About the CMC
The Centre for Medicinal Cannabis has a formidable in-house mix of medical expertise, political nous and analytical skills that our members can depend on to bring about positive reform.
Carly Barton, Founder | Cancard
The general attitude of law enforcement in the UK around the consumption of cannabis has significantly changed in the past two years. Despite there being a lack of Home Office or police guidance around the law change in 2018 that brought about a clinical access route for medicinal cannabis, policing approaches are evolving. Cancard – a policing tool that aids use of discretion for cases of simple cannabis possession for medicinal consumers – has seen a dramatic uptake in engagement from police forces who have felt the pressure of criminalising bona fide patients for whom the current lawful access route is not adequate.
The general attitude of law enforcement in the UK around the consumption of cannabis has significantly changed in the past two years. Despite there being a lack of Home Office or police guidance around the law change in 2018 that brought about a clinical access route for medicinal cannabis, policing approaches are evolving. Cancard – a policing tool that aids use of discretion for cases of simple cannabis possession for medicinal consumers – has seen a dramatic uptake in engagement from police forces who have felt the pressure of criminalising bona fide patients for whom the current lawful access route is not adequate.
The illicit market itself has also adapted since the 2018 law change and in many ways is providing a service that many medical consumers are choosing, over an expensive, private clinic pathway. However, criminalisation of cannabis patients continues, and will persist unless changes are made to accommodate existing users who are outside of the present legal access pathway.
Patient demand and current access challenges
The latest and most in-depth data we have available with regards to medicinal consumption was conducted via a YouGov survey in 2018. This research showed that 1.4 million people in Britain report consuming illicit market cannabis to treat a medically diagnosed condition. If we compare the condition lists that are currently being covered by private clinics in the UK against the list of reported conditions surveyed patients are using cannabis for, we can safely estimate that a little over 1.1 million of these people would likely already qualify for a private prescription based on their diagnosis
General cannabis consumption may be on the rise. This could be due to laws changing in other countries and also due to a better understanding of its medicinal properties. Policing this is becoming problematic. In fact it could be argued that ongoing prohibition and the current tight legal regulations around prescribing cannabis medicines has generated a perfect space for organised crime to thrive, by doing little to provide adequate legal access but managing to legitimise the medicinal benefit of the plant, thus actually encouraging illicit suppliers and giving more confidence to users.
The current state of the illicit cannabis market is fraught with contradiction. Demand is currently being met by two very different types of supplier: those involved in organised crime and those who would be considered to be specialist caregivers in many other countries.
Organised crime in the illicit cannabis market is something that negatively impacts all our communities. This comes with rising levels of violence, friction for control of territory, child and human trafficking, theft of electricity, anti-social behaviour in housing areas, a pathway for organised European (mainly Albanian) gangs. Patients are very aware that this is an issue and generally would much rather not engage with any market that is causing harm.
On the other hand, particularly since international law changes, access to educational courses, better research and international patient advocacy, the illicit market has an army of experienced suppliers who are nothing short of specialists in this area. Many of these suppliers charge little in the way of fees for their service. They will often provide clean, safe cannabis that has been grown organically, extracted, and blended to a ratio to suit the condition that is being treated. These caregivers are forging a path to an underground market that is often much more sophisticated than products available in dispensaries in legal countries.
Demand is currently being met by two very different types of supplier: those involved in organised crime and those who would be considered to be specialist caregivers in many other countries.
In terms of ease of access within this market, patients will often request a ‘menu’ of available products via smartphone messages. These products will be a mix of flower, concentrates, oils, topicals, capsules and edibles and will often contain information about genetics, how the plant was grown, terpene profiles, likely effects, and occasionally lab test results. They will often receive a same or next day service to their front door, ongoing support, advice and a range of other products available to try.
Estimates suggest more than 10,000 private prescriptions have been written in the UK since 2018, which is far below the number of patients using cannabis obtained from the illicit market to self-medicate. But all of these patients are putting themselves at the risk of prosecution, which is where Cancard plays a role.
Why Cancard is needed
In polling and through patient disclosures, we know that medicinal consumers in 2018 were still frequently being enforced against – either charged, fined or issued a cannabis warning which impacted their ability to travel to certain countries and to pass CRB checks for employment or volunteering roles. In data from 2021 we have found that the vast majority (98%) of stops and searches of patients carrying their Cancard ID not facing a criminal record nor having their medicine confiscated. It is important to note that while discretion has always been an option for officers on the street, historically we have never seen a tool of this kind being utilised at such a high rate.
Cancard, a medical ID that records that a patient has a condition for which they are using cannabis medicinally, has seen 50,000 patient registrations in a little over 12 months. All of those patients have been medically qualified and undergone passport style ID checks in order to be part of the scheme. All Cancard holders are given support in the event that their consumption has an impact on their lives or if they are investigated criminally. The scheme is supported by the National Police Chiefs’ Council, the Police Federation, the Police Foundation and many other policing organisations. Every force in the UK has received a briefing and the project is now available nationally.
