September 2026 update
Introduction
Following changes to the misuse of drugs legislation in 2018, cannabis-based products can be prescribed by some doctors for medicinal use where there is special clinical need. SPICe published a blog following the change in legislation in November 2018, outlining the changes and providing context around medicinal cannabis.
Since 2018, multiple news stories have described situations where patients have still been unable to access specific medicinal-cannabis products.
A related public petition (PE1884: Make whole plant cannabis oil available on the NHS or alternative funding put in place) was previously under consideration by the Citizen Participation and Public Petitions Committee. The petition closed in 2023 awaiting upcoming clinical trials of cannabis-based products for medicinal use.
This blog explains how medicinal cannabis/cannabis-based medical products (CBMPs) can be prescribed in Scotland and some of the issues around prescribing.
Contents
Is the matter of medicinal cannabis reserved or devolved?
The regulation of medicines and medicinal products, under the Misuse of Drugs Act 1971, is reserved to the UK Parliament and is the responsibility of the Medicines and Healthcare products Regulatory Agency (MHRA). Funding for cannabis-based products through NHS prescriptions is a devolved matter.
What cannabis-based medical products are licensed in the UK?
Three CBMPs are licensed by the MHRA in the UK. These are Epidyolex, Sativex, and Nabilone.
Epidyolex, Sativex, and Nabilone have been licensed for the following conditions:
- Epidyolex is licensed for the treatment of seizures associated with two forms of epilepsy, Lennox-Gastaut syndrome and Dravet syndrome. It is also licenced for treatment of seizures associated with Tuberous Sclerosis Complex (TSC).
- Sativex is licensed to treat spasticity in adults with Multiple Sclerosis who have been unresponsive to standard anti-spasticity medication.
- Nabilone is licensed for treatment-resistant nausea and vomiting caused by chemotherapy.
Can you get Epidyolex, Sativex, and Nabilone on the NHS in Scotland?
The Scottish Medicines Consortium (SMC) reviews medicines licensed for use in the UK by the MHRA. Before a new medicine can be prescribed routinely by the NHS in Scotland, it has to be accepted for use by the SMC.
The SMC has accepted Epidyolex and Sativex for use in Scotland. Nabilone does not fall within the SMC’s remit, as it was licensed and available on the UK market before the SMC was established.
In 2020, the SMC accepted Epidyolex as an add-on therapy with clobazam, a benzodiazepine, for seizures associated with Lennox Gastaut syndrome and Dravet syndrome, both rare forms of epilepsy, in patients aged over 2 years. In 2022, the SMC also accepted Epidyolex for use together with one or more anti-epileptic medicines to treat the rare genetic disease TSC. The SMC have published summaries of their decision for Lennox-Gastaut syndrome, Dravet syndrome and TSC.
Sativex (nabiximols) was accepted for use within NHS Scotland in 2022 for the treatment of moderate to severe spasticity in adults with multiple sclerosis (MS) whose symptoms have not responded adequately to other anti-spasticity medications and who demonstrate clinically significant improvement during an initial trial of therapy. The SMC has also published a summary of this decision.
What clinical guidelines and evidence are available?
In November 2019, NICE published guidance on prescribing CBMPs in England. NICE guidance is often considered and used elsewhere in the UK.
The guidance focused on the current evidence to support CBMPs in treating intractable nausea and vomiting, chronic pain, spasticity, and severe-treatment resistant epilepsy.
NICE made multiple recommendations based on the evidence available, including:
- To consider the use of nabilone as an add-on (additional) treatment for adults (18+) with nausea and vomiting caused by chemotherapy, which has been resistant to conventional antiemetics.
- To not offer nabilone, dronabinol, THC, or a combination of CBD with THC to treat chronic pain in adults.
- To offer a 4-week trial of THC:CBD spray as a treatment for moderate-to-severe spasticity in adults with Multiple Sclerosis under specified conditions.
A clarification of guidance was released in March 2021. While NICE found “insufficient evidence of safety and effectiveness to support a population-wide practice recommendation” of cannabis-based medical products for severe treatment-resistant epilepsy, NICE clarified that healthcare professionals should not feel prevented from considering the use of unlicensed products if appropriate for individual patients.
To support the Citizen Participation and Public Petitions Committee’s consideration of PE1884, SPICe published a literature review of international evidence around the use of CBMPs for epilepsy.
What are unlicensed products?
All cannabis-related products for medicinal use that do not have market authorisation in the UK (i.e. those other than Sativex, Nabilone, and Epidyolex) are unlicensed medicines, also referred to as ‘specials’. Regulation 167 of the Human Medicines Regulations 2012 allows the supply of unlicensed medicines in cases when licenced medicine cannot meet the clinical needs of a patient.
