Rescheduling in 2018 made cannabis prescribing lawful — it never made a single flower or oil a licensed medicine, and that gap explains everything else

The 2018 change moved cannabis medicines into Schedule 2 — it did not licence a single one of them

On 1 November 2018 SI 2018/1055 came into force and inserted a new category into regulation 2 of the Misuse of Drugs Regulations 2001. A “cannabis-based product for medicinal use in humans” is a product which “(a) is or contains cannabis, cannabis resin, cannabinol or a cannabinol derivative (not being dronabinol or its stereoisomers); (b) is produced for medicinal use in humans; and— (c) is— (i) a medicinal product, or (ii) a substance or preparation for use as an ingredient of, or in the production of an ingredient of, a medicinal product”. Regulation 7 of SI 2018/1055 added that phrase to Schedule 2 of the 2001 Regulations.

That is the whole of the change. Schedule 1 drugs need a Home Office licence for almost any handling; Schedule 2 drugs can be prescribed, dispensed and lawfully held by a patient. Moving a product between schedules says nothing about whether it works or whether anyone has assessed it. That assessment is done by the MHRA and produces a marketing authorisation. Almost no cannabis product has one.

Cannabis itself was not legalised. Schedule 2 Part II to the Misuse of Drugs Act 1971 still lists “Cannabis and cannabis resin”, “Cannabinol” and “Cannabinol derivatives” as Class B drugs. The rescheduling reached only material produced for medicinal use in humans.

Only a doctor on the GMC Specialist Register can start you on an unlicensed cannabis medicine

Regulation 4 of SI 2018/1055 also inserted regulation 16A. A person “shall not order (whether by issuing a prescription or otherwise) a cannabis-based product for medicinal use in humans for administration, unless that product is— (a) a special medicinal product that— (i) is not also an investigational medicinal product, but (ii) is for use in accordance with a prescription or direction of a specialist medical practitioner”, or is a trial product, or holds a marketing authorisation. Regulation 16A(6) defines the term: “‘specialist medical practitioner’ means a doctor included in the register of specialist medical practitioners kept under section 34D of the Medical Act 1983 (the Specialist Register).”

Those words are more precise than the shorthand. The rule is not that only a specialist may sign; it is that the supply must be for use in accordance with the prescription or direction of a specialist. That is why the GMC and NHS England both describe a specialist initiating and a GP possibly continuing under shared care. A GP cannot start you. The hook is direction, not signature.

That gives a patient one check that costs nothing. The GMC's medical register is public and free, and it shows whether a doctor holds specialist registration and in which specialty. Look up the prescribing doctor before you pay for anything: one licensed to practise but not on the Specialist Register cannot lawfully be the source of that direction. Little else here is so cheap to verify.

Three cannabis-related medicines hold a UK licence; everything else is a special

Sativex oromucosal spray (nabiximols) is authorised under PL 61050/0001, held by SVX Therapeutics Limited, for spasticity due to multiple sclerosis where other treatment has not worked adequately. Epidyolex 100 mg/ml oral solution (cannabidiol) is authorised under PLGB 36772/0001, held by Jazz Pharmaceuticals Research UK Limited, for seizures in Lennox-Gastaut and Dravet syndromes with clobazam, and in tuberous sclerosis complex, from age two. Nabilone capsules are authorised under PL 25298/0158, held by Brown & Burk UK Ltd, for chemotherapy-induced nausea and vomiting where conventional antiemetics have not worked.

Nabilone carries a caveat that usually gets dropped. Its own summary of product characteristics calls it “a synthetic cannabinoid”. It is not made from the plant, and Schedule 2 to the 2001 Regulations lists it under its own name, separately from cannabis-based products for medicinal use in humans. Cannabis-derived, it is not.

Everything else a UK patient will meet — every dried flower, every oil — has no marketing authorisation and is supplied as an unlicensed special under regulation 167 of the Human Medicines Regulations 2012. Regulation 167(1) requires that the product “is supplied in response to an unsolicited order”, is manufactured “in accordance with the specification” of a named prescriber, and “is for use by a patient for whose treatment that person is directly responsible in order to fulfil the special needs of that patient”. Condition B, at regulation 167(3), is short and absolute: “no advertisement relating to the medicinal product is published by any person.” A special is a bespoke supply for one identified patient, not a product line.