The main drug offence recorded in the recent national statistics Drug Crime: Statistics for England and Wales 2020/2021 report was possession of cannabis. This amounted to 63% of all drug offences in the year. This is an increase of 20% from the previous year. After cases of drunk and disorderly, possession of cannabis was the second most common offence for which the offender received a monetary sanction. Many also received a criminal record, despite only consuming cannabis in order to treat a legitimate medical condition for which cannabis provides them relief.
After cases of drunk and disorderly, possession of cannabis was the second most common offence for which the offender received a monetary sanction.
There is also an economic imperative to justify more discretion in police enforcement of cannabis possession. A recent research paper by the Taxpayers’ Alliance demonstrates that approximately 200 million pounds per year is spent on policing cannabis alone. When looking at the wider context of cost saving and based on cost savings to the NHS, police and courts, legal aid funds, etc the estimated savings amount to £892 million annually. This is not taking into consideration any generated income that would come with a regulated market, which has been estimated in a report by Health Poverty Action to be worth between £1bn-£3.5bn to the treasury in tax revenue per year.
Law enforcement are not immune to balance sheets and common sense approaches. The vast majority of cannabis cases that are dealt with are ‘offenders’ who are non violent, not involved in any other crimes and hold cannabis for personal use only. Continuing to criminalise these people does not add up financially or morally: this is the current attitude of law enforcement in the UK. Cancard has given officers on the beat an appropriately regulated tool with which to justify use of discretion in cases where no harm is being caused, at least initially for those who have a medical condition.
Cancard has given officers on the beat an appropriately regulated tool with which to justify use of discretion in cases where no harm is being caused
The scheme has been met with enthusiasm by the police and positive input generating policing partnerships, training programmes and greater visibility of potentially vulnerable medicinal cannabis patients.
Uptake of Cancard
Cancard has published the following results (data as of December 2021):
The implications of this de facto decriminalisation against Home Office legislation governing clinical access could be significant. It suggests that those in uniform who have first hand experience of policing in this area feel that the time is right for change.
Moving forward
There have been many suggestions for pilot schemes, regulation changes and access improvements made by various organisations in the past year. To conclude, below is a summary of one route which may be a viable opportunity to follow the lead of the police and make sensible and appropriate moves towards a more acceptable market for cannabis consumers in the UK.
Access:
In order to improve access and accountability of suppliers a first step towards evidence gathering and reducing harm for marginalised groups would be to initiate a national trial for those patients who are already benefiting from illicit market cannabinoids. This could be introduced via an online pharmacy which could hold a formulary of expanded products and offer full traceability and sales tracking. Patients could opt in via self certification/medical evidence of diagnosis similar to registration for Cancard. This would provide lower cost for patients, stable genetics and dependable product. It would also allow real world evidence generation and access to advice and support via a buddy system of caregivers. Such a scheme would need an official ID card for the benefit of police and other third parties. Together it would contribute to harm reduction by helping to move 1.4 million people away from the illicit market.
Supply:
With imported products that are currently on the private market it is clear that both the pricing and the quality of these products is not acceptable to every cannabis consumer. In order to develop a quality range of official products that could feed into this trial cultivation, the UK needs more domestic cultivation and licenses to cultivate cannabis must be more accessible. A cooperative community owned cultivation model at a number of smaller sites across the UK could generate employment, and better quality products with room for research and development and less dependence on imports. It would also mean less dependence on the illicit market, specialist knowledge sharing and the beginning of a UK-wide industry (to also include hemp). This industry could spawn educational centres and more university partnerships, as well as small scale trials into practical issues like wattage limits on a grow your own model.
Better legal regulations that widened access and regulated domestic supply could see our knowledgeable experts recognised as such and given the opportunity to create small businesses. This is a far cry from being considered to be drug dealers and could lead to sharing and expanding knowledge for the benefit of millions of patients.
While there are hundreds of possible avenues to expand access and increase research it would seem that the best route would be to ‘on-board’ existing medicinal consumers – many of whom are Cancard users – and provide them with trial products to generate required evidence for confidence building among clinicians. With the recent MHRA draft guidance on randomised real-world evidence to support regulatory decisions – it would seem that the time is certainly right to explore options to apply these protocols to a medicine that cannot readily fit within a randomised controlled trial model.
While there are hundreds of possible avenues to expand access and increase research it would seem that the best route would be to ‘on-board’ existing medicinal consumers – many of whom are Cancard users – and provide them with trial products
The time has also come to stop criminalising patients, caregivers, specialists and experienced cultivators and instead provide a framework for them to be legitimated, so they can generate an industry that will contribute towards the health of the whole country and the individuals that live within it.
The Centre for Medicinal Cannabis has a formidable in-house mix of medical expertise, political nous and analytical skills that our members can depend on to bring about positive reform.