“We’ve lost doctors because of it” – Concerns over “abusive” behaviour in medical cannabis sector

Medical cannabis clinics are reporting a rise in ‘threatening’ abuse being directed at staff from a ‘small number’ of patients.

Healthcare professionals working in the medical cannabis field have revealed the extent of abusive behaviour they are experiencing at the hands of a small minority of patients.

Staff have reported experiencing a “pressure to prescribe” with some patients becoming more “aggressive” – and even threatening to report doctors to the General Medical Council (GMC) – when they have refused to provide a specific treatment. 

In the most extreme cases clinicians are said to have left the sector due to the stress that was being placed on them.

A source from one UK clinic, which is said to have been reported to the Care Quality Commission (CQC) “several times”, although none of these were upheld, told Cannabis Health: “Overall I have seen hundreds of patients, and the majority would say the experience has been positive, and even life-changing for them, but there is a cohort that can be very abusive and rude towards staff.

“Some patients have been using cannabis for a long time and are very knowledgeable, they know exactly what they want, and we get a lot of the blame when products aren’t available or there are issues with the supply chain.”

They continued: “We have lost doctors and other members of staff because of it, it’s very demoralising.

“All of our doctors are specialists in their field, they have spent many years as consultants in the NHS, but some are being told repeatedly by patients that they don’t know what they are doing.”

Feeling pressured to prescribe

Another prescriber, who asked to remain anonymous, said they have experienced more abusive behaviour from such patients when prescribing medicinal cannabis than they previously saw working in the NHS.

“What I’ve experienced and heard from colleagues is a real pressure to prescribe, in a way that the patient wants to dictate and not listen to medical advice from the doctor. When declined they have become quite abusive and threatening,” they said.

“We’re never doing it to deny people medication, but we have to prescribe within the framework.”

The doctor added: “I understand it’s frustrating and it’s fine for people to feel anxious, but on a couple of occasions I have had patients be verbally aggressive and vile towards me.

“We are just human beings at the end of the day, and it’s never nice to be treated in that way.”

Staff also referred to a “vocal online community” where “upsetting” comments are made about clinicians, with individuals often being named in threads. 

In one recent incident a member of staff had their personal details shared on social media and received an onslaught of phone calls from patients out of hours.

Rising frustrations

Medical cannabis patients have become increasingly frustrated with industry standards in recent months, with supply issues leaving some experiencing delays to their prescriptions and in some instances going for periods without access to medication.

Earlier this month, two batches of cannabis flower products were recalled after they were suspected to be contaminated with a potential mould, which has heightened tensions further. The Medicines and Health Regulatory Authority (MHRA) and manufacturer BOL Pharma are currently undergoing investigations. 

But there are fears that the actions of a minority of patients could have a detrimental effect on continued access to this new treatment option.

As one source puts it: “If prescribers who have the knowledge and experience in cannabis leave the sector, what do we have left?

“We want to spend our time treating patients, not writing responses to complaints, it takes us away from what we want to be doing, which is helping patients. If this continues, it’s hard to see how cannabis medicines will ever be accepted by the NHS.”

Another industry expert agreed that there are areas which need improvement, but urged patients to have “reasonable expectations”.

Since medical cannabis was legalised in November  2018, the industry has grown from a handful of patients to several thousand over the last 18 months, with access now more widely available since the introduction of schemes such as Project Twenty21. 

But restrictive regulations around the importation of cannabis medicines and the growing and manufacturing of them here in the UK, have resulted in a system struggling to keep up with demand.

“Nobody is hiding from the fact that patients need access to quality medicines on time, but there needs to be reasonable expectations,” they told Cannabis Health.

“The industry has grown from zero to thousands of patients in a very short space of time, there are going to be unexpected issues on occasions. 

“It’s not acceptable in healthcare and we’re doing everything we can to improve it, but we are limited by the regulations we have to follow and the infancy of the supply chains.”

They added: “Like most other people in this industry I’m here because I wanted to make a difference to people’s lives. 

“It is a minority of people, but unfortunately it’s often the minority who shout the loudest and we’re at a crucial point for the industry if we want to move forward.”

Patient-led advocacy group, PLEA (Patient-Led Engagement for Access) told Cannabis Health it was aware of “several ongoing issues” affecting patients in the prescription medical cannabis space which “need to be addressed” – but that abusive behaviour was “never acceptable”.

“Frustrations are quite understandable – patients are paying a huge amount of money for treatment; access to good quality products is needed, on time and with a good standard of care,” said Abby Hughes, chair and outreach director of PLEA.

“Sadly, PLEA is also aware of some aggressive behaviour from a small minority of those caught in these situations. Things do not always go to plan, yet, however frustrating, abusive behaviour towards others is never acceptable.”

She continued: “It is important for patients to recognise that industry stakeholders must work within their means, including where things may have gone wrong and need rectifying. PLEA is working with clinics and pharmacies to ensure patients are aware of reporting processes, and with patients to offer support through these processes where requested.”

Calls for industry ‘code of conduct’

Early discussions are said to be taking place among members of the newly-formed Cannabis Industry Council around the introduction of a code of conduct to improve things for both patients and prescribers. 

Meanwhile PLEA says clear systems should be in place for patients to provide feedback on their clinical experience.

“Patients should be actively encouraged to share their experiences, particularly with reporting any issues that need rectifying, so that care can continue to be improved,” said Hughes.

“Systems should be in place for patients to provide feedback, however it is understood that processes are not always clearly defined, often leading to further frustrations.”

PLEA is currently exploring the development of a “more robust support system” to allow patients to share their experiences anonymously and where necessary request assistance from a patient liaison. 

“The newly formed Cannabis Industry Council is a welcome development also, with a Standards Subgroup operating to hold the industry to account,” added Hughes.

“It is hoped that a ‘code of conduct’ will be developed for both industry stakeholders and patients to work together cohesively to improve this rapidly developing space.”

Zero tolerance

Those on the frontline say they understand the frustrations and acknowledge patients’ right to complain, but abusive behaviour towards staff is “never acceptable” and “will not be tolerated”.

“Cannabis is a very new field, things are changing all the time and we want patients to work with us to help us provide a good standard of service and care,” said the clinic.

“We always welcome valuable feedback where it is within our power to improve things.

“But abuse towards healthcare professionals would not be accepted in the NHS, why should the cannabis sector be any different?”

Any patient who requires assistance can contact PLEA on hello@pleacommunity.org.uk for support.