Frequently Asked Questions

+ What conditions can medicinal cannabis treat?

Medicinal cannabis is a licensed treatment for patients with MS-related muscle spasticity that has not got better with other treatments & Lennox-Gastaut and Dravet syndromes (rare forms of epilepsy).

Clinicians are able to prescribe medicinal cannabis for any patient they believe could benefit. Patients may have needed to try alternative treatments before a clinician is willing to prescribe. Most patients receiving private prescriptions have pain, neurological and psychiatric conditions, such as fibromyalgia, multiple sclerosis, epilepsy, anxiety & PTSD.

+ What is the endocannabinoid system?

The endocannabinoid system is an internal body system that is involved in regulating a wide range of processes. Research has linked the system to many functions, including digestion, inflammation, chronic pain, memory, muscle formation, sleep, mood and motor control.

Cannabinoid nerve receptors can be found throughout the body and the brain. The body naturally makes endocannabinoids at all times, and consuming cannabinoids can assist the system functioning by stimulating receptors. This is why medicinal cannabis has a wide range of potential benefits and applications.

+ What are CBD & THC?

CBD (cannabidiol) and THC (tetrahydrocannabinol) are two of the most commonly known cannabinoids. Both CBD and THC have medicinal properties and can be prescribed.

CBD's medicinal benefits include anxiety, pain, sleep and epilepsy management. CBD does not cause intoxication and can reduce potential negative effects caused by THC.

THC's medicinal benefits include pain, nausea and muscle spasm relief and sleep management. THC can cause intoxication, and is usually highly concentrated in black market cannabis.

Clinicians usually prescribe a high CBD product, and slowly introduce THC dosage as necessary based on how the patient responds. When prescribed and monitored by a clinician, patients can find the optimum dosage of CBD and THC which provides symptom relief and a low risk of side effects.

+ What formulation/ consumption method is medicinal cannabis prescribed as?

Medical cannabis can be prescribed as a wide array of products, most commonly as an oil. Cannabis flower for vaporisation can also be prescribed, usually for patients requiring breakthrough symptom relief.

+ How long does medicinal cannabis take to work?

When medicinal cannabis is consumed as an oil, the effects usually set in within 2 hours and last up to 6-8 hours. When consumed via vaporisation, the effects usually set in within minutes, and last up to 3 hours.

Patients are usually prescribed a low dose that is slowly increased to optimum dose based on their response. Patients may need to try a range of products to find the most suitable consumption method, dose and cannabinoid profile for them.

+ What are the side effects of medicinal cannabis?

According to the World Health Organisation, CBD (cannabidiol) is generally well tolerated with a good safety profile.

Short-term side effects

Cannabis based medications containing THC have potential short-term side effects of dizziness, disorientation, drowsiness, increased appetite, anxiety and dry mouth. These side effects are dose-dependent, meaning the likelihood of experiencing them increases at higher doses. When prescribed by a doctor, they will therefore start with a small dose and gradually increase, to minimise potential side effects.

Long-term side effects

THC has been linked to psychosis in those with a genetic predisposition and/or previous history of psychosis. With careful clinical assessment by a specialist doctor, this risk can be mitigated by identifying previous and family history of psychosis, and limiting THC in favour of CBD. THC-related psychosis is often reversible when the medication is stopped, and so can also be managed with ongoing monitoring from your doctor. It is therefore rare to experience this serious side effect when using medical cannabis under the supervision of a specialist doctor.

+ What drugs can medicinal cannabis interact with?

Medical cannabis is generally well tolerated when taken alongside other medications.

Some medications may increase the plasma concentration of THC when taken alongside medical cannabis (e.g. amiodarone, cimetidine, cotrimoxazole, metronidazole, fluoxetine, clarithromycin, erythromycin, cyclosporine, verapamil) this means lower doses of medical cannabis are required to achieve the same effect. Medical cannabis may also increase the effects of other medications, such as clobazam and warfarin, when taken together.

It is important to take a list of your medication to your doctor’s appointment, where your doctor will alert you of any possible medication interactions.

+ Can I become addicted to medicinal cannabis?

Prolonged daily use of recreational cannabis has been known to result in cannabis use disorder. This condition describes compulsive daily use of the drug, at the expense of the person’s every day wellbeing and functioning (e.g. a person may forgo attending work to smoke cannabis at home instead). They may also experience withdrawal symptoms, such as insomnia and anxiety, on cessation of the drug. This is generally associated with THC - CBD can in fact be taken to mitigate THC withdrawal symptoms.

When prescribing medicinal cannabis, your doctor will carefully weigh up the potential risks and benefits, to ensure this medication will improve your quality of life. Medical cannabis is therefore unlikely to result in cannabis use disorder, and would be discontinued if the medicine started negatively impacting your everyday functioning.

+ Can you overdose on medicinal cannabis?

Patients can experience unpleasant effects, such as palpitations, nausea, sweating and disorientation, if they take large doses of medicinal cannabis, but these will pass within a few hours. Cannabis overdoses are not fatal and nobody has died directly from an overdose of cannabis.

If you are concerned about a large overdose, go to A&E and tell them what you have taken.

+ Is medicinal cannabis manufactured safely?

Prescribed medicinal cannabis is GMP (Good Manufacturing Practice) certified, therefore meeting the highest standard of consistency. The prescribing doctor will make a clinical decision on products that are safe for you.

