmacies without a prescription.

However, while the laws have been changed so you can buy CBD oil over-the-counter, there are currently no products approved for sale.

Firstly, these products won’t get you high. This is only low-dose CBD oil we’re talking about and products won’t be allowed to have more than 1 per cent THC (which is the psychoactive part of the plant).

When the changes come in on February 1 next year, the maximum dose for adults will be limited to 150mg per day, which is why it’s considered low-dose. It’s expected patients would use this to help them sleep, reduce anxiety or depression and treat pain, although there’s currently not much evidence the oil is effective at this strength.

The decision from the Therapeutic Goods Administration (TGA) changes low-dose CBD oil from a schedule four drug, which doctors have to prescribe, to a schedule three drug, which chemists can hand out over-the-counter without a prescription.

Cassandra Hunt, the managing director of cannabis industry consultancy, Fresh Leaf Analytics, told Hack the change is significant.

“It’s the biggest milestone since legalisation in 2016 and it’s going to dramatically change access for patients in Australia.”

She says this will make life much easier for people who want to use this drug.

“Previously, they’ve had to go to a GP and they’ve had to talk to the GP about what they’re trying to treat, and then the GP has had to get special permission in order for them to be able to access a prescription.”

There will be a wait for products

While the changes will come into effect in early 2021, it could be years before there’s actually a product to buy.

Cassandra Hunt from Fresh Leaf Analytics told Hack that it’s unlikely anything will be on the shelves in February.

“In order for companies to get these products registered or available over-the-counter in pharmacies, they have to be registered as an S3 medicine,” she said.

“What that requires is quite significant data about the safety and efficacy and quality of the products.”

According to Cassandra, because the Australian cannabis industry is still so new, they don’t know how effective their low-dose CBD products are and it could take years to get that data.

She says it’s not clear what info the TGA wants, but if it’s expecting companies to run clinical trials then it could be a five-year wait for products.

“That data, given the industry is so young, isn’t easy to come by.”

Medical Association “surprised” by down-scheduling

The Australian Medical Association (AMA) doesn’t support the TGA’s decision to down-schedule low-dose CBD oil.

In a statement to Hack, the AMA said it isn’t confident pharmacists have the education to properly advise patients, and that side effects could go unchecked.

“Medical practitioners have only been prescribing CBD products for a few years, the evidence is still emerging, more education around its use is required,” the AMA said.

When it comes to possible side effects, the medical association fears doctors won’t be able to properly monitor patients when the CBD oil is sold through pharmacies.

“There is a risk that patient conditions that are associated with CBD use (e.g. anxiety, psychosis, chronic non-cancer pain, and epilepsy) will go unchecked and cause further harm to the patient,” the AMA told Hack.

The TGA told Hack the decision to make low-dose CBD oil available over the counter wasn’t based on how well it works, just that it isn’t harmful.

“The scheduling decision was made on the basis of the safety profile of CBD at this dose,” a TGA spokesperson said.

Cassandra from Fresh Leaf Analytics admits evidence of how well these products work is hard to come by but agrees they’re not harmful.

“There is good safety data to show that at the types of doses we’re talking about CBD is very safe.”

The illicit silver lining

According to Cassandra Hunt from Fresh Leaf Analytics, the TGA could also be trying to move CBD users away from the black market.

“I think one of the other motivations of the TGA is to make it easier for people to access these products where they might otherwise be using illicit channels,” she told Hack.

“The problem with some of the illicit channels is that the quality of the products is not always good.”

“Sometimes those products say they have something in them and that’s not in there, so you can’t really rely on the fact that you’re getting a good product.”

She also says that for the first time, as the cost of medical cannabis production comes down, legal products are reaching price parity with the illegal market.

“If you couple that with making it more easily accessible through pharmacies, that should hopefully make a big difference for people who’ve been getting relief through those channels, but maybe can’t rely on those products being good quality.”

From early 2021 you’ll technically be allowed to buy low-dose cannabis oil from pharmacies without a prescription.