The NHS route is closed by a guideline and a funding decision, not by a prohibition

NICE published NG144 on 11 November 2019 and last updated it in March 2021. Recommendation 1.2.1 reads: “Do not offer the following to manage chronic pain in adults: nabilone, dronabinol, THC (delta-9-tetrahydrocannabinol), a combination of cannabidiol (CBD) with THC.” Recommendation 1.2.2 adds: “Do not offer CBD to manage chronic pain in adults unless as part of a clinical trial.” Its positive recommendations attach to licensed products only, and for severe treatment-resistant epilepsy it made recommendations for research rather than practice.

Now the number everyone quotes. It is common to read that the NHS has issued three prescriptions for unlicensed cannabis medicines since 2018. Drug Science published that figure in November 2021 and cites no source for it. The government has twice said it will not release the figure. Answering PQ 117459 on 13 January 2023, the Department of Health and Social Care said the NHSBSA data could not be disclosed because the items were attributed to fewer than five patients. Answering PQ 40028 on 26 March 2025: “Data on National Health Service prescriptions for unlicensed cannabis-based medicines is withheld in accordance with the UK General Data Protection Regulation.”

So the honest statement is not “three”. It is that NHS prescribing of unlicensed cannabis medicines in England has stayed small enough, for seven years, to be suppressed as disclosive. Licensed products behave differently: the same March 2025 answer reported 5,413 items of Epidyolex, nabilone and Sativex dispensed in England to 880 identified patients between February 2024 and January 2025. Private prescribing is another scale again. The Commons Library briefing of 29 January 2025, citing NHSBSA FOI-02030, gives private unlicensed items dispensed in English community settings as 278 in 2019 and 182,008 in the ten months to October 2023 — items, not patients.

What the private route consists of, and which parts of it you can check

A private route starts with a referral or self-referral, a consultation with a doctor on the Specialist Register, and usually a multidisciplinary team review before a first prescription is agreed. NHS England's prescriber guidance says the decision should generally be agreed by an MDT, and the GMC and CQC repeat that. The prescription is dispensed by a pharmacy holding the licences and safe-custody arrangements for Schedule 2 drugs. Clinics publish consultation fees, and those fees are the part you can compare directly.

Two features of a Schedule 2 private prescription are objective. Regulation 15(1)(aa) requires it to be written on a prescription form provided by NHS England or an equivalent body for private prescribing, unless it is electronic; regulation 15(1)(ab) requires it to specify the prescriber identification number. Regulation 16(1)(e) bars a pharmacist from supplying against it “later than twenty-eight days after the appropriate date”. A prescription on clinic letterhead, or one you are told is still good three months later, is not compliant.

CQC registration is often presented as approval for cannabis prescribing. It is not. CQC registers providers to carry on regulated activities defined in Schedule 1 to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, and the relevant one is “treatment of disease, disorder or injury”. It proves the provider is lawfully carrying on that activity and is open to inspection, and says nothing about any medicine.

Driving is where a lawful patient is most likely to get into trouble

Section 5A of the Road Traffic Act 1988 makes it an offence to drive, attempt to drive, or be in charge of a motor vehicle with a specified controlled drug in your body above a specified limit. No impairment need be proved. The Drug Driving (Specified Limits) (England and Wales) Regulations 2014 (SI 2014/2868) set the limit for delta-9-tetrahydrocannabinol at 2 microgrammes per litre of blood; SSI 2019/83 sets the same for Scotland. Section 5A does not extend to Northern Ireland.

There is a statutory medical defence, and its terms matter more than its existence. Section 5A(3) provides that it is a defence to show that “(a) the specified controlled drug had been prescribed or supplied to D for medical or dental purposes, (b) D took the drug in accordance with any directions given by the person by whom the drug was prescribed or supplied, and with any accompanying instructions (so far as consistent with any such directions) given by the manufacturer or distributor of the drug, and (c) D's possession of the drug immediately before taking it was not unlawful under section 5(1) of the Misuse of Drugs Act 1971 … because of an exemption in regulations made under section 7 of that Act”. Section 5A(4) removes that defence if your actions were “contrary to any advice … about the amount of time that should elapse between taking the drug and driving a motor vehicle”. Section 5A(5) puts the burden back: once evidence raises the issue, the court “must assume that the defence is satisfied unless the prosecution proves beyond reasonable doubt that it is not”.

