Cannabis in the UK: Medicine, Culture, or Both?

Lily Temperton
Oct 10
9 min read

The paradoxes at the heart of UK cannabis

Since November 2018, doctors on the General Medical Council’s specialist register have been able to prescribe cannabis-based medicinal products (CBMPs). The change followed high-profile cases of children with severe epilepsy whose parents campaigned for access to treatment - a compassion-driven policy shift that continues to shape today’s divide between medical and recreational reform.

Nearly seven years on, the role of cannabis in UK healthcare remains unsettled. Yet cannabis is entering a mainstream phase: advertised on billboards, discussed on morning talk shows, circulating on social media, and even featured in national TV campaigns. While many remain unfamiliar with how the system works, or whether they themselves are eligible, awareness of medical cannabis is undoubtedly rising and so are patient numbers.

In 2023 private clinics in England dispensed around 150,000 items of unlicensed CBMPs through March 2023. By March 2024, that figure had leapt to almost 350,000 (CQC Annual Update, 2024). Since legalisation, more than 75,000 patients have received prescriptions across roughly 40 clinics and 160 prescribers (MCCS, 2025).

More than 100,000 have registered their interest and completed an eligibility check with one clinic alone, Releaf (Releaf, 2025). NHS access, by contrast, is negligible - so low that in some years fewer than five patients are captured in official data. What explains such a low patient base? And what barriers prevent broader NHS adoption?

This rapid expansion has brought growing scrutiny. Tensions are mounting over how medical cannabis should be managed and integrated, both within conventional medicines frameworks and in wider society.

In this piece, we explore four of the most visible flashpoints:

Pharmaceutical vs botanical models
Celebrity involvement vs medical credibility
Strain names vs prescribing by compound
Medical vs recreational boundaries

Tension 1: Pharmaceutical vs botanical models

Almost 80% of medical cannabis prescriptions in the UK are reportedly for dried flower (Cannabis Startups, 2025) - a reminder that, despite calls for standardisation, most patients still rely on botanical products rather than pharmaceutical-style formulations.

Some policymakers and clinicians believe medical cannabis will only achieve long-term legitimacy if it speaks the same language as other medicines: licensed products, defined dosing, and rigorous clinical trials. To them, following the pharmaceutical playbook is the route that reassures policymakers, protects prescribers, and builds trust with patients. Their conviction comes from a belief that only by meeting these standards can cannabis truly endure as a credible part of modern medicine. Consider adding something about the argument on dosing challenges and nomenclature of cultivars.

Critics, however, point out that standardising cannabis is inherently difficult. Unlike conventional medicines, cannabis products vary widely in their chemical profiles, with cultivars, or “strains,” often named and classified inconsistently. This variability makes defining precise doses and ensuring reproducible effects a continuing challenge for regulators and clinicians alike.

In practice, cannabis behaves differently than a single molecule. Many patients depend on the whole-plant ‘entourage effect’, the synergistic interaction between cannabinoids, terpenes, and flavonoids that may enhance therapeutic outcomes through the body’s endocannabinoid system, which helps regulate mood, sleep, appetite, and pain. While still considered theoretical, the concept is widely accepted as a framework for understanding cannabis’ complex pharmacology. Terpenes likely play a key role in this synergy but remain largely excluded from formal prescribing protocols, which still focus mainly on cannabinoids such as THC and CBD.

Patients have also faced criticism for high flower consumption, which some regulators frame as recreational rather than therapeutic. The Care Quality Commission (CQC) has reported instances of patients receiving quantities above recommended limits or requesting very high-THC flower, and the watchdog has described the sector as being at a “tipping point” where stronger oversight is becoming essential.

Origins of the tension

In the UK, only doctors on the General Medical Council’s specialist register can prescribe cannabis-based medicines, and only a handful of products are available through the NHS. The NHS pathway follows the same pharmaceutical standards as any other medicine: products must be licensed, supported by rigorous clinical trials, and prescribed within clearly defined protocols.

At present, this includes:

Sativex (nabiximols): a THC:CBD mouth spray licensed for spasticity in multiple sclerosis
Epidyolex: a cannabidiol oral solution for severe childhood epilepsies such as Dravet and Lennox–Gastaut syndromes
Nabilone: a synthetic cannabinoid used to treat chemotherapy-induced nausea
Synthetic THC (dronabinol): available privately but remains unlicensed for NHS use

Beyond these products (prescribed to a small set of patients for very specific conditions) NHS access remains extremely limited. This is a common point of confusion amongst patients and the general public, as this narrow list of conditions has often been mistaken for the full eligibility framework.

