On 1st November 2018, medical cannabis became legal in the UK. It was a somewhat surprising, albeit positive and seismic decision from the Home Secretary at the time, Sajid Javid. A heartfelt campaign led by parents of children with severe epilepsy managed to do what all campaigners dream of, to change the mind of a government minister and force a change in the law.
With the government recognising its medical benefits, medical cannabis was moved from Schedule 1 to Schedule 2, enabling licences to be issued by the Home Office to import medical cannabis. The emotive campaigns, focusing on the suffering of young children, helped to initially shift public perceptions and increase support for the legalisation.
But after the initial announcement and press coverage at the time, polls then suggested the general public had either forgotten or were not aware of the law change in the first place. A survey conducted by UK medical cannabis clinic Mamedica last summer suggested more than half of people in the UK were unaware they could access medical cannabis on prescription. Of course, it’s easy to see why there might be some confusion. Cannabis continues to be an illegal Class B drug and the government certainly does not hold back in its rhetoric and decision making when it comes to drug policy (let’s not get into the latest nitrous oxide law change here).
Add to that the caveats that came with the law change itself. Prescriptions must come from a specialist doctor, not a GP. These prescribing doctors must be listed on the General Medical Council’s specialist register. They must make decisions on a case by case basis and only when the patient has an ‘unmet special clinical need that can’t be met by licensed products.’ Not surprisingly then that there are only, to date, three known medical cannabis prescriptions via on the NHS, with most prescriptions coming from private clinics.
An estimated 1.8 million people in the UK are using cannabis medicinally, however, only an estimated 25,000-32,000 patients are legally prescribed. Worryingly, that means about 98% of people are still accessing medical cannabis illegally. Research by Volteface has also revealed the hesitations and lack of confidence in the medicine by clinicians themselves. Our recent Known Unknowns report looked to find solutions to these barriers, with only 0.25% of clinicians who could prescribe medical cannabis currently doing so.
So are things starting to change? Are more people starting to research and come forward for medical cannabis prescriptions?
According to MedBud.wiki, they are. MedBud wiki is a non-for-profit organisation impartially tracking the British and Irish medical cannabis industry. As an external, independent online resource, it seems more and more patients and potential patients are using it to research the availability and price of medicinal cannabis, as well as the prescribing clinics, dispensing pharmacies and producers and brands.
According to their latest data, their website is receiving roughly 40,000 users a month, with around 12,000 regular users. They say the proportion of these users being new patients is increasing heavily, suggesting that public awareness seems to be spreading.
Its founder, Ralph Leonardo MacMurray said:
“I think it’s a general awareness thing. Looking at more generalised cannabis groups on social media, there seems to be an awareness that you can access medical cannabis legally in the UK. It is shocking to everyone that there hasn’t been greater interest so far, however cost is still a huge issue for most.”
With MedBud wiki offering up-to-date information in terms of price and availability, Ralph recognises that a lot of the traffic to his website is patients trying to navigate the UK’s current cannabis clinic model.
“Mostly people are looking at what produce is available and where,” he explained. “Right now, it’s a spider’s web trying to figure out how to access a particular medication. There’s specific offers at specific pharmacies, and trying to figure it out is a minefield.”
In fact, the traffic to Ralph’s website is increasing even more, thanks to a recent social media post from a prominent YouTuber, which mentioned the MedBud wiki site.
Ralph added: “There’s been a lot of media pieces lately, we’ve seen The Times, The Guardian, The Telegraph and Sky News even in the last month. That coupled with prominent YouTubers who are really targeting a high interest sub-group of the population, that’s having a monumental effect. I hope that I’ll continue to hear from clinics that they’re seeing an uptick themselves that they can’t explain.”
This idea of an increase in patients doesn’t appear to be solely coming from MedBud wiki. Industry analysts have predicted that this year will see an increase in the number of medical cannabis patients. A recent article in Cannabis Health News quotes a report by Prohibition Partners, which predicts the UK is set to become the second largest European market by the end of the year.
Are attitudes generally changing?
