UNDERSTANDING MEDICAL CANNABIS IN THE UK
How to Talk to Your GP About Medical Cannabis
1.1 What is Medical Cannabis?
Medical cannabis refers to prescription-only products containing THC (tetrahydrocannabinol), the main psychoactive compound, cannabidiol (CBD), and sometimes other cannabinoids. In the UK, these are only available on prescription and regulated as medicines. They differ from CBD oils sold in wellness shops, which can’t legally contain more than 1 mg of THC per pack.
1.2 Legal Framework: The Misuse of Drugs Regulations and NICE
Since November 2018, specialist doctors in the UK can prescribe medical cannabis under the Misuse of Drugs Regulations 2001. The National Institute for Health and Care Excellence (NICE) provides best-practice guidance on conditions with evidence, such as spasticity due to multiple sclerosis, chemotherapy-induced nausea, and certain paediatric epilepsy syndromes. However, NHS prescribing remains limited with only a few NHS-funded prescriptions to date, while private clinics often write prescriptions for accepted and off-label uses.
1.3 Extracting Responsible Guidance from Research
Although clinical evidence is growing, it remains limited for many conditions. Notably, the Medicinal Cannabis Clinicians Society (MCCS) has produced guidance to help doctors and patients use real-world data to support prescribing.
1.4 What This Means for You as a Patient
You can try medical cannabis, but only via a prescription and typically from a specialist.
It’s unlikely your GP alone will initiate prescribing, but they will support your care.
You need to gather credible documentation, e.g.,:
Specialist records
Results of other treatments tried
Clear symptom tracking
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2. PREPARING FOR THE CONVERSATION
2.1 Self‑Assessment: Identifying Your Needs
Define your medical condition(s) clearly (e.g. chronic pain, anxiety, epilepsy).
Track your symptoms daily (e.g. pain scores, seizure frequency, sleep quality).
Journal any previous treatments, doses, side-effects, and your response.
Reflect on your goals: Do you want fewer seizures? Better sleep? Reduced dependency on opioids?
2.2 Researching Evidence & Regulations
Find summaries from respected bodies (e.g. NICE, British Pain Society, NHSE).
Focus on UK-based evidence and real-world case series (e.g. spasticity improvement in MS, reduced opioid use).
Understand which products are licensed versus unlicensed (e.g. Sativex® for MS spasticity).
2.3 Getting Support Materials
Bring the Medicinal Cannabis Clinicians Society (MCCS) guidance documents.
Download relevant infographics or plain-language leaflets.
If you already saw a specialist (pain clinic, neurologist, oncologist, etc.), bring your notes or referral letter.
2.4 Anticipating GP Concerns
GPs may raise concerns about:
1. Clinical evidence: some conditions lack strong RCT data.
2. Safety issues: psychosis risk, cannabis use disorder, drug interactions.
3. Non-standard prescribing: medical cannabis is complex, labeled as unlicensed in most cases.
4. Cost implications: private prescriptions cost significantly; the NHS covers mainly Sativex®.
By preparing answers—like showing you’ve tried standard options, tracking symptoms, knowing side effects—you demonstrate maturity and commitment.
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3. STRUCTURING THE APPOINTMENT
3.1 Planning the Conversation
1. Start with symmetry: “I want to follow NHS/guidelines and explore all options together.”
2. Be transparent: “I’m considering medical cannabis as a possible treatment to improve my X, but I want to do so safely, under your supervision.”
3. Acknowledge professional limits: “I know usually specialists prescribe these, but I wanted to discuss whether a referral or your support might be appropriate.”
3.2 Briefer Script You Can Adapt
Opening: “Hello Dr. X, I’m here to discuss a potential treatment option I’ve been researching: medical cannabis.”
Background: “As you know, I’ve had X condition for Y years, and tried A, B, C.”
Evidence point: “NICE and MCCS provide guidance on certain cannabis-based products for people like me with spasticity/chronic pain/epilepsy.”
Goal: “I’d like your perspective on whether this could be appropriate, what the process involves, and whether you’d support via referral to a specialist.”
