What Changed in November 2018 for Medical Cannabis in the UK?

November 2018 marked https://bizzmarkblog.com/which-conditions-does-the-nhs-actually-fund-medical-cannabis-for/ a significant turning point for medical cannabis in the United Kingdom. The changes introduced then reshaped the legal and clinical landscape for patients and prescribers alike. Terms like schedule 2 cannabis UK, the Misuse of Drugs Regulations 2001, and specialist-only prescribing rules became more than just legal jargon—they defined who could access cannabis-based treatments, how they could be prescribed, and what the NHS's stance would be.

In this post, we'll break down what exactly changed in November 2018, why it matters, and how these changes affect patients seeking medical cannabis treatment today. We'll also clarify the persistent confusions around NHS funding, legal prescribing, and the use of unlicensed cannabis-based medicines. Plus, handy links to resources like medicalcannabis.co.uk and releaf.co.uk will help you explore clinic options and understand medical cannabis better.

The 2018 Rescheduling of Cannabis: What Exactly Happened?

Prior to November 2018, cannabis-based products for medicinal use were generally classified under Schedule 1 of the Misuse of Drugs Regulations 2001. Schedule 1 drugs are considered to have no medicinal value and are highly restricted, meaning they could not be prescribed on the NHS and were essentially off-limits for medical use except in research settings.

On 1 November 2018, the UK government amended the Misuse of Drugs Regulations 2001, rescheduling certain cannabis-based products for medicinal use from Schedule 1 to Schedule 2. This shift meant that these cannabis-derived medicinal products (also called cannabis-based medicines or CBPMs) were legally accessible for prescribing by doctors under controlled conditions.

Schedule 2 drugs include substances like morphine and methadone. The rescheduling recognized that cannabis-based medicines have legitimate therapeutic uses but require strict controls due to their potential for abuse.

In simple terms: what did this rescheduling mean for patients?

• Doctors with specialist expertise—mostly consultants—could now prescribe cannabis-based medicines legally in the UK.
• Patients with appropriate conditions, such as severe epilepsy, multiple sclerosis, or chemotherapy-induced nausea, could potentially access cannabis treatments via prescription.
• Cannabis products had to come from licensed manufacturers and meet pharmaceutical standards when possible.
• Medical use still faced tight regulation, meaning access was not open or widespread.

This was a breakthrough because prior to that, legal medical cannabis access was all but impossible except through private clinics or overseas.

Specialist-Only Prescribing Rules: Who Can Prescribe Medical Cannabis?

One of the key restrictions introduced along with the rescheduling was strict limits on who could prescribe cannabis-based medicines on the NHS. Unlike many other medicines that can be initiated in primary care (i.e., by GPs), medical cannabis prescribing was limited to specialists.

Why specialist-only prescribing?

• The evidence base for medical cannabis is still emerging and varies by condition.
• Specialists are trained to make nuanced decisions about risks, benefits, and dosing for complex conditions.
• Regulators wanted to ensure controlled use and close monitoring.

This means:

• Patients interested in medical cannabis usually need a referral to a specialist consultant experienced in relevant conditions.
• GPs cannot start cannabis prescriptions themselves—though they may continue prescribing once initiated, in some cases.
• Private clinics offering medical cannabis often highlight their specialist prescribers to comply with these rules.

NHS Funding vs Legal Prescribing: The Persistent Confusion

Just because medical cannabis became legally prescribable in 2018 doesn’t mean the NHS widely funds it. This is a crucial distinction too often glossed over.

Legal prescribing means there is no criminal or regulatory barrier to doctors writing prescriptions for cannabis-based medicines (within the specialist-only rules). NHS funding means NHS organisations cover the cost of these prescriptions.

Here's the reality:

• Legal to prescribe but not routinely funded: Most cannabis-based medicines remain unfunded on the NHS as of 2024. This means patients often pay privately if they want access through UK-prescribed cannabis products.
• NHS England’s special advisory panel: Since 2019, NHS England has reviewed applications for routine funding of various cannabis-based medications. So far, only a handful of products and indications have been approved for NHS funding.
• Individual funding requests (IFRs): Sometimes a hospital or clinical commissioning group (CCG) may consider an IFR for exceptional cases, but this is not guaranteed.

The bottom line: legal access via prescription opened the doors but didn't make NHS-funded access mainstream or easy.

Important note for patients:

Accessing prescribed medical cannabis through NHS clinics remains challenging. Many patients turn to private clinics—like those listed on medicalcannabis.co.uk—to obtain prescriptions, bearing the cost themselves because NHS funding is limited.

Unlicensed Cannabis-Based Medicines and NHS Caution

Cannabis-based medicines come in two broad types:

• Licensed medicines: Products that have undergone rigorous regulatory approval as medicines, like Epidyolex (cannabidiol) for rare epilepsy.
• Unlicensed medicines: Products without full licence approval but prescribed under a “specials” or unlicensed status, often imported or compounded for individual patients.

Many cannabis-based products fall into the unlicensed category. This creates several challenges:

• NHS caution: NHS prescribers tend to be cautious about using unlicensed cannabis medicines due to limited clinical trial data, variable product quality, and regulatory complexity.
• Variability: Unlike standard licensed medicines, unlicensed cannabis products can vary in cannabinoid content, sourcing, and purity.
• Funding limitations: NHS funding is even less likely for unlicensed medicines, further restricting access.

This cautious approach is summarised neatly on releaf.co.uk, which explains why doctors and NHS bodies proceed carefully to balance potential benefits against risks and costs.

Summary Table: What Changed in November 2018?

Aspect Before November 2018 After November 2018 Legal Classification Cannabis-based products for medical use classified as Schedule 1 (no medicinal use allowed) Certain cannabis medicines reclassified as Schedule 2, allowing legal medical prescriptions Prescribing Eligibility Not legally prescribable on NHS, only research exceptions Legal prescribing permitted but restricted to specialist consultants NHS Funding Not applicable (no legal prescribing) Very limited routine NHS funding; mostly private prescriptions unless exceptional approval Access Only private or overseas access, no UK prescriptions Legal UK prescriptions possible but specialist-only and NHS funding limited

Price Example and Transparency

As of now, no specific standardized prices for medical cannabis prescriptions were stated in publicly scraped data. However, if future verified sources mention prices, it is vital to quote them exactly and attribute accordingly. For instance, private clinics listed on sites like medicalcannabis.co.uk provide patient-facing information about consultation and prescription costs, but these nhs ifr for cannabis vary widely based on the product, condition, and dosage.

Closing Thoughts

The November 2018 changes brought medical cannabis into the realm of legal prescribing in the UK for the first time in decades. They created a system where specialist doctors can prescribe these medicines, patients can hope for legal access, and the NHS can cautiously evaluate evidence to decide on funding. However, many challenges and restrictions remain:

• NHS medical cannabis prescribing is specialist-only and still rare in routine practice.
• Funding mostly comes from private payers, not the NHS, limiting availability.
• Unlicensed cannabis medicines face extra scrutiny and caution from prescribers.
• Patients need clear guidance on pathways to access and what to realistically expect.

For patients navigating this complex landscape, tools like medicalcannabis.co.uk provide directories and clinics comparison, while releaf.co.uk offers detailed explanations of conditions and treatment options.

Understanding the legal framework under the Misuse of Drugs Regulations 2001, the meaning of Schedule 2 cannabis UK status, and the NHS's cautious role helps separate fact from hype and empowers patients to make informed decisions about medical cannabis in the UK.