Cannabis clinics see rise in patients

Private cannabis clinics are seeing a rise in patients as people choose the drug to treat chronic pain and mental health conditions.

One medical cannabis clinic in Westminster, Mamedica, said it had seen the number of patients increase by more than 10 times in 2023, rising from 250 to 2,750.

CEO Jon Robson said this was down to a “large number of patients who are transitioning to us not just from the illicit market, but because they haven’t found the treatments that the NHS can provide to be sufficient for their conditions”.

The majority of patients at the clinic take medical cannabis for psychiatric conditions, such as anxiety and depression, with 40% taking the drug to treat chronic pain.

In a statement, the Department for Health and Social Care said that "licensed cannabis-based medicines are routinely funded by the NHS where there is clear evidence of their quality, safety and effectiveness".

But it added that "most products on the market are unlicensed medicines, and clinical guidelines from the National Institute for Health and Care Excellence (NICE) demonstrate a clear need for more research to support routine prescribing and funding decisions on the NHS".

One patient taking the drug for chronic pain is Julie Gould, from Wimbledon in south London.

The 64-year-old started using medical cannabis in 2020 after being diagnosed with multiple sclerosis (MS) in her 30s.

“I've got permanent damage. My walking's affected, my bowel, my bladder is affected,” she says, comparing one of her symptoms to someone “hammering your brain with an ice-pick”.

She used paracetamol and ibuprofen to relieve the pain until her neurologist prescribed her with amitriptyline, a pain medication also used as an antidepressant.

But the drug aggravated the symptoms of another condition - restless legs syndrome (RLS), which causes an “unpleasant crawling or creeping sensation” in the legs.

Ms Gould wants the drug to be “heavily subsidised”, adding that it's become “too expensive for most people”, especially if they need to take it more regularly to manage their symptoms.

“I can remember going to my GP, saying: ‘I don't think I'm going to make it through. I haven't slept for two days and I really can't cope with this.

“I remember bursting into tears in front of her and she looked at me and said, ‘as we get older we all get aches and pains’.”

Ms Gould started taking medical cannabis oil after getting a prescription through a private clinic and says it “instantly stops” the nerve pain she experiences.

“In my view, it's just a miraculous drug,” she says, adding that it helped her through withdrawals after she was put on a new medication for her RLS.

She now only uses the medicine occasionally, but is concerned about how she would afford it if her symptoms got worse.

“In 2020, 100ml of the oil I used cost about £150 - now that same 100ml is £350,” she says.

Sativex, a cannabis-based spray used to treat MS muscle spasms, is licensed for prescription on the NHS, but the MS Society says there is an “unacceptable postcode lottery” for the drug.

NHS England says it already offers several cannabis-based treatments that have been approved by the MHRA but "many doctors and professional bodies rightly remain concerned about the limited evidence available concerning the safety and efficacy of unlicensed products".

In a statement, it said "manufacturers are encouraged to engage with the UK medicines licensing process, which can help provide specialist doctors with the confidence to use the products, in the same way they use any other licensed medicines that are recommended for use on the NHS.”

Before 2018, medical cannabis products could not be legally prescribed in the UK.

This is because they were classified as Schedule One drugs, meaning that they were judged as having no therapeutic value.

After a successful campaign to allow access to medical cannabis for children with severe epilepsy, medical cannabis was legalised.

This allows NHS or private specialist doctors to prescribe the drug - but only if other treatments have not been effective.

But an investigation by the BBC in 2023 found that fewer than five NHS patients had been prescribed with the drug so far.

One reason for this is that not all medical cannabis products are licensed.

First, they need to go through clinical trials that are costly and complicated because of the many compounds in the cannabis plant.

There are a few licensed medical cannabis products, but they do not contain the whole plant.

They can only be prescribed on the NHS, external for severe epilepsy, for nausea from chemotherapy or for muscle spasms caused by multiple sclerosis.

Specialist NHS doctors can still prescribe unlicensed products if they think the patient will benefit, but they have to ask NHS England to pay for individual cases and are often turned down.

Private specialists can also prescribe unlicensed products, but this often comes at a high cost for patients.

Epidemiologist Michael Lynskey leads research on the T21 Project, the UK’s biggest non-profit observational study of patients taking medical cannabis.

Founded by London-based charity Drug Science in 2019, the programme now has more than 4,600 patients nationwide.

It enables patients to access medical cannabis clinics at a discounted price and collects their data to provide evidence on the effects of the drug.