3.3 In-Practice Communication Tips
Use non-confrontational language.
Stay curious, not demanding.
Listen to your GP’s perspective and concerns; validate them.
Ask clarifying questions: “What would you want to see in order to feel comfortable supporting this?” or “Who might you consider referring me to?”
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4. DISCUSSING CLINICAL AND SAFETY CONCERNS
4.1 Review of Evidence & Counselling
GPs will ask about:
Quality of evidence (RCTs, real‑world data, patient surveys).
Indication-specific effectiveness: e.g., Sativex® reduces MS spasticity, CBD lowers seizure frequency in epilepsy.
Safety considerations:
Psychosis risk, especially with high THC
Potential dizziness, dry mouth, fatigue
Interactions (e.g. with opioids, benzodiazepines, warfarin)
Risk of cannabis use disorder in some patients
4.2 Risk Mitigation Strategies
Start low, go slow (e.g., micrograms of THC, titrate gradually).
Close monitoring: side-effect diary, mental health checks.
Regular follow-ups: every 4–6 weeks initially.
Provide written safety info, e.g. from GMC or BMA guidance.
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5. EXPLORING PRESCRIBING PATHWAYS
5.1 Specialist vs GP Roles
Most prescriptions are initiated by specialists at NHS or private clinics.
GPs typically act to:
1. Provide medical records/history
2. Administer repeat prescriptions if the consultant recommends
You can ask your GP to refer you to a specialist clinic if they agree it’s warranted.
5.2 NHS vs Private Routes
NHS Route:
If your condition aligns with NHS-approved indications (e.g., MS spasticity, chemotherapy-induced nausea), your GP may be willing to refer you.
NHS clinics are limited in number; waiting lists are variable.
Private Route:
Consult with a private medicinal cannabis clinic (doctors are typically UK-registered consultants).
You’ll pay consultation and prescription fees.
The private clinic can initiate treatment and coordinate with your GP.
5.3 Working with Your GP
With referrals: “Would you write a referral to Dr. Y at X clinic and share my medical history?”
With private prescribing: “They’d like your support for prescribing repeat supply. Would you be willing to co-manage this?”
Clarify responsibilities: e.g. repeat prescriptions, monitoring tests, side-effect reporting.
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6. STRUCTURING A TREATMENT PLAN
6.1 Choosing the Right Product
Licensed: Sativex® (nabiximols) is licensed for MS spasticity.
Unlicensed but commonly used: Oils containing CBD:THC in various ratios.
More regulated via UK prescription. Hosted on Registry.
Your care team should choose products based on specific symptoms, tolerance, and interaction considerations.
6.2 Dosage & Titration
Initial instructions often recommend “start low”:
e.g., 1–2 sprays daily of Sativex®, or 2.5 mg THC/CBD twice a day for oils.
Titrate up every few days based on symptom control and side effects.
Agree on monitoring frequency (e.g., monthly initially).
6.3 Monitoring & Review
Your plan should include:
Symptom tracking tools: pain scales, spasticity questionnaires, seizure logs
Side-effects diary: sedation, appetite, mood, cognition
Regular in-person or remote review (e.g., via telephone or video)
A shared, written follow-up schedule
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7. POTENTIAL COSTS AND FUNDING CONSIDERATIONS
7.1 Expenses in Private Care
Expect:
Consultation fee: ~£200–350
Products:
Sativex®: ~£450 per month
Unlicensed oil: £100–300 per month
GP repeat prescription: ~£12.35 per item + pharmacy charge
Monitoring (blood test fees, appointment fees, etc.)
7.2 NHS Funding Possibilities
Sativex® may be funded by the NHS for qualifying MS patients.
Other products funded on a case-by-case basis; Rare Disease Pathways may help.
If your GP believes NHS use is appropriate, they can initiate the process.