For the last three and a half years, independent, science-led charity Drug Science has run T21 (formerly known as Project Twenty21), a project that allows medical cannabis patients to access treatment at a discounted price, whilst collecting data to build up real-world evidence on the effects of cannabis-based medicinal products. It currently has 3,500 patients. Despite no recent notable rise, Research Officer and Manager of T21, Alkyoni Athanasiou-Fragkouli, is hopeful attitudes are starting to change.
“I don’t think we’re really seeing that in the project right now, but that doesn’t mean that it’s because people are not learning more about medical cannabis,” Alkyoni told me. “Everyone around me talks about cannabis, so it’s a little bit difficult! But I do think things are changing, because I keep seeing stories about cannabis more in the mainstream media, rather than in the specific cannabis press. For example, interviews are being picked up by The Guardian and the BBC. So I do think things are changing.”
For Alkyoni and the team at Drug Science, education is key. Last year, the charity organised the first UK Patient Conference, to coincide with Medical Cannabis Awareness Week. She explained:
“When it became legal, unfortunately, there wasn’t any effort to educate doctors or the police about it. Still more than four years in, patients are having issues with the police who question their legal prescription. It’s difficult to overcome all those years of prohibition and the media twisting facts and exaggerating the harms, but I do feel it’s slowly starting to be undone.
That’s why we have a lot of educational events at Drug Science as well. We go to a lot of universities for example to educate the students. They are the future doctors and psychologists, so what we’re doing, it will take a few years to catch up as these students grow up.
We keep seeing more and more doctors being interested in finding out more as well, and that will make a big difference. I do think the one thing that would really help people know about medical cannabis is for GPs to be allowed to prescribe. Then medical cannabis would become more accessible, and ideally we would want it available on the NHS.”
The data collected from Drug Science’s T21 project will be used to provide evidence for NHS funding of medical cannabis treatment. Currently, the team are working on a Health Economic Analysis, using data from the project to look at how medical cannabis will work on the NHS and how much money it could potentially save the service overall.
But even with emerging data, it is likely that medical cannabis will not be made widely available on the NHS anytime soon. That means, for now, most prescriptions in the UK will continue to come from private medical cannabis clinics.
But what about these clinics themselves? Have they seen an increase in interest?
Lyphe Group is one of the largest medical cannabis groups in the UK, with an estimated 30% share of all private medical cannabis patients in the country registered at Lyphe Clinic. They carry out clinical consultations virtually via video consultations, and offer patients a digital prescription management tool in the form of partnered pharmacy Dispensary Green. So are they also seeing any increase in patients, or an influx of enquiries?
The Chief of Marketing at Lyphe Group, Andrew Tyler shared with Volteface:
“As the market leader in the UK, we can certainly help gauge any change in attitudes and any increases in demand and have certainly seen the market grow. Of course, we’re dealing with patients with chronic conditions, some of them suffering from long-term and debilitating conditions. That’s why we are focused on offering a direct-to-patient and technology-led approach to make it easier for patients to access our services.
That absolutely needs to remain our focus and the focus of others in the industry going forward. We must make it easy and accessible for patients to get the help they need. It is encouraging that anecdotally, it appears perceptions amongst the general public are changing. Hopefully, this will continue.”
In 2018, the change in the law regarding medical cannabis appeared quick and reactionary, as opposed to being founded on an evidence base that had grown and strengthened public opinion over time. This has led us to the unique situation where education and awareness raising is still required post-legalisation to bring professionals and the public up to date. Through the interviews and evidence collected, perhaps we are now beginning to wake up to the reality that is legal medical cannabis, reflected in both increased awareness and patient numbers.
It will be a journey to reach full normalisation of medical cannabis in the UK, but there’s no doubt that we’re heading in the right direction.
Lisa Darvill is Volteface’s Head of Media and a former broadcast journalist with over 10 years experience. Since starting a family, Lisa has stepped away from broadcasting and is using her expertise in the field to offer communications support and advice, as well as facilitating media training. Tweets at @lisamdarvill
Written By: Lisa Darvill