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.
Pierre van Werpen, CEO | Grow Group UK
December 2028, 100,000 patients in the UK have access to medical cannabis – how we got here…
Looking back at ten years of medical cannabis legalisation in the UK, we can see that some important lessons were learned, and the industry had to adapt to a very special context for a new medical frontier in the British healthcare landscape. The first three years (2019-21) was good old emerging market ‘everybody competing against each other’. Every supplier competing over market share and almost no one taking a step back and looking at the bigger picture.
Important early investments were made at this time, and the returns were based on growth curves that very quickly looked very much out of reach. The CEO still walking into the room and demanding to see how much market share growth has been achieved over the last quarter. All inspired by Canadian, American, Israeli, Australian and German uptake curves that showed markets worth billions of dollars and pounds. In reality all these markets were years ahead of the UK and most importantly, everybody who ventures into pharmaceuticals and healthcare in the UK will learn very painfully that nothing goes fast here.
Uptake of licensed, very clearly beneficial and sometimes even revolutionary pharmaceutical products is slow, no matter what you do, no matter what you try. The British healthcare machine works at a certain speed, hurdles are there by design to regulate any uptake of new medications and new technologies, even the licensed ones. And there we were, as new companies offering an unlicensed one; a whole raft of unlicensed ones. All lacking randomised controlled evidence, no UK pilot data, no clear dosing advice; flowers, oils, capsules, tinctures, sprays, all very alien to the average clinician, and crucially doctors who were sceptical, not yet trained on the endocannabinoid system, worried about their liability, worried about ‘what if it goes wrong?’.
After the law changed in 2018 and prescribing became legal, this new industry was glaringly unaware of all the inner workings of the NHS and how prescribing could scale, whilst the NHS lacked understanding of cannabis medicines as a new option for managing symptoms of many diseases. We were supported by a small group of brave parents campaigning for medical cannabis for their epileptic children without structured evidence and constantly emphasising the enormous cost to them – thousands of pounds per month – as an argument for including it on the NHS. Perhaps an unhelpful argument to make; the fact that something is expensive makes NICE and the NHS nervous. And even with the two licensed products on the market, NICE saying yes to a cannabis-based treatment does not mean that the local NHS offers it. Local Clinical Commissioning Groups will create their own pathways and treatment algorithms based on local priorities and financials.
Most of those involved in the early medical cannabis industry had very little if any knowledge of the UK healthcare system, no understanding about how to communicate with healthcare professionals, little recognition of the compliance limitations of marketing in an unlicensed medicine environment and not helped by the fact that the market predominantly consisted of patients who were already taking cannabis for medical purposes supplied by a dealer.
In the early years, most of these patients were not aware that cannabis medicines had been made legal to prescribe, and even those who did were not aware of the obvious advantages of medical oversight, improved quality of products (pharmaceutically grown, not laced or contaminated) and yet the newly licensed industry could not talk to them. And we could not talk to the hundreds of thousands of patients in the NHS or private pain clinics that could benefit from medical cannabis but were unaware of the option, their doctor did not want to speak about it, and if aware they would not know how to get to it.
Most of those involved in the early medical cannabis industry had very little if any knowledge of the UK healthcare system, no understanding about how to communicate with healthcare professionals, little recognition of the compliance limitations of marketing in an unlicensed medicine environment and not helped by the fact that the market predominantly consisted of patients who were already taking cannabis for medical purposes supplied by a dealer.
We saw cheap marketing ploys to lure patients in with the promise of generating evidence via registries that had never been approved or submitted to the MHRA and were lacking in quality to the degree that neither NICE nor the NHS would ever consider their results, so professional doctor associations and societies simply ignored them.
Early 2022 all of that changed. More experienced professionals with experience from the pharmaceutical industry joined the medical cannabis industry: medical advisors and medical directors, trial design and importantly communications and marketing specialists who understood healthcare, the NHS and the private market. The established players in the market started to see reason. The calls for working together became louder and we started to truly collaborate.
Somehow in 2022 we reached a point where we started talking to each other, where the industry started thinking about working together to grow the market, to increase awareness with the general public, to start generating safety and efficacy data through proper MHRA and REC approved protocols with control groups.
It all started with the first ever MHRA and REC approved trial with an unlicensed cannabis medicine, launched in early 2022, from the LVL clinic with their partners Aurora and Grow Pharma (IRAS 304548). The trial was in non-oncological pain and garnered significant media attention. This not only increased general awareness but, with the data that were presented at the end of the trial, also gave clinicians more confidence in the safety and in the benefits of symptom management with cannabis medicines. During 2022 there was also a significant increase in clinics and their marketing activities, suddenly psychiatrists started to see the benefits of CBMPs in areas like PTSD, sleeping disorders and anxiety.
The narrative started to shift from ‘the NHS has to do this’ towards simply focusing on the patients that could be helped with medical cannabis and how they could get access for example through their GP referring them to a clinic or from their NHS specialist writing a private prescription for them because they too started to see the evidence and rationale behind medical cannabis. The industry was working together, clinics were talking to each other. All finally understanding that the market was big enough for all of them and there would be an upside in bringing in new ‘cannabis-naïve’ patients instead of competing for the pool of existing ones.
