{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T20:42:41Z","timestamp":1785530561256,"version":"3.56.0"},"reference-count":24,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2020,8,18]],"date-time":"2020-08-18T00:00:00Z","timestamp":1597708800000},"content-version":"unspecified","delay-in-days":17,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2020,7,8]]},"published-print":{"date-parts":[[2020,8]]},"abstract":"<jats:p>Although cannabis-based products for medicinal use are now legal in the UK, it is still challenging for patients to gain access, and only very few National Health Service prescriptions have been written to date. This paper attempts to make sense of why the UK lags behind so many other countries which also have legalised medical cannabis. From consulting with parents and patients, prescribers, pharmacists and decision-makers it seems that there are a series of distinct barriers to prescribing that need to be overcome in order to improve patient access to medical cannabis in the UK. These include concerns about the perceived lack of scientific evidence. To alleviate these concerns, we highlight the importance of patient-centred approaches including patient-reported outcomes, pharmacoepidemiology and n=1 trials, which can contribute to the development of the evidence base for medical cannabis. We hope that this paper will help policymakers and prescribers understand the challenges to prescribing and so help them develop approaches to overcome the current situation which is detrimental to patients.<\/jats:p>","DOI":"10.1136\/bmjopen-2020-038687","type":"journal-article","created":{"date-parts":[[2020,9,22]],"date-time":"2020-09-22T00:00:15Z","timestamp":1600732815000},"page":"e038687","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":50,"title":["So near yet so far: why won\u2019t the UK prescribe medical cannabis?"],"prefix":"10.1136","volume":"10","author":[{"given":"David","family":"Nutt","sequence":"first","affiliation":[{"name":"Faculty of Medicine, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steve","family":"Bazire","sequence":"additional","affiliation":[{"name":"NHS, Redditch, Worcestershire, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence D","family":"Phillips","sequence":"additional","affiliation":[{"name":"Department of Management, London School of Economics and Political Sciences, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2074-1917","authenticated-orcid":false,"given":"Anne Katrin","family":"Schlag","sequence":"additional","affiliation":[{"name":"Drug Science, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,9,21]]},"reference":[{"key":"2026062608022246000_10.9.e038687.1","unstructured":"Sumnall H . Medicinal cannabis: legalised yet impossible to access. The independent. Available: https:\/\/www.independent.co.uk\/life-style\/health-and-families\/health-news\/medicinal-cannabis-legalised-access-marijuana-nhs-a8903051.html [Accessed 13 May 2019]."},{"key":"2026062608022246000_10.9.e038687.2","unstructured":"Wickware C . Nhs England cannabis access review to speak with families paying \u00a340k for private prescriptions. The pharmaceutical. Available: https:\/\/www.pharmaceutical-journal.com\/news-and-analysis\/news\/nhs-england-cannabis-access-review-to-speak-with-families-paying-40k-for-private-prescriptions\/20206525.article [Accessed 13 May 2019]."},{"key":"2026062608022246000_10.9.e038687.3","unstructured":"Couch D . Left behind: the scale of illegal cannabis use for medicinal intent in the UK, 2020. Available: https:\/\/www.thecmcuk.org\/left-behind-the-scale-of-illegal-cannabis-use-for-medicinal-intent-inthe-uk [Accessed 11 Jun 2020]."},{"key":"2026062608022246000_10.9.e038687.4","unstructured":"National Academies of Sciences, Engineering, and Medicine (NASEM) . The health effects of cannabis and cannabinoids: the current state of evidence and recommendations for research. Washington, DC: The National Academies Press, 2017."},{"key":"2026062608022246000_10.9.e038687.5","unstructured":"Health Canada . Canada vigilance adverse reaction online database. Available: https:\/\/www.canada.ca\/en\/health-canada\/services\/drugs-health-products\/medeffect-canada\/adverse-reaction-database.html [Accessed 11 Jun 2020]."},{"key":"2026062608022246000_10.9.e038687.6","unstructured":"Minnesota Department of Health : Medical Cannabis Programme Data. Available: https:\/\/www.health.state.mn.us\/people\/cannabis\/data\/index.html [Accessed 11 Jun 2020]."