Medical Cannabis Is Legal in the UK. Sort Of.

Medical cannabis has been legal in the UK since 1 November 2018, but only on prescription from a specialist doctor, and very few people get one on the NHS. Everything else, including the cannabis most people mean when they say the word, is still a Class B drug.

That gap between what the law allows and what actually happens is the whole story of medical cannabis in the UK. The 2018 change opened a door the health service has barely walked through, and a private sector has grown up in the space it left. This is a post about the law, not about anyone's health: questions about a condition belong with a doctor.

A word on terms first. "Medical marijuana" is the American phrase, and you will see it everywhere online, but medical marijuana in the UK does not exist as a legal category. The law talks about "cannabis-based products for medicinal use", a deliberately narrow label, and the narrowness matters for everything below.

What did the 2018 law change actually do?

It moved one category of product, not the plant. Before November 2018, cannabis sat in Schedule 1 of the Misuse of Drugs Regulations 2001, the list for drugs judged to have no medical use, which doctors cannot prescribe at all. The 2018 amendment regulations created a new class, "cannabis-based products for medicinal use", and put it in Schedule 2, next to drugs like morphine that are tightly controlled but can be prescribed.

The trigger was political rather than scientific. Through the summer of 2018 the cases of two boys with severe epilepsy, Billy Caldwell and Alfie Dingley, whose families had been using cannabis oil, ran on the front pages for weeks. Billy's oil was confiscated at Heathrow, and within days the Home Office issued an emergency licence to hand it back. The Home Secretary, Sajid Javid, ordered a review, accepted the recommendations that came back from the ACMD and the Chief Medical Adviser, and announced the change in October 2018.

The same announcement was careful about what it was not. It did not pave the way for recreational use, and the penalties for possession and supply stayed exactly where they were. Without a prescription, possession still carries up to five years in prison and supply up to fourteen under the Misuse of Drugs Act 1971.

Who can prescribe medical cannabis in the UK?

Only a doctor on the General Medical Council's specialist register. A GP cannot start a prescription.

The specialist has to decide case by case, and only where the patient has a clinical need that licensed medicines cannot meet. That condition carries more weight than it looks. Most cannabis-based products prescribed in the UK are unlicensed, meaning the MHRA has not assessed them for a particular use, and a doctor who prescribes an unlicensed product takes on personal responsibility for that decision. The professional guidance has been cautious from the start, too: NICE's 2019 guideline recommended against routine use for chronic pain, on evidence it judged too weak.

So the law says yes, the guidance says rarely, and the specialist who signs carries the risk. Read it that way and the NHS numbers explain themselves.

Why do so few people get it on the NHS?

Because the NHS mostly prescribes the few products that hold a licence, and those cover narrow ground. The NHS's own page says very few people in England are likely to get an NHS prescription, and names three situations where one might be considered:

Product	What it is	Where the NHS uses it
Epidyolex	Purified CBD liquid, no THC	Two rare forms of epilepsy, Lennox-Gastaut and Dravet syndromes
Nabilone	Capsule that acts like THC	Sickness caused by chemotherapy
Sativex (nabiximols)	Mouth spray	Muscle spasticity in multiple sclerosis

Even then, each comes up only when other options have failed or are not suitable. Long-term pain, the thing most people picture when they hear "medical cannabis", is not on the list; the NHS says the evidence is not yet strong enough.

Look at the table again and notice what is missing. No herbal cannabis. No flower, nothing resembling what a licensed shop in Toronto sells over the counter. Where the NHS route exists at all, it runs mostly through pharmaceutical products developed and licensed like any other medicine.

What are private cannabis clinics?

They are the reason the 2018 change is not purely symbolic. The law lets any doctor on the specialist register prescribe, and it does not require that doctor to work for the NHS. Since 2018 a private sector has filled that space: clinics employing specialists who assess patients, often by video, and prescribe unlicensed products, most of them imported, with the patient paying for both the consultation and the medicine.

This is legal, and it is where most legal medical cannabis in the UK now comes from. The clinics are not a grey area either: in England a private service of this kind has to register with the Care Quality Commission, the same regulator that inspects private hospitals, and the prescribing doctor still has to be on the specialist register. It is also why the picture looks so odd from outside. Herbal cannabis, which the NHS almost never supplies, makes up much of what the private sector prescribes. Same regulations, two very different systems, and which one a patient meets depends a good deal on money.

We do not name clinics here and will not. The point is policy. A rule written with a handful of severe epilepsy cases in mind became the legal footing for a paid private market, and that is a bigger change than anyone announced in 2018.

Is CBD the same as medical cannabis?

No, and the confusion is understandable, because the high street is full of it. CBD oils sold in shops are not prescribed medicines. The NHS describes them as products sold legally as food supplements, with no guarantee of quality or of any health benefit.

What keeps a shop product on the right side of the law is the amount of controlled substance in it, not the label. The Misuse of Drugs Regulations 2001 carve out "exempt products" that contain no more than one milligram of a controlled drug per container, among other conditions. A product that breaks that line is a controlled drug, whatever the packaging calls it.

Does medical cannabis bring legalisation any closer?

Not directly. So is medical cannabis legal in the UK? Yes. Does that make the rest of cannabis any less illegal? Not by a gram. Medical access and adult legalisation are separate legal questions. The 2018 change was made by statutory instrument, which a minister can lay; a licensed adult market would almost certainly need new primary legislation, which takes Parliament and a government willing to spend time on it.

What medical access has changed is the argument. There are now people in the UK who use cannabis legally, carrying a prescription, and every one of them weakens the old line that the plant has no legitimate place. Canada ran a medical scheme for the best part of two decades before it legalised for adults in 2018. That is a pattern, not a prediction, and we have set out why nobody honest can give you a date for the UK. For what is moving now, see where UK cannabis legalisation stands, and for how other countries did it, the running list of where weed is legal.

High in Hackney is a waitlist for the day UK law changes for adults, not just patients. Nothing is sold here and nothing can be until Parliament acts, but the people on the list hear first when it does. Join the waitlist