Prof Lynskey says the number of people signing up to the project has been "relatively constant" and there has been an increase in people looking to be prescribed cannabis in the UK overall, especially with patients over 65.

About a third of UK patients try the drug to treat psychiatric conditions such as anxiety or PTSD, but the charity says this is still an "emergent field".

The UK medical cannabis market is the second largest in Europe and is expected to be worth £300m in 2025, according to market researchers Prohibition Partners.

Prof Lynskey says it is "unfortunate" that some people are "excluded" due to the cost of cannabis from private clinics, especially as many of those living with chronic conditions are "not working or not working full time and struggling financially".

Even if the drug is made more accessible on the NHS, he says that attitudes towards medical cannabis may take longer to change.

“There’s still a lot of stigma in the general population against it and that includes actually a lot of doctors, who either don’t know it’s legal or don’t believe it should be,” Prof Lynskey says.

For Stephen - not his real name - his employer or colleagues finding out that he takes medical cannabis is “one of his biggest fears”.

“You don't tell people. It's a secret,” the 52-year-old software developer from London says.

He tried the drug for the first time in 2022 after receiving a prescription from a private clinic through the T21 Project.

Like most other patients, he had to prove he had already been prescribed at least two other treatments that had been ineffective and now has checkups with a private GP every three months to review his treatment.

It costs £60 a session and a further £80 to £180 for the supply of medical cannabis oil.

“I’m very lucky I am able to afford this, I’m in a good job, but there will be many people who really struggle to pay for it,” he told the BBC.

Stephen is among a growing number of people who are turning to medical cannabis to treat their mental health.

The T21 Project says that 42% of patients on the programme take the medicine for psychiatric conditions - making them the second largest group behind chronic pain patients.

After he attempted to take his own life in his late teens, Stephen was diagnosed with what was then called "bipolar depression" and prescribed a series of antidepressants on and off until the age of 49.

“It sort of turned me into a zombie,” he says, adding that the SSRIs he was prescribed “seemed to increase” his anxiety.

“At one stage I was also prescribed benzodiazepines for my anxiety, which I got very, very addicted to. And then spent a good two years trying to wean myself off that.”

He was finally diagnosed with autism, PTSD and anxiety disorder after two years on the waiting list.

He began taking medical cannabis oil shortly afterwards and said it had been “transformative”, helping him to cope with the “hectic environment” at work.

“It’s also had the weird effect of helping me be more empathetic with family members," he added.

He says that while he understands medical cannabis will not work for everyone, he wants people with complex mental health needs to have access to a wider range of treatments.

“I wouldn't necessarily claim that it would work for everybody, because I think that's always a dangerous claim, but I think, you know, it's always good for there to be options.”

Despite this, he still says the fear of being found out for using the legal drug “terrifies” him.

“There's such a stigma attached to it because of the status of recreational use.”

Some campaigners also argue that this stigma is a major roadblock on the path to making medical cannabis more accessible for those who could benefit, especially in minority communities.

Katrina Ffrench is the founder of UNJUST, a not-for-profit organisation that campaigns against discriminatory practices in policing and the criminal legal system.

She argues that while it’s “fantastic” that people can access medical cannabis on the NHS, “so much more” needs to be done.

“What we do see is the ongoing criminalisation of predominantly black communities around the use of cannabis and that it’s incredibly difficult to then encourage communities to seek cannabis as a medicine when they’re criminalised for its use in other spheres, so there’s a lot of mixed messaging.”

In a statement, the Department for Health and Social Care said there was a need for more research on the effects of medical cannabis before any changes could be made to how it is prescribed on the NHS:

"Until the evidence base improves, prescribers will remain reticent to prescribe and no decision can be made by the NHS on routine funding.

"That is why we continue to call on the manufacturers of these unlicensed products to conduct research and are ourselves working closely with regulatory, research and NHS partners to establish clinical trials to test the safety and efficacy of these products."

The National Institute for Health and Care Excellence (NICE) is responsible for deciding what drugs are available on the NHS.

The body said its clinical guideline reflected "the overall lack of clinical and cost-effectiveness evidence" for cannabis-based medicinal products and encouraged specialist doctors to consider the "relative risks and benefits in choosing treatments".

It also added that it was "important to point out that even had NICE recommended widespread use of these products, it would not necessarily mean that they would become routinely available on the NHS" as the majority of cannabis-based products are unlicensed.

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