7.3 Cost-Benefit Framing
Discuss:
Potential to reduce usage of painkillers/opioids
Quality-of-life improvements (work, sleep, social activity)
Avoiding risky DIY/self-medication
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8. COMMON GP QUESTIONS & HOW TO ANSWER
GP Question How to Answer
“What evidence supports this?” “For example, NICE recommends a trial of Sativex® in MS spasticity; CBD reduced seizure frequency in Dravet syndrome.”
“Is it safe?” “Side effects are dose-related—using lower THC and setting up monitoring helps reduce risks.”
“Who will manage your prescriptions?” “The specialist will start it, but I’d appreciate your help with ongoing prescriptions and monitoring.”
“Can you afford it?” “Yes, but I’m aware of costs, and taking legal prescribed medicine is better than illicit sources.”
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9. FOLLOW‑UP AND LONG‑TERM CO‑MANAGEMENT
9.1 Timelines
First follow-up: 4 weeks after treatment start
Subsequent reviews every 4–8 weeks until stable, then every 3–6 months
9.2 Monitoring Parameters
Condition-specific outcomes (e.g., pain, spasticity, seizure frequency)
Side effects (mood, judgment, fatigue, appetite)
Vital signs, liver function, or other tests as needed
9.3 Reporting & Documenting
Keep a written log or digital tracker.
Provide updates to GP and specialist at each review.
Use disease-specific assessment tools (e.g., pain visual scale, Pittsburgh Sleep Quality Index, spasticity scales).
9.4 Adjusting or Stopping
If side effects are significant, taper down or stop
On improvement, consider dose reduction
Document changes jointly with GP and specialist, who should share letters
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10. WHAT IF YOUR GP IS HESITANT?
10.1 Understanding Hesitancy
Common issues:
Concerns about evidence or safety
Staff workload and prescribing complexity
Lack of experience with cannabis prescribing
10.2 Steps to Address Hesitancy
Offer to educate together (share MCCS/NICE guidance)
Offer a single, supervised trial via a private or NHS specialist
Emphasize shared care: specialist initiates, GP supports
Provide reassurance: you want to go through medical channels, not self-medicate
10.3 Escalating Gently
If they still decline:
Ask: “What information would convince you?”
Offer to “leave this on pause” if you can gather specialist input
Consider approaching another GP or changing practice—do so respectfully
How to Talk to Your GP About Medical Cannabis
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11. SELF-ADVOCACY AND YOUR RIGHTS
11.1 Empowering Yourself
You have the right to ask about legitimate treatments.
While GPs are not required to prescribe, they should:
Listen respectfully
Support you in reasonable referral requests
Provide evidence-based advice
11.2 Escalation Options
If needed: the Patient Advisory Liaison Service (PALS) at your NHS trust.
How to Talk to Your GP About Medical Cannabis
In case of a dispute: contact the General Medical Council (GMC) for guidance.
How to Talk to Your GP About Medical Cannabis
11.3 Keeping Perspective
Medical cannabis isn’t right for everyone.
Being prepared, courteous, and grounded in evidence increases your chance of success.
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12. SAMPLE APPOINTMENT OUTLINE (FULL SCRIPT)
1 Greeting & Context
“Hi Dr. X—thanks for seeing me. I wanted to discuss something I’ve been researching: medical cannabis.”
2. Situation Summary
“As you know, I’ve had chronic pain for X years post‑surgery/radiation/MS/arthritis.”
3. Previous Attempts
“I’ve tried paracetamol, NSAIDs, gabapentin, opioids—with limited relief and some side effects.”
4. Evidence-Focused Request
“I read that Sativex® is recommended for MS spasticity, and that NICE recognises nausea control in chemo. The MCCS guidelines support trials in chronic pain too.”
How to Talk to Your GP About Medical Cannabis
5. Goal Expression
“I’m hoping to reduce pain, and maybe reduce opioids, but I want to do so safely with medical oversight.”
6. Proposed Pathway
“I know a consultant would need to start it. Could you support a referral—or, if it’s private, help with ongoing prescriptions and monitoring?”
7. Open Dialogue
“What concerns do you have? What would you need from me to feel comfortable?”How to Talk to Your GP About Medical Cannabis