+ What is the difference between prescribed and illicit cannabis?

Unregulated cannabis is of unknown CBD and THC concentration, and has no guarantee of consistency, quality or safety. Synthetic cannabis (or ‘spice’) may also be sold on the black market masquerading as plant cannabis. This can pose significant risk to the user, as synthetic cannabinoids have much higher potency, therefore increasing the likelihood of negative effects including psychosis.

Medicinal cannabis products are prescribed by a clinician to monitor and improve patient outcomes. Prescribed medicinal cannabis products are legal, regulated and have a consistent cannabinoid content.

+ Can I be prescribed medicinal cannabis on the NHS?

Currently, certain cannabis based medicinal products can be prescribed for a number of conditions on the NHS. These are:

• Sativex (THC:CBD spray) to treat moderate-to-severe spasticity in adults with Multiple Sclerosis who have not found other drug treatment to be effective.
• Epidiolex (CBD isolate) alongside clobazam to treat seizures associated with Lennox-Gastaut syndrome and Dravet syndrome.
• Nabilone (synthetic THC) as an add-on treatment for intractable chemo-induced nausea and vomiting.

Patients with these conditions may find that they obtain greater relief from unlicensed cannabis based medicines, available on private prescription. While these medications can be legally prescribed by an NHS consultant, very few prescriptions have been written or funded within the NHS.

+ How do I get a medicinal cannabis prescription?

As medicinal cannabis is only available for a very limited number of patients on the NHS, the majority of prescriptions are private and so incur costs. There are a range of clinics across the UK that can prescribe cannabis based medicines.

The following medical cannabis clinics are CQC (Care Quality Commission) regulated:

• My Access Clinics
• Sapphire Clinics
• The Medical Cannabis Clinics

Independent prescribers may also be willing to prescribe medicinal cannabis.

You may require a referral letter from your current doctor, or you may be able to self refer with your medical records. When a referral has been received and accepted by the clinic, you will be able to book an appointment with a prescribing doctor. The doctor will review whether they think medical cannabis is an appropriate treatment, and prescribe appropriate medicines.

Private prescriptions are usually fulfilled at pharmacies that specialise in specials medicines. The clinic should suggest where you can send your prescription, but patients are able to have their medication dispensed at any pharmacy. However, dispensing fees and potential delays vary between pharmacies.

When the pharmacy has received your prescription, they will contact you for payment. On receipt of payment, medication will be dispensed and delivered to your address by courier.

At times, there are delays in receiving medication due to the complexities involved with importing and dispensing cannabis based medicines. Pharmacies should update patients on expected arrival times in the event of a delay.

Medical cannabis is available at a subsidised rate for certain conditions through Project Twenty21, from £150 per month for medication. More details can be found here.

Patients who are unable to afford the costs of a medicinal cannabis prescription may wish to apply for assistance from the Sapphire Medical Foundation, who fund grants to support the cost of a medical cannabis prescription.

+ What can I expect at a medicinal cannabis clinic consultation?

At a medicinal cannabis consultation, the doctor will assess your medical history, current symptoms and quality of life. They will discuss whether medicinal cannabis might help your condition, and decide which product would be suitable and the dosage.

If you have previously consumed cannabis or CBD oil, you should feel comfortable sharing this with your doctor including:

1. What has been most effective at managing symptoms (including THC and CBD dosage if known)?
2. How this is taken - by oil, edibles, balm, smoking or vaporising?
3. Any issues or side effects experienced from using cannabis previously

+ How much does medical cannabis cost?

The cost of a medical cannabis prescription varies significantly, depending on the products prescribed and quantity required. Patients have reported this ranging from £30-1000+ a month. Patients should discuss cost limitations with their doctor, so that the most suitable and cost-effective medication can be prescribed.

Patients will also need to fund private consultation fees. These usually cost £100-200 for an initial consultation, reducing in cost for follow up appointments. When you have stabilised on your medication, doctors are often able to review less frequently and at a lower cost.

Medicinal cannabis is available at a subsidised rate for certain conditions through Project Twenty21, from £150 per month for medication. More details can be found here.

Patients who are unable to afford the costs of a medicinal cannabis prescription may wish to apply for assistance from the Sapphire Medical Foundation, who fund grants to support the cost of a medical cannabis prescription.

+ Can I drive with medicinal cannabis?

Patients prescribed medicinal cannabis should not drive if impaired. Like many prescribed medications, the medication label will state that the medication may cause drowsiness and if affected, you should not drive or operate machinery. Patients should discuss driving with their prescription with their doctor.

If a medical cannabis patient were drug tested, they would likely have levels of THC above the legal limit in their system. If a patient exceeds the specified limit of a controlled drug when driving, it is a permissible defence if the patient has taken a prescribed drug as directed. (S.5A(3)b of the Road Traffic Act 1988).

+ Can I travel with medicinal cannabis?

Travelling with medicinal cannabis is possible depending on the destination. Check the legality of cannabis in the country you are travelling to and contact the embassy in advance about travelling with your prescription medication. When travelling, ensure that the medication is kept in the original container, and bring a copy of your prescription, which you can ask for from your prescribing doctor.

+ Can I go to work with medicinal cannabis?

Workplaces should provide suitable workplace accommodations for disabled employees who have a medicinal cannabis prescription. Patients with technical jobs should discuss this with their doctor.