Cannabis Health Symposium 2025: Key Takeaways Part 1

Opening Remarks: Education, Access and Recognition 

Sarah Sinclair, editor of Cannabis Health, opened the symposium by reflecting on her vision to bring the medical cannabis community together to this landmark in-person event.

She paid tribute to Hannah Deacon, an instrumental figure in the legalisation of medical cannabis in the UK, co-founder of the Medical Cannabis Clinicians Society (MCCS), and a tireless advocate for education and access to cannabis medicine.

“Hannah would have loved to see you all here today. She was passionate about educating doctors and medical professionals, and it’s amazing to see all of you here today. “

Jan Armstrong from the event’s headline sponsors Curaleaf Laboratories, set the tone for the day with a rallying call to action, emphasising that the symposium was about igniting a movement to ensure anyone who could benefit from medical cannabis has access to it.

“Medical cannabis is not a trend; it is a therapeutic revolution, and revolutions require leaders. Let us be those leaders.”

Building Prescriber Confidence: Best Practice, Training, and Governance

Consultant Neurologist and medical cannabis stalwart Professor Mike Barnes, Chair of the MCCS) delivered the symposium’s first major session, outlining the MCCS Good Practice Guide and addressing variations in clinical standards across the sector.

Current landscape and key statistics

• Approximately 80,000 patients are currently being treated with CBPMs by around 160 prescribers
• Only six or seven NHS prescriptions are being issued, 99% of prescribing takes place in the private sector
• While most clinics operate to high standards, some cut corners in ways that compromise patient safety

Regulatory challenges

• Cannabis prescriptions must be issued by a doctor on the GMC Specialist Register, a requirement Barnes believes is misplaced
• The first prescription must be approved by a panel, though this is often not enforced in practice
• Some clinics conduct consultations as short as 10 minutes, which Barnes considers insufficient for patient safety
• Communication with GPs is ‘basic, sensible medical communication’, but doesn’t always happen, especially problematic for psychiatric cases

Common misconceptions

• Patients do not need to have tried two ‘licensed’ treatments first, only ‘established treatments,’ which may include non-pharmacological interventions
• There are no absolute contraindications to cannabis use, though active psychotic episodes remain a major red flag
• Fewer than 5% of patients are turned away
• Cannabis does not cure anything, it is a symptom and quality-of-life treatment

Product selection and prescribing

• Anything available through licensed pharmacies has been approved and is safe, despite isolated contamination incidents
• Recreational strain names and sativa/indica classifications are meaningless in medical contexts and should be scrapped
• Clinicians should focus on chemovars and Certificates of Analysis
• FSA’s recommended 10mg daily intake is ‘complete and utter nonsense’ with no human evidence base

Dosing and formats

• Medical cannabis requires a “start low and go slow” approach
• UK relies too heavily on flower (80% of prescriptions vs 50-60% in other markets)
• Barnes recommends peer approval for prescriptions exceeding 2g per day or 25% THC content
• Clinic management must not interfere with clinical decisions, and economic drivers should never dictate product choice

Systems and training

• Paper-based prescribing and postal dispensing are outdated and unsafe, electronic prescribing is needed
• MCCS is now offering specialist training alongside basic training
• Goal is to make medical cannabis more commonly accepted across healthcare

The Value of Real-World Evidence in Cannabis Medicine

Dr Anne Schlag from Drug Science presented a compelling case for the importance of real-world evidence (RWE) in advancing the understanding and acceptance of cannabis-based medicines.

The limitations of RCTs

• RCTs remain the gold standard, but are poorly suited to cannabis medicine due to product variety and patient complexity
• RCTs would not allow for the personalised treatment CBPMs require
• Rigid structures exclude the very patients who stand to benefit most

The UK’s largest registry

• Drug Science operates the UK’s largest non-profit medical cannabis registry with over 4,500 patients followed for up to five years
• Includes a broad range of indications, detailed demographics, comorbidities, concomitant medications, and standardised outcome measures
• Very few patients have no secondary diagnoses; most present with multi-morbidity, often up to 10 conditions

PTSD and comorbid depression

• Patients with higher baseline depression often experienced greater symptom reduction with medical cannabis
• Significant reduction in PTSD symptoms at three months, with those with comorbid depression showing even greater improvement
• These patients would be excluded from traditional trials, leading to unrepresentative results

Paediatric epilepsy

• Case series of 10 paediatric patients with treatment-resistant epilepsy showed substantial seizure reduction on CBPMs
• Despite this evidence, many families still struggle to obtain funded prescriptions
• Qualitative interviews with parents highlighted broader quality-of-life impacts beyond seizure reduction

Advantages of RWE

• Larger and more diverse patient cohorts
• Inclusion of rarer conditions
• Higher ecological validity
• Ability to track outcomes over much longer periods
• Significantly lower costs compared to RCTs

Regulatory implications

• Growing recognition of RWE by agencies such as the European Medicines Agency
• Regulators must give greater weight to high-quality real-world data when making licensing and reimbursement decisions

Panel Discussion: NHS Integration – Bridging the Gap Between NHS and Private Providers

Despite over 60,000 patients now receiving CBPM prescriptions, NHS access remains extremely limited. This panel explored how private clinics and NHS providers can collaborate more effectively.

The two-tier system

• The hundreds of thousands of private prescriptions vs a handful on the NHS creates an entrenched two-tier system with gaps in continuity of care, information sharing, and governance

Where responsibility lies

• Dr David Tang: Private prescribers must do more proactive outreach—Grand Rounds, college events, GP teaching, medical school education
• Nitin Makadia: How can clinicians prescribe when CBPMs aren’t supported by insurance, NICE guidance, or institutional frameworks?
• Sal Aziz: Stigma remains a significant barrier, with patients reluctant to disclose CBPM use for fear of being labelled substance misusers
• Dr Rob Forbes: NHS uptake requires both confident clinicians and formal pathways, NICE guidance offers no advocacy for CBPMs

NHS prescribing barriers

• For unlicensed medicines like CBPMs, every single licensed medicine must have been tried first, not just two
• NHS is short of time and money, introducing something new remains a low priority
• NICE guidance and Trust policies create a ‘do not touch’ signal for NHS clinicians

Individual Funding Requests

• Forbes recounted successful IFR cases, including chronic pain and a terminal patient who returned to work
• However, single-patient successes haven’t translated into broader policy change
• IFR processes are administratively heavy and difficult to scale

Communication failures

• Private clinics often struggle to access NHS patient records, relying on patients to provide medical histories
• CBPMs are often recorded as ‘cannabis misuse disorder’ on NHS records, causing patients to lose access to mental health services
• GPs are reluctant to share data with private providers
• NHS systems remain chaotic and vary between hospitals and trusts

Solutions needed

• Standardised service specifications and documentation aligned with NHS expectations
• Consistent templates for clinic letters and prescribing information
• Digital systems built to be interoperable with NHS infrastructure
• Integrate ECS and CBPM content into medical curricula
• Focus on clinically relevant outcomes and health economic metrics
• Private clinics must “get their house in order” on data standards
• More coherent national guidance on NHS-private integration