Ten doctors have prescribed more than half of all cannabis drugs since they were legalised for medical use, The Times has found.
The ten consultants, operating from private clinics, have issued more than 800,000 cannabis medications since 2019, about two thirds of which have been dried cannabis flowers.
The sheer scale of the prescribing by such a small number of specialists has raised concerns over whether patients are receiving the most suitable products and appropriate clinical oversight.
Most patients using private cannabis clinics are being treated for psychiatric conditions, such as depression and anxiety, yet many cannabis medicines contain higher levels of tetrahydrocannabinol (THC), the psychotropic compound, than typical street “skunk”.
The Royal College of Psychiatrists says there is insufficient evidence to support treating mental health conditions with cannabis and warns that it may exacerbate disorders such as depression and psychosis. General Medical Council rules say that medical cannabis must be prescribed only after a thorough assessment, risk evaluation and continuous monitoring. Industry guidelines add that clinics should carry out comprehensive psychiatric assessments and ensure multidisciplinary oversight.
These standards appear difficult to reconcile with the figures obtained by The Times. They show, for example, that a single consultant is responsible for more than one in every ten cannabis medicines that have been prescribed in the UK. In the first five months of last year, this unidentified doctor prescribed nearly 46,000 cannabis medications, which amounts to a prescription every two working minutes.
The strongest medical cannabis available in the UK is a strain of plant named “Space Cake”, which is produced by the Canadian company, Northern Green. It has a THC content of 34 per cent. By comparison, street skunk seized by the police typically contains between 14 per cent and 16 per cent THC.
Cannabis was legalised for medical use in 2018 after an outcry over the seizure of medication from Billy Caldwell, a severely epileptic child. Billy’s mother, Charlotte, has revealed that her son, now 20, has not had a seizure in three years thanks to his cannabis medication.
Billy Caldwell and his mother, Charlotte, in 2018charles mcquillan/Getty Images
However, eight years after the law was changed to help patients like Billy, medical cannabis is now mostly issued to patients complaining of mental health problems. Almost all prescriptions come from about 40 profit-driven private clinics, which charge patients for consultations, prescriptions and the supply of the drugs.
Initial consultations usually cost about £100, and the typical patient then spends between £80 and £300 a month on cannabis medicines.
The data, obtained from the NHS Business Services Authority using freedom of information laws, shows the breakneck growth in prescriptions. In 2020, there were fewer than 400 cannabis medications dispensed every month. By the first five months of last year, this had increased to 85,000 items a month.
Consultant psychiatrists willing to prescribe cannabis medications against the guidance of their royal college can be handsomely rewarded.
Montu, an Australian company that operates Alternleaf, one of Britain’s biggest medical cannabis clinics, is advertising for a consultant psychiatrist to work remotely at a salary of between £250,000 and £275,000, although an industry representative said pay on this scale was an “outlier”.
Mamedica, another large medical cannabis clinic, reports that the majority of its 12,500 patients present with psychiatric conditions. The company says cannabis treatment can be “game‑changing” for these patients, with improvements in mood, hope and functioning, and that many have been able to reduce or discontinue existing psychiatric medications.
Yet a study published in The Lancet this year found no evidence that medicinal cannabis was an effective treatment for common mental health conditions and could do more harm than good.
The exact number of Britons using private cannabis clinics is unknown but estimates suggest it could be as high as 100,000, implying that tens of thousands of patients with mental health conditions are being prescribed cannabis. The risks are stark: an inquest this year found that prescriptions issued by the Curaleaf clinic contributed to the death of a patient.
Oliver Robinson, 34, had a history of depression, including prior psychiatric admissions, as well as addictive tendencies yet was prescribed cannabis plants