As a result of conversations between all parties, acknowledging that the goal was simply to provide a stable and controlled pathway and system for widespread medical cannabis access, we launched new educational initiatives that addressed the actual needs of the market. Doctors wanted the knowledge and security to be confident that what they were doing was safe. Many doctors were wary about the opioid crisis and started to be even more careful with new medications, including cannabis medicines, rather than the opposite. These initiatives created a much more positive environment.
Supported by the data we educated specialists about the endocannabinoid system and how to prescribe CBMPs. We educated GPs and pharmacists to think about medical cannabis and importantly, we found a way to explain to the public the difference between CBD (bought in health stores and online) and medical cannabis. We also found ways to educate MPs and regulators about the difference.
People also gradually learned about the limitations of CBD. Yes, it improves sleep and anxiety, but for pain relief, MS, Parkinson’s, epilepsy, IBD, oncological pain, for end of life support replacing high dose painkillers, you need THC containing cannabis treatments with medical oversight, high quality products, supported by data, prescribed by an appropriate medical professional and dispensed through a licensed pharmacy.
We all finally started to see that this was about patients actually getting prescriptions, patients and doctors being educated about the right medicine for the symptoms they were trying to manage. We now knew much more about these medicines, from the second they were grown to how all the different administration forms worked (flower, vapes, oils, inhalers, capsules, patches) to how they were being used by patients day-to-day. We were able to improve the lives of thousands of cannabis naïve patients whose symptoms were often much better managed than with conventional high dose and addictive painkillers that would stop working after six months if not stopped sooner due to their side effects.
We got the narrative right, started talking about the benefits in symptom management, started sharing the data and looked at making small, incremental steps. The first step was onboarding more specialists in more disease areas. The second was NHS doctors accepting the potential benefits and, instead of their patients using a street drug dealer, they would refer them to a clinic. Some began writing private prescriptions for these patients so they could access legal products. The third step saw more GPs referring patients to specialists for CBMPs and importantly being open to having an informed conversation about medical cannabis with their patients and not being dismissive and shrugging their shoulders if asked for advice about it.
We got the narrative right, started talking about the benefits in symptom management, started sharing the data and looked at making small, incremental steps.
Shifting attitudes among clinicians was key. Not sending people to buy retail CBD but actually being able to have a conversation and explain the difference between CBD and medical cannabis. That was a big thing in 2023 when we got to over 25,000 patients. Eventually GPs wanted to start prescribing themselves for certain symptom clusters. They were tired of writing prescriptions for high dose painkillers with significant side effects. By mid 2025 we had reached 70,000 patients in the UK. The evidence was getting increasingly compelling, several proper clinical trials were starting to report data and some private insurers were now including CBMPs in their packages and some even started advertising about it to potential clients looking for private healthcare policies.
By the middle of the decade, the UK had finally fully embraced cannabis medicines as a treatment option for patients with chronic pain, pain related to cancer or other diseases and symptom management in Parkinson’s, epilepsy, MS, endometriosis and others. Sleeping disorders, PTSD and other mental health issues were regularly being addressed and treated with cannabis medicines, a significant percentage of illicit market consumers had converted to having medical oversight of their treatment instead of going to their street dealer. Many patients who were cannabis naive and on high dose painkillers and opioids had managed to reduce those and replace them with cannabis medicines, also reducing the number of side effects and deaths related to high dose opioid use. Medical cannabis prescriptions were still private, but the NHS had allowed and endorsed these prescriptions to be written during NHS consultations.
The result of all these changes meant that by 2028, ten years after the law was changed, 100,000 patients in the UK are now regularly using cannabis medicines and the evidence from all prescribing is being collected properly in an official national registry supported by the Department of Health and the MHRA. Public awareness and acceptance also with pharmacists, nurses and other healthcare professionals has increased and there are now hundreds of prescribers across the country.
This is how we got here. It happened because we started talking to each other, because we understood how to talk to HCPs and patients. Pharmacists got involved in their medication reviews with patients. Prices have come down for patients to more affordable levels, supply is consistently reliable and many different modes of administration and cannabinoid ratios are available to address different patient needs.
The result of all these changes meant that by 2028, ten years after the law was changed, 100,000 patients in the UK are now regularly using cannabis medicines and the evidence from all prescribing is being collected properly
Unlicensed medical cannabis is not on the NHS yet in 2028, but there has been talk about certain limited indications to run a national pilot and see how it goes. With decreased cost and the positive evidence around it there are already areas where the use of CBMPs as part of the pathway will reduce cost for the system and that is what mobilises the NHS and their commissioners. Importantly for future long-term growth and innovation, training and education about the endocannabinoid system are now part of the curriculum for medical and pharmacy students.
Looking back from 2028 we should be proud of what we achieved together as an industry and how we did it. We focused on the bigger picture. We focused on the patients and on the healthcare professionals who take care of them. We understood we had to focus on the accumulation of evidence to drive and create the right climate for changes to the public system, rather than trying to change the system by force.
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.