Three things follow. The defence is raised at court, not at the roadside: a positive screen still means arrest and a blood sample. Carry the dispensing label bearing your name, the pharmacy and the prescriber, and keep any written advice about waiting time after dosing — that advice is what can destroy the defence. And section 5A is not the only offence. Section 4 makes it an offence to drive when “unfit to drive through drink or drugs”, a person being unfit “if his ability to drive properly is for the time being impaired”. It has no threshold and no medical defence.

A UK prescription is a UK document and stops working at the border

Home Office guidance sets the threshold plainly: you may travel with up to a three-month supply of a Schedule 2 to Schedule 4 Part I drug in the form of a medicinal product without a personal licence, and you need one above that. Below the threshold, carry a letter from your prescribing clinician giving your name, the medicines with doses and frequency, your travel dates, and the prescriber's signature and registration details. That letter is also what is asked for on the way back in.

That licence is an export and re-import document. It creates no right to bring the medicine into another country, and the guidance says so: other countries have their own import laws, and you could be fined or imprisoned for travelling with medicine that is illegal there. Several countries that permit medical cannabis domestically do not recognise foreign prescriptions. Check the destination's embassy or health ministry before booking.

It runs in reverse too. A prescription written in Germany, Canada or a US state confers nothing here, because the exemption a patient relies on for lawful possession comes from the Misuse of Drugs Regulations 2001 and attaches to a prescription given under those Regulations. Moving to the UK on a cannabis prescription means a UK specialist assessment, not a transfer.

Why UK cannabis pages read so strangely, and what that tells you about a site

Regulation 279(1) of the Human Medicines Regulations 2012 provides that “a person may not publish an advertisement in Great Britain for a medicinal product unless one of the following is in force for the product” — a UK marketing authorisation, a temporary regulation 174 authorisation, a certificate of registration, or a traditional herbal registration. There is no audience qualifier. It is not a rule about advertising to the public; it is a rule about advertising unlicensed medicines to anyone. Every cannabis flower and oil dispensed here is an unlicensed special, so regulation 279 prohibits advertising all of them.

Regulation 284(1) adds that “a person may not publish an advertisement that is likely to lead to the use of a prescription only medicine”, and regulation 282 confines regulations 283 to 292 to “advertisements wholly or mainly directed at members of the public”. A clinic therefore faces two overlapping restrictions: none of an unlicensed product to anyone, and none of a prescription-only medicine to the public. That is why UK clinic sites talk about conditions, eligibility and consultations, and go quiet the moment you look for the medicines themselves.

The doorway that makes information sites possible is regulation 7(3)(b): references to an “advertisement” do not include “reference material and announcements of a factual and informative nature”, including trade catalogues and price lists, “provided that no product claim is made”. Factual description with no claim attached is not advertising. The doorway is narrow, and closes the moment a page suggests a product will help with something. If a page names a product and tells you what it does for a condition, it is not relying on regulation 7(3)(b), and you should ask who paid for it.

The 2018 settlement is currently under formal review

On 2 June 2025 the Minister of State for Policing, Fire and Crime Prevention wrote to the Advisory Council on the Misuse of Drugs commissioning a review: whether the 2018 legislation has had the desired impact, what unanticipated consequences followed, and how private prescribing may have affected incentives to run NHS trials. A call for evidence ran in autumn 2025. Any change would come by statutory instrument.

Two regulators have looked at the same sector from the delivery side. The CQC has published concerns about clinical governance and about communication between clinics, pharmacies and GPs in independent services, and the General Pharmaceutical Council reviewed registered pharmacies supplying these products in October 2025. Neither changes what a patient may lawfully be prescribed. Nothing in the framework above has changed as at the date on this page. Regulation 16A stands as inserted in 2018. NG144 stands as updated in 2021. Three products hold marketing authorisations. If a page tells you the law has recently opened up, check when it was written and which instrument it names, then read that instrument on legislation.gov.uk yourself.