Medical Cannabis in the UK: Why Clinician Education Became a Barrier to Access
The United Kingdom did not broadly “legalize cannabis” for medical use in 2018. Instead, on 1 November 2018, it created a tightly controlled legal route for specialist doctors to prescribe cannabis-based products for medicinal use. Under the government’s framework, prescribing decisions had to be made by doctors on the General Medical Council’s specialist register, rather than by GPs.
That distinction helped explain why the change in law did not immediately translate into widespread NHS access. Most relevant products were unlicensed, and the evidence base varied considerably by condition, formulation and dose. The government’s rescheduling guidance specifically noted that prescribing was restricted because of the limited evidence and the additional responsibility carried by doctors using unlicensed medicines.
Advocates of wider access argued that a lack of clinical education was another major obstacle. Professor Mike Barnes, a neurologist and one of the founders of the Academy of Medical Cannabis, said many doctors had received little or no formal teaching on cannabinoids, the endocannabinoid system or the practical considerations involved in prescribing them.
In his view, uncertainty was reinforced by cautious guidance from medical organizations, complex hospital approval procedures and concern about assuming personal responsibility for an unlicensed product. Doctors could also be reluctant to prescribe when they lacked experience assessing the potential benefits, risks, interactions and appropriate formulations.
The Academy attempted to address that gap through free online education. Its modular courses were designed to introduce healthcare professionals to cannabis pharmacology, available evidence, clinical decision-making and the legal framework. The aim was not simply to encourage prescribing, but to give clinicians enough knowledge to decide when cannabis-based treatment was, and was not, appropriate.
A similar approach shaped the launch of Sapphire Medical Clinics in London in 2019. In its original announcement, the clinic described itself as a specialist, second-opinion service for patients referred by GPs or hospital consultants. Its clinical team included doctors from fields such as neurology, pain medicine, psychiatry, palliative care and gastroenterology.
Dr Mikael Sodergren, Sapphire’s managing director and academic lead at the time, presented the clinic as a source of expertise for doctors who were interested in cannabis-based medicines but did not feel qualified to prescribe them. The clinic also proposed collecting patient information through a registry, reflecting the need for better real-world evidence while more rigorous clinical research was conducted.
That need for evidence remains central to the debate. The Advisory Council on the Misuse of Drugs’ 2020 review found that the 2018 law change had not produced a significant increase in NHS prescribing of unlicensed cannabis-based products during its first year. It also distinguished between evidence for licensed medicines and evidence for a much wider range of unlicensed cannabis products.
Subsequent NICE guidance, published in November 2019, recommended cannabis-based medicines only in specific circumstances. For example, it supported consideration of nabilone for some adults with chemotherapy-induced nausea and vomiting and a trial of THC:CBD spray for certain adults with multiple sclerosis-related spasticity, while advising against routine use of most cannabis-based products for chronic pain.
Education, therefore, could help remove one barrier, but it could not substitute for reliable evidence, clear clinical guidance or NHS funding decisions. The case made by Barnes, Sodergren and their colleagues was that doctors should be equipped to assess cannabis-based medicines responsibly rather than left to navigate an unfamiliar field on their own. For patients, the practical challenge was ensuring that better-informed prescribing developed alongside appropriate safeguards—not ahead of them.
