Towards a United Kingdom of Cannabis

With my cup half full, I can confidently say that there is a way to reduce the red tape currently hampering what could be a multi-billion-pound cannabis industry in the UK. And I know that unlocking that industry would transform the lives of patients. However, the way forward requires us to face a dreaded word: change.

First and foremost, we must change where cannabis conversations take place; currently, legislation, licensing, and health decisions are spread across multiple government departments, including the Home Office, the Department for Health and Social Care, the Ministry of Justice, the Medicines and Healthcare products Regulatory Agency, and the Food Standards Agency. Hardly a recipe for harmony.

In our report, we set out 10 recommendations that we believe will solve many of the issues caused by this muddled approach. For the UK to successfully begin helping people with chronic health conditions, we deem it vital that these recommendations are implemented through a unified Office for Medicinal Cannabis. Indeed, such an approach has been applied by other countries – including the Netherlands, where the sector has seen considerable success.

In the UK’s case, it is crucial that the Home Office and Department for Health and Social Care collaborate to explore recommended initiatives, technologies, and investment. And this effort should be underpinned by a comprehensive review into the legislation that facilitates the use of medicinal cannabis internationally.

Not recommended!

The consequences of not following our 10 recommendations are significant, but can be summarized in six distinct points:

1. Miss out on a potential £2 billion market

According to The UK Cannabis Report by Prohibition Partners, there will be around 337,000 potential medicinal cannabis patients in the UK by 2024 – together they represent a potential economic value of £1 billion. It’s an impressive figure, but it is only half the story.

Lack of access means that there are approximately 1.4 million people in the UK using cannabis illegally for medical reasons. There are also potentially many more who would benefit but do not wish to criminalize themselves by buying products on the black market. Assuming Prohibition Partners is correct with its estimate of £1 billion for 337,000, some simple maths tells us that even if half of the suggested 1.4 million people were to be granted a justifiable medical prescription, the potential value would be somewhere in excess of £2 billion.

2. Loss of potential tax revenue

If the UK relaxed laws to allow for the creation of a domestic market, the government could benefit from a substantial tax revenue. With a population of 66 million people, this would mean an income of around £350 million per annum, an amount which should be looked upon favourably by a government on track to hit a peacetime deficit record.

3. Unsecure supply chain

Patients taking medicinal cannabis products are in dire need of a secure supply chain. If epileptic children, for example, do not receive their medicines, they can become extremely ill very quickly. And those using medicinal cannabis for chronic pain may swiftly face disabling symptoms.

In the Christmas week of 2020, the Department of Health announced that medicinal cannabis prescriptions issued in the UK would no longer be lawfully dispensed from EU Member States because of the end of the Brexit transition period. Delivered to the prescribing doctors of over 40 medicinal cannabis patients, the news came as a bombshell to affected families, who were effectively given just two weeks’ notice before losing access to life-saving medicine Bedrocan from the Netherlands. Supply chain issues are a serious health risk for children who depend on medicinal cannabis. Hopefully, this issue is being resolved but it illustrates the disadvantages of relying on a purely imported market.

Furthermore, if patients face poor product availability they may be pushed to the black market, which provides an accessible alternative. Unfortunately, patients are unlikely to have full transparency on where their cannabis is coming from – or even what they are being supplied. Surely, patient health should be key, which should mean easy access to prescribed medicinal cannabis from a regulated practitioner.

4. Loss of investment opportunities

In September 2020, medicinal cannabis companies were cleared by the UK’s financial regulator (Financial Conduct Authority) to float on the London Stock Exchange, giving many investors a significant opportunity to invest in the UK Market. Unfortunately, there is a serious obstacle for overseas producers looking to make profit from their own legal, recreational market; they must demonstrate that their operations comply with the UK’s Proceeds of Crime Act 2002 (PoCA).

5. Loss of job opportunities

Cannabis related industries require farmers, researchers, production workers, accountants, lawyers, IT specialists, financial experts, researchers, and lab technicians to name just a few – in other words, it's a huge job market. With unemployment expected to peak at 7.5 percent in the second quarter of 2021 (around 2.6 million people out of work) the need for new employment streams is significant. In the USA, ZipRecruiter highlighted that over the course of 2017, the number of cannabis industry jobs grew by 445 percent, outpacing both the technology (254 percent) and healthcare (70 percent) industries. If extrapolated to the UK, it is estimated cannabis could create the equivalent of 97,000 jobs.

6. Lack of CBD market

CBD has huge potential within the UK. The market is already worth £300 million – thanks to 11 percent of the British public already using CBD products. If we were able to produce a greater variety of high-quality products – both for domestic use and for exportation – much more money would be retained in the UK economy. The good news is the foundations are already there.

In 2019, the UK was home to a mere 900 hectares of hemp farmland, used to produce farm products, such as rope, textiles, and seeds. The Financial Times reported that one acre of hemp could be worth £10,000 per annum, so if the whole plant could be used with a view to harvesting cannabinoids, those 900 hectares (2,224 acres) alone could actually be worth over £22 million in revenue. And if farmers were able to grow hemp for CBD purposes more easily, many would likely choose to do so to increase the worth of their land.