The MHRA has published guidance in relation to the supply, manufacture, importation and distribution of unlicensed CBMPs in the UK.
Who can prescribe medicinal cannabis?
Cannabis-based medicines can be prescribed on the NHS or by private health providers. The General Medical Council (GMC), which regulates doctors in the UK, has published guidance for doctors in relation to prescription of CBMPs.
Unlicenced CBMPs can only be prescribed by, or under the direction of, a doctor on the GMC’s Special Register. This applies both to the NHS and private healthcare providers.
Within the NHS, patients must initially be referred by their GP to a specialist medical practitioner. After the initial referral, GPs may continue the prescribing of medicinal cannabis in some circumstances under a shared-care arrangement. You can read more about shared care in our blog Attention Deficit Hyperactivity Disorder (ADHD) in Scotland – Prevalence, treatment, and private care.
There are a number of independent clinics prescribing medicinal cannabis in the UK. Independent clinics often prescribe unlicensed CBMPs for people with conditions that are not routinely covered by the NHS, including chronic pain. CBMPs are also prescribed for treatment of mental health conditions such as anxiety and PTSD. The effectiveness of these treatments is debated. Patients can often self-refer to a private clinic.
All private healthcare services must be registered with Healthcare Improvement Scotland. Further information on private healthcare is available in our blog Private healthcare in Scotland.
How is cannabis for medicinal use manufactured in the UK?
Companies wishing to manufacture CBMPs require authorisation by both MHRA and the Home Office and there are complex procedures and safeguards in place.
The MHRA has produced a blog which outlines the process for approving Manufacturing Authorisations or API Registrations in relation to unlicensed CBMPs in the UK.
A UK Government drug licensing factsheet notes:
“Cannabis is a Class B controlled drug under Part II, Schedule 2, of the Misuse of Drugs Act 1971 (MDA 1971). It is also listed in Schedule 1 to the Misuse of Drugs Regulations 2001 (MDR 2001) and designated under the Misuse of Drugs (Designation) (England, Wales and Scotland) Order 2015 (2015 Order). As such, it is unlawful to possess, supply, produce, import or export this drug except under a Home Office licence. It is also an offence to cultivate any plant of the genus Cannabis except under a Home Office licence.”
Why aren’t more people getting prescribed medicinal cannabis?
The report Barriers to accessing cannabis-based products for medicinal use on NHS prescription: Findings and Recommendations, published by NHS England and NHS Improvement, suggested that weak clinical evidence has prevented the prescription of CBMPs by clinicians. Similar barriers have been reported in Scotland, as highlighted by the Chief Pharmaceutical Officer for Scotland’s written submission for PE1884 in August 2021.
The Chief Pharmaceutical Officer for Scotland stated that many specialist doctors have concerns around the ‘safety and efficacy’ of cannabis-based medical products and the ‘lack of robust evidence on their use’. Unlicensed products have not been through the same tests for safety, efficacy, and quality as licensed medicines. Their prescription therefore puts greater responsibility on the prescribing doctor, who is ‘professionally and clinically responsible’ for any medicines that they prescribe.
The National Institute for Health Research (NIHR) and NHS England are currently developing a programme of two randomised control trials into the use of CBMPs to treat medicine-resistant (refractory) epilepsy. The study will compare medicines that contain CBD only with those that contain CBD plus THC and placebos. It has two primary aims: to find out if CBMPs are effective in reducing seizures, and whether they have an effect on learning, sleep, behaviour, quality of life, stress and anxiety. The two trials are expected to run until 2029. Further information on the progress of the trials is not yet available.
What is the Scottish Government’s response?
In response to a parliamentary question on the prescription and affordability of medicinal cannabinoids, the Scottish Government stated that it is “encouraging companies to participate in clinical trials so that these products can be tested for quality, safety and efficacy.” The written submission for petition PE1884 also emphasised the Scottish Government’s support of clinical trials.
Where I can I find out more?
The House of Commons Library has published a briefing on the medical use of cannabis.
The Advisory Council on the Misuse of Drugs (ACMD) is currently reviewing the impact of the 2018 changes to the Misuse of Drugs Regulations 2001. To support this review, ACMD launched a call for evidence on the use of CBMPs, this closed in October 2025. The evidence has not yet been published.
The UK Parliament’s Private Member’s Medicinal Cannabis (Access) Bill sought to improve access to cannabis-based medicines for medical use. The Bill fell at the end of the 2021-22 parliamentary session when Parliament was prorogued.
Lena Phalen, Enquiry Officer (2026 update)
Cristina Marini, SPICe Trainee (2022)