As the UK medical cannabis industry reaches a ‘tipping point’, experts are urging clinics to follow best practice guidelines, as regulators look to crackdown on what has been described as a ‘pseudo-recreational market’.
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Health and social care watchdog, the Care Quality Commission (CQC) recently reported a 118% increase in prescriptions of unlicensed cannabis-based medicines between 2021 and 2023, noting that numbers continue to increase by at least 100% annually.
However, the Safer Management of Controlled Drugs report, published in July, also highlights a number of issues with current prescribing of cannabis-based medicines, suggesting that a ‘multi-agency review’ of the impact of the 2018 law change would be ‘beneficial’.
The CQC flagged issues with providers not always communicating information with other healthcare professionals in a ‘timely’ fashion, and patients struggling to access ‘joined up’ care.
At the same time, some experts in the sector have expressed further concerns about some of the prescribing practices and what has been described as a ‘pseudo-recreational market’.
This includes patients being prescribed more than the recommended monthly dosage and requesting flower products containing upwards of 30% THC levels.
Professor Mike Barnes, founder of the Medical Cannabis Clinicians Society (MCCS)—and the first doctor to obtain a licence to prescribe medical cannabis in the UK— told Cannabis Health the organisation is ‘concerned’ about the amount of cannabis being prescribed to some patients.
“Things need to change, and I think quite rightly, the CQC should look carefully at the prescribing practices,” said Prof Barnes.
“I’m very against some of those in the sector using medical cannabis prescribing as a pseudo-recreational market.”
Good practice guidelines – THC caps and 2g limit
The MCCS recently published the Good Practice Guide for the prescribing of cannabis-based medicines. It recommends that any prescriptions of more than 2g of cannabis per day and products containing levels of higher than 22% THC should be approved by a panel of peers.
“The majority of patients need no more than 2g a day, whereas some are being prescribed up to 6g,” explains Prof Barnes.
“There are a minority of people who do need more than 2g a day, but in order to be sensible and controlled about it, it should go to a peer review panel to be approved.”
He adds: “Likewise, if you’ve got a product with a very high THC percentage, by definition it will contain less minor cannabinoids and terpenes and therefore has less medical value. Again, there are a small number of people—nearly all of them will have severe chronic pain—who do benefit from high THC percentages, but the top six flowers prescribed in the country are 22% or less.”
The last 12 months has seen an influx of North American brands, associated with ‘recreational’ cannabis use, coming to the UK, such as Tyson 2.0 and Cookies.
Prof Barnes also says the sector needs to move away from an “obsession with flower” – which currently makes up around 80% of prescriptions in the UK and clinics must ensure they are accessing a patient’s medical records rather than relying on self-reported health questionnaires, to ensure that they do have a “genuine medical issue”.
‘Recreational’ strain names
The MCCS also recommends that producers avoid using ‘recreational’ names such as Girl Scout Cookies and Gorilla Glue, as they ‘do not convey useful information about the medical value of the plant’.
While strain names can play an important function for patients, helping them identify products which have been helpful for them in the past—and are a huge part of cannabis culture— many believe it is inappropriate for doctors to be prescribing products in this format.
In recent weeks, some producers have introduced a new naming system, giving products codes related to strain names so patients can still associate these with the cultivars they are familiar with.
“The MHRA has said that it expects the industry to apply common sense. This is a serious medicine and we must treat it seriously,” says Prof Barnes.
“[Clinics] are trying to get as many patients through the door as possible, so are catering deliberately to the current illegal market, some of whom are absolutely genuine medical patients. But they’re missing the bigger picture, that a lot of other people who don’t use illegal cannabis would also benefit from this medicine.”
Competing for patient numbers has also led to some aggressive marketing strategies being deployed by clinics, designed to ‘appeal to recreational consumers’, despite the fact that the promotion of unlicensed medicines is prohibited by the MHRA.
A ‘tipping point’?
While the tactics appear to be paying off, it could come at a cost, cautions Robert Jappie, a partner at law firm Fieldfisher, who believes the sector has reached a ‘tipping point’ seeing enough growth to warrant greater scrutiny from regulators.
“We’ve been talking about growing the sector and there’s now sufficient patient numbers and sufficient operators that the regulators are going to have to get involved,” he says.
“Obviously, increased scrutiny potentially causes more problems for some of the clinics, who have taken the view that one less person buying from the illicit market can only be a good thing.
Jappie says clinics feel comfortable ‘pushing the boundaries’ of the MHRA Blue Book as regardless of how their marketing strategies may appeal to ‘recreational’ consumers, ultimately any prescription must still be signed off by a specialist doctor.
“The doctors are the gatekeepers,” he adds.
“If there’s any suggestion that there’s recreational consumers being admitted to the medical market then you’re going to have to prove that the doctor hasn’t done his job properly. Doctors are careful about their reputation and their position, they have to be prepared to defend their decision.”
But with regulators starting to pay closer attention, Prof Barnes fears that placing too much focus on the recreational market could risk “jeopardising” future access to cannabis medicines in the UK.
‘Active dialogue’ with regulators
The Cannabis Industry Council (CIC) says it supports an “independent and effective regulatory regime” for clinics and is in “active dialogue” with the CQC and other regulators to support efforts to ensure compliance and patient safety.
It is also lobbying for policy changes which it says will improve communication among healthcare providers, such as allowing e-prescribing to remove additional bureaucracy and help collect and monitor data on patient outcomes.
“The CIC calls on the Government and NHS Digital to step up and enable the electronic prescribing of cannabis medicines by private clinics,” said CEO, Mike Morgan-Giles.
“The current paper-based system is inefficient, results in incomplete patient records, and brings data security risks. Allowing e-prescribing will improve medical outcomes, will help build an evidence-base for the effectiveness of cannabis medicines, and will reduce the bureaucracy imposed on doctors,”
He added: “Furthermore, allowing GPs to prescribe cannabis medicines to their patients would also bring greater medical and public understanding of the availability and benefits of these medicines for treating a range of conditions. It would also ensure a more coherent and joined up healthcare system, as well as reducing NHS waiting lists and bringing more people back into work.”
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