What Changed in November 2018 for Medical Cannabis in the UK?

November 2018 marked a significant turning point in the landscape of medical cannabis in the United Kingdom. Amendments to the Misuse of Drugs Regulations 2001 came into effect, officially rescheduling cannabis-based medicinal products and opening the door—at least legally—for doctors to prescribe them to patients where clinically appropriate.

However, the reality since then has been nuanced and complex. While the law shifted, access remains tightly constrained, and a meaningful gap has persisted between legality and real-world availability. In this article, we unpack what changed in November 2018, focusing on:

The legal reclassification under the Misuse of Drugs Regulations
How this relates to Schedule 1 rescheduling
Who can prescribe cannabis-based medicinal products and why
The role of video consultations and remote prescribing following these changes
The regulatory oversight by the Care Quality Commission (CQC) in England
Common pitfalls such as clinics omitting consultation and prescription pricing

Legal Changes: Schedule 1 Rescheduling and the Misuse of Drugs Regulations

Before November 2018, all cannabis-based products were classified as Schedule 1 drugs under the Misuse of Drugs Regulations 2001. Schedule 1 drugs have "no recognised medicinal use," making their prescription effectively illegal except under very limited Home Office licences for research.

The official amendment in November 2018 removed cannabis-based medicinal products from Schedule 1 and placed them primarily into Schedule 2 or Schedule 3, depending on the specific product. This rescheduling meant:

Cannabis-based medicinal products could now be prescribed by doctors, subject to standard controlled drug prescribing rules.
Patients with certain qualifying conditions could potentially access these medicines through NHS prescriptions or private clinics.
Pharmacies could dispense these medicines under appropriate licensing.

However, importantly, the rescheduling applied only to products derived from cannabis authorised as medicinal products; recreational cannabis remained firmly illegal.

Key Points on Schedule 1 Rescheduling

Before November 2018 After November 2018 Cannabis products classified as Schedule 1 (no medicinal use) Some cannabis products reclassified as Schedule 2 or 3 (recognised medicinal use) Prescribing cannabis-based medicines was not legally permitted Doctors can prescribe cannabis-based medicinal products when clinically appropriate No regulation of private cannabis prescribing healthcare services Private services must declare remote prescribing arrangements to the CQC (in England)

The NHS Funding Gap and Private Market Reality

Despite the rescheduling, real-world access remains tightly restricted, especially through the NHS. National guidelines are cautious. The National Institute for Health and Care Excellence ( NICE) currently recommends medical cannabis only for specific rare epilepsy syndromes as confirmed by specialist consultant teams. As a result, NHS prescriptions are rare.

Most UK patients seeking cannabis-based medicinal products are thus turning to private clinics where:

Access tends to be quicker but at substantial cost
Costs include consultation fees and prescription charges, often not transparently advertised
Products are often imported, which adds to expense and limits product range

Important: Many private clinics fail to clearly list consultation or prescription todaynews.co costs upfront—this is a common point of consumer confusion and criticism.

Who Can Prescribe Medical Cannabis: The GMC Specialist Register Requirement

Post-November 2018, only doctors registered on the General Medical Council (GMC) Specialist Register can prescribe cannabis-based medicinal products in the UK. This means:

General practitioners (GPs) without specialist registration are not authorised to prescribe medical cannabis.
Consultants or specialist doctors with the relevant expertise and registration must lead the prescribing process.
This helped maintain standards and ensure treatment is reserved for appropriate clinical conditions.

This rule underscores the importance of genuine clinical expertise, preventing the cropping up of unqualified practitioners offering cannabis prescriptions without adequate oversight.

Video Consultations and Remote Prescribing: Navigating Regulation

One important practical development since November 2018 has been the rise of video consultations combined with remote prescribing. Particularly for medicines like cannabis products, many patients may find in-person visits challenging.

In England, if a private clinic plans to conduct video consultations and issue remote prescriptions (sending prescriptions without face-to-face meetings), they are legally required to:

Declare these arrangements to the Care Quality Commission (CQC);
Adhere to standards for safeguarding patient safety, confidentiality, and quality of care;
Ensure patient identity verification and maintain clear clinical records.

The CQC’s oversight is crucial for patient protection, especially because medical cannabis products are controlled substances necessitating strict prescribing safeguards.

Checklist: What Patients Should Verify Before Using Private Video Consultations for Medical Cannabis

Does the clinic openly declare its remote prescribing policy on its website or patient materials?
Is the clinic registered and inspected by the CQC if operating in England?
Can the clinic confirm that the prescribing doctor is GMC-registered and on the Specialist Register?
Are consultation and prescription fees clearly stated to avoid unexpected costs?
Is there clear information on follow-up appointments or ongoing monitoring?

Regulation and Oversight: Separating Legality from Availability

It is essential to distinguish between:

Legality: Medical cannabis is now legally prescribable by qualified doctors in the UK post-November 2018 changes.
Availability: Actual availability on the NHS remains largely limited to exceptional cases, forcing many patients to the private market.

The Care Quality Commission (CQC) in England regulates private providers, particularly those offering remote services that must comply with safety and prescribing standards. In Wales, Scotland, and Northern Ireland, other regulators oversee healthcare providers, so patients should check local rules.

Regulation does not guarantee ease of access or affordable treatment, but it does mean that private providers must meet minimum patient safety and quality standards.

Common Mistake: Missing Consultation and Prescription Prices

A pervasive problem with many private medical cannabis providers is the lack of transparency around costs:

Many websites highlight "prescriptions available" without stating consultation fees or ongoing prescription costs
Patients frequently report surprise at follow-on fees or the high price of imported cannabis products
There is often little clarity on whether medications will need repeating prescriptions or ongoing clinician review, adding costs

As a consumer, always seek explicit price information before booking any consultation or committing to prescriptions. The absence of this information should raise red flags.

Summary: The November 2018 Changes in Context

The November 2018 reclassification of cannabis-based medicinal products marked a fundamental legal shift in the UK, moving cannabis away from Schedule 1 to a prescribable controlled substance under Schedule 2 or 3. This change legitimised medical cannabis prescriptions but also introduced strict prescribing criteria, requiring specialist doctors on the GMC register.

The medical cannabis sector has since seen:

NHS prescribing limited by tight clinical guidelines and funding constraints.
A growing private market leveraging video consultations and remote prescribing—declared under CQC in England—to provide access.
Ongoing challenges with transparency around pricing and the practical affordability of treatment.
The essential differentiation between what is legal and what is realistically accessible for UK patients.

For patients considering medical cannabis post-2018, being informed about regulation, who can prescribe, and what reasonable expectations around costs and access exist is crucial. Always consult with GMC-registered specialists and use CQC-registered services where possible to ensure safe and legitimate care.