},{"key":"2026062608022246000_10.9.e038687.7","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2016-011666"},{"key":"2026062608022246000_10.9.e038687.8","unstructured":"The Royal College of physicians: Sir Michael Rawlins attacks traditional ways of assessing evidence, opinion former article 16 October, 2008. Available: https:\/\/www.politics.co.uk\/opinion-formers\/royal-college-of-physicians\/article\/royal-college-of-physicians-sir-michael-rawlins-attacks-trad"},{"key":"2026062608022246000_10.9.e038687.9","doi-asserted-by":"crossref","first-page":"1577","DOI":"10.2147\/JPR.S192174","article-title":"Effectiveness and tolerability of THC:CBD oromucosal spray as add-on measure in patients with severe chronic pain: analysis of 12-week open-label real-world data provided by the German Pain e-Registry","volume":"12","author":"Ueberall","year":"2019","journal-title":"J Pain Res"},{"key":"2026062608022246000_10.9.e038687.10","doi-asserted-by":"publisher","DOI":"10.1097\/WNF.0000000000000246"},{"key":"2026062608022246000_10.9.e038687.11","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-018-37570-y","article-title":"Real life experience of medical cannabis treatment in autism: analysis of safety and efficacy","volume":"9","author":"Bar-Lev Schleider","year":"2019","journal-title":"Sci Rep"},{"key":"2026062608022246000_10.9.e038687.12","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1038\/s41746-019-0203-0","article-title":"Digital clinical trials: creating a vision for the future","volume":"2","author":"Steinhubl","year":"2019","journal-title":"NPJ Digit Med"},{"key":"2026062608022246000_10.9.e038687.13","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1016\/S2215-0366(19)30298-6","article-title":"Pharmacoepidemiology research: delivering evidence about drug safety and effectiveness in mental health","volume":"7","author":"Davis","year":"2020","journal-title":"Lancet Psychiatry"},{"key":"2026062608022246000_10.9.e038687.14","doi-asserted-by":"publisher","DOI":"10.2217\/pme.11.7"},{"key":"2026062608022246000_10.9.e038687.15","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m122"},{"key":"2026062608022246000_10.9.e038687.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.04.020"},{"key":"2026062608022246000_10.9.e038687.17","unstructured":"Spiegelhalter D . The art of statistics: leaning from data. United Kingdom: Penguin Random House, 2019."},{"key":"2026062608022246000_10.9.e038687.18","unstructured":"Uk trials not needed for medical cannabis licensing process, says Hancock. The pharmaceutical Journal. Available: https:\/\/www.pharmaceutical-journal.com\/\/news-and-analysis\/news-in-brief\/uk-trials-not-needed-for-medical-cannabis-licensing-process-says-hancock\/20206808.fullarticle?firstPass=false [Accessed 15 Jul 2019]."},{"key":"2026062608022246000_10.9.e038687.19","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejim.2018.01.004"},{"key":"2026062608022246000_10.9.e038687.20","unstructured":"House of Lords report. cannabis: the scientific and medical evidence, 1998. Available: https:\/\/publications.parliament.uk\/pa\/ld199798\/ldselect\/ldsctech\/151\/15102.htm [Accessed 11 Jun 2020]."},{"key":"2026062608022246000_10.9.e038687.21","unstructured":"Davis DS . Cannabis scheduling review part 1- the therapeutic and medicinal benefits of cannabis based products \u2013 a review of recent evidence, 2018. Available: https:\/\/assets.publishing.service.gov.uk\/government\/uploads\/system\/uploads\/attachment_data\/file\/722010\/CMO_Report_Cannabis_Products_Web_Accessible.pdf [Accessed 11 Jun 2020]."},{"key":"2026062608022246000_10.9.e038687.22","doi-asserted-by":"crossref","DOI":"10.1016\/j.jhealeco.2019.102273","article-title":"The impact of cannabis access laws on opioid prescribing","volume":"69","author":"McMichael","year":"2020","journal-title":"J Health Econ"},{"key":"2026062608022246000_10.9.e038687.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2016.03.002"},{"key":"2026062608022246000_10.9.e038687.24","doi-asserted-by":"publisher","DOI":"10.9740\/mhc.2018.05.110"}],"updated-by":[{"DOI":"10.1136\/bmjopen-2020-038687corr1","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2022,3,10]],"date-time":"2022-03-10T00:00:00Z","timestamp":1646870400000}}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2020-038687","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:11:35Z","timestamp":1782486695000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2020-038687"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,8]]},"references-count":24,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2020,9,21]]},"published-print":{"date-parts":[[2020,8]]}},"alternative-id":["10.1136\/bmjopen-2020-038687"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2020-038687","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,8]]}}}