The literal ins and outs of the UK market

Right now, the process for cultivation and extraction license applications for cannabis products is convoluted, confusing, and time-consuming. In fact, the UK medical cannabis industry finds itself in serious risk of being subject to a pharmaceutical monopoly (the current regulations favor large pharmaceutical companies, who have the resources to adhere to them). But medicinal cannabis is not a single pharmaceutical product.

It is a plant comprising hundreds of compounds with some proven and various potential medical benefits; however, the regulatory system does not reflect this reality. Clearly, there is an opportunity to nurture and grow a truly domestic industry that can provide not only assistance in the recovery of an ailing economy post-Brexit and post-pandemic, but also serve to be a pioneer in the medicinal cannabis sector globally.

Today, production within the UK is confined to one main grower – British Sugar – and one main manufacturer, GW Pharmaceuticals. In 2016, the UK was supplying 44.9 percent of the reported world total of legal cannabis, yet this relates almost solely to two products, Sativex and Epidiolex (1). These products are licensed for use in the UK to treat the common MS symptom of spasticity, as well as specific forms of epilepsy. However, they are rarely used by the internal UK market, where medicinal cannabis patients are usually prescribed imported full-spectrum products.

As of October 2019, there were just 19 extant licenses to cultivate high-THC cannabis in England, Wales, and Scotland – and many of these are owned by GW Pharmaceuticals. It is a pitiful number, when one considers that applications to grow cannabis for medical purposes have been open for several years…

The lack of licenses combined with dissatisfied or even desperate patients who must turn to imported medicinal cannabis despite the UK’s reputation and stature as a producer and makes for a bleak outlook.  Even if patients are lucky enough to receive a medicinal cannabis prescription, they face high costs and long waiting times, which in turn leads to frustrated businesses and severely hampered economic prospects.

And the issues don’t stop there. The same UK laws are also hindering the domestic CBD market. According to Prohibition Partners, the UK’s CBD market was worth £300 million in 2019, making it the second largest market globally. This figure is expected to reach £1 billion by 2025. Hemp has a crop value of £10,000 per acre, far greater than the average of £400 per acre of wheat. So, why aren’t we taking advantage of it?

Simple: the UK law will not allow the production of hemp without a license. Under the terms of this law, the stalks of the hemp plant can be used for textiles and the seeds for food products, but its flowers and leaves – where CBD resides – must be destroyed. And so, despite the UK having a growing CBD market, (a YouGov poll published in October 2019 estimated 11 percent of UK adults had tried a CBD product (2)) the great majority of CBD products on British shelves come from foreign sources.

Doctor, doctor, where’s my medicine?

On November 1, 2018, the Misuse of Drugs Regulations 2015 was amended to allow for the rescheduling of cannabis-based products for medicinal use (CBPMs) in humans, allowing a legal route for CBPMs to be prescribed by doctors on the General Medical Council (GMC) Specialist Register.

However, general practitioners are not allowed to be primary prescribers but can prescribe under the guidance of a specialist for follow-up prescriptions. These specialists can prescribe for any condition but are hampered, particularly in the NHS, by restrictive guidance issued by the National Institute for Health and Care Excellence (NICE), as well as other medical establishment bodies. As a result, there have been only three NHS prescriptions for full-spectrum cannabis products and only 6,000 in the private sector. The latter remains expensive and unaffordable for many who would benefit from less restrictive access.

It is worth noting that a CBD (hemp) product producer is legally prohibited from making any medicinal claims about its product. Understandably, this makes it difficult for consumers to know what types of product to buy or what dose they should take – or, in fact, why they should consider taking it at all! Even though CBD is itself a medicine, the UK regulator has determined that it will not intervene if medicinal claims (including reference to medical conditions) are not made on product packaging or linked marketing.

A brighter, better future?

The 10 recommendations support our overarching aspiration to instigate an irreversible shift in the government’s approach towards the UK medical cannabis and CBD industry. We hope our recommendations open a dialogue with the government – bringing to its attention the significant economic and social benefits that a functioning medical cannabis and CBD market could present to the UK.

We aim to convince the relevant departments, in particular the Department of Health and the Home Office, to seriously consider the implementation of our recommended changes and begin building momentum in the industry. Most importantly, this report seeks to unite the patients, organizations, and government bodies so that we can all work together to achieve shared goals.

In 10 years, we want the UK to have fully capitalized on the medical cannabis market’s potential. This would include reaching the potential market value of £2 billion; making £350m per annum in tax revenue; having a water-tight supply chain; attracting foreign investment from medical cannabis companies; and creating around 100,000 jobs. Clearly, the economic incentives are enormous, but we must not distract from the root cause of our paper: to put patient’s wellbeing at the heart of this movement.

The industry must speak with one voice. To that end, we have recently set up the Cannabis Industry Council which now has 100 members from all stages of the cannabis journey from growers to dispensaries, clinics and hemp trade bodies to specialist magazines, law firms and parliamentary bodies. Let us hope that the government and others listen to the expertise in the Council to make valuable change and progress.  

We need to see more eligible people gaining access to cannabis-based medicinal products through the NHS. Let us also not forget the need for more education – not only for patients but also for practitioners – regarding the benefits of medicinal cannabis in alleviating pain and suffering of certain symptoms. Globally, we would like to see governments across Europe and the rest of the world adopt more progressive legislative and bureaucratic frameworks to help their populations benefit from a functional medical cannabis industry.

I hope you stand with us.