In reality, the vast majority of UK prescriptions come through a different route: the “Specials” pathway, which allows clinicians to prescribe unlicensed cannabis-based medicinal products (CBMPs) for any condition when no licensed alternative meets the patient’s needs.

These unlicensed CBMPs (primarily dried flower and simple oil extracts) are imported and dispensed by private clinics. Regulators emphasise that they are not formally evaluated for quality, safety, or efficacy in the way licensed medicines are. Some clinicians argue that cannabis flower cannot easily be “tamed” into the conventional pharmaceutical model: its chemical complexity, natural variability, and reliance on whole-plant interactions challenge standard drug frameworks. While thousands of cannabis-related patents exist globally, most cover extraction methods, formulations, or specific cultivars, not the flower itself.

By 2025, the private sector has expanded the UK’s medical cannabis patient base from a few thousand to more than 75,000 (MCCS, 2025). This growth has been driven largely by online clinics, direct-to-patient advertising, and digital education campaigns that normalise cannabis as a legitimate treatment option.

Yet very few patients receive licensed pharmaceutical products compared to flower-based CBMPs; a pattern that speaks both to clinical preference and patient experience. Many patients who have tried both Sativex and whole-plant products report preferring the latter, citing greater symptom relief, improved tolerability, or simply a more familiar format for dosing and inhalation. Cannabis is clearly a special case - one that may not fit neatly within the pharmaceutical playbook. This debate between legitimacy and practicality sits at the heart of the UK’s evolving cannabis model.

Tension 2: Involvement & investment from cultural figures and celebrities

Amid - and often driving - the growth of UK medical cannabis, celebrity involvement and cannabis culture have become increasingly visible forces shaping the market.

Recent years have seen a rise in celebrity-linked medical cannabis ventures, including Cookies (founded by US rapper Berner), Tyson 2.0 by Mike Tyson, Big Narstie Medical, and Nines’ Crop Circle. More recently, Rizzle Kicks’ Jordan Stephens announced a partnership with Alternaleaf, while comedian Dom Joly fronted a national TV campaign for MAMEDICA®. In parallel, cultural brands from the recreational space (such as Doja, DOE Medical, and Sherbinskis) have also entered the medical market, often through collaborations with licensed producers or wholesalers to offer prescription-grade products.

These affiliations have generated polarising reactions. Supporters argue that celebrity partnerships bring much-needed visibility, investment, and mainstream appeal to a sector still battling stigma. Critics counter that such associations risk trivialising the medical market, framing it as a “back door” for recreational use, and undermining efforts to establish cannabis as a credible therapy. Their concern is that celebrity-led campaigns can blur boundaries between advocacy and promotion, potentially glamourising cannabis rather than focusing on patient care.

When entertainers invest, they bring capital and cultural influence - yet often face accusations of glamorising cannabis or chasing publicity. In 2021, Casa Verde Capital (co-founded by Snoop Dogg) invested $15 million in Portuguese firm AceCann, seen as a vote of confidence in Europe’s medical cannabis industry. But when Casa Verde made a £4.5 million investment in UK clinic MAMEDICA®, which now serves over 7,500 patients, the response was more divided. Some within the sector questioned whether such high-profile backing helps legitimise the field, or reinforces recreational stereotypes that regulators and clinicians are still working to dispel.

A prominent example is Big Narstie, a household name in UK grime and television and one of the country’s most visible advocates for cannabis reform. His launch of Big Narstie Medical (in partnership with Grow Group and IPS Pharma) drew criticism from parts of the medical cannabis industry and some commentators who argued that his recreational image risked undermining professional credibility. Yet the initiative was able to reach new audiences, educating potential patients on how to access legal treatment and normalising conversations that traditional campaigns have struggled to ignite.

By contrast, when senior executives from alcohol, pharmaceutical, or tobacco backgrounds enter the cannabis space, they often face little scrutiny, despite those industries’ far greater public health burdens. The difference reveals a lingering bias: celebrity investors rooted in cannabis culture are seen as risky, while corporate figures from “respectable” sectors are welcomed.

This raises the question: does the stigma surrounding the types of celebrities associated with cannabis play a role? Figures such as Snoop Dogg, Willie Nelson, Tommy Chong, Big Narstie, and Jim Belushi are among the most recognisable celebrity investors or advocates, but each has been strongly tied to recreational cannabis use throughout their public careers. This has helped humanise cannabis for some audiences but limited its appeal for others.

One might wonder whether an endorsement from a public figure outside the stereotypical "stoner" image could have a greater impact. For instance, Martha Stewart helped normalise cannabis within her demographic by highlighting its therapeutic benefits, offering a perspective far removed from recreational stereotypes. Endorsements from individuals who are not primarily associated with cannabis culture may ultimately be better positioned to broaden acceptance and resonate with wider audiences.

Tension 3: Strain names vs prescribing by compound

Few issues capture the cultural–clinical divide more sharply than Strain Nomenclature. Patients and communities continue to use traditional cultivar names, while regulators push for code-based systems and plain packaging.

For patients, names like Amnesia Haze or OG Kush act as a shared language, signalling expected effects and linking to decades of breeder heritage. Many view them as part of cannabis literacy. Stripping these names risks erasing history and alienating those who feel rooted in the culture of the plant.

Many take the opposite view, arguing colourful or playful names are incompatible with medical credibility. Producer names like Cake & Caviar, Lot420, and Four20 Pharma have also attracted criticism for carrying recreational echoes. The MCCS Good Practice Guide cautions prescribers not to rely on strain names, noting that cannabinoid and terpene profiles vary depending on genetics, cultivation methods, and harvest timing. It recommends avoiding names such as Girl Scout Cookies or Gorilla Glue, which provide no clinically useful information.

The MHRA has reinforced this stance, citing examples like Atomic Sour Grapefruit or Pink Monkey as inappropriate for human medicines and signalling stricter enforcement ahead.

Caught between these positions, producers are now adopting hybrid approaches, using neutral code-based systems on packaging while still giving patients a way to recognise familiar cultivars. This compromise reflects the reality that cultural knowledge and clinical caution will need to coexist if medical cannabis is to remain credible while staying accessible.

Tension 4: How medical sits alongside recreational use

The blurred line between medical and recreational use adds further complexity.

Most patients turn to cannabis only after conventional treatments have failed. NHS guidance acknowledges CBMPs are unlicensed and should only be considered after at least two alternatives. Yet many arrive with prior knowledge: preferences for certain cultivars, ratios, or products shaped by years of personal experimentation in illicit markets.

Many patients prescribed cannabis today had already used it non-medically before legalisation. Internationally, this is common. In the US, millions hold medical cards while also consuming recreationally. Canada, Germany, and Switzerland now operate parallel medical and adult-use markets.

Attempting to enforce neat boundaries often obscures more than it clarifies. A single patient may use cannabis to treat neuropathic pain at night and also to relax socially in the same evening. It is equally difficult to “spot” a medical cannabis patient from appearance or usage - the demographics are expanding across ages, conditions, and social groups.

For the UK, the opportunity lies in building a dual model: robust clinical frameworks for safety and efficacy, paired with respectful recognition of cultural knowledge and lived experience. Germany’s evolving “medical first, recreational later” approach offers one possible blueprint.

Recognising the dual nature of cannabis

Cannabis cannot be reduced to a single identity. It is medicine, and it is culture. Attempts to confine it to one category risk alienating patients, erasing history, and narrowing the industry’s potential.

The way forward is dual: clinical rigour to ensure safety and efficacy, alongside cultural acknowledgement to honour lived experience and broaden access.

Other European markets show possible paths forward. Germany’s Cannabis Act (CanG) created a dedicated framework for both medical and non-medical cannabis, moving it out of narcotics law. Switzerland is piloting adult-use sales while running a separate federal programme for medical cannabis, also shifting away from its previous narcotics classification.

France has taken smaller steps, with a tightly controlled medical pilot and ongoing debates about whether cannabis needs bespoke legislation beyond the unlicensed medicines pathway. Together, these examples highlight that cannabis is increasingly treated as a category of its own.

For the UK, the opportunity lies in developing a similar parallel framework that recognises cannabis for what it is: neither just another pharmaceutical nor just another consumer good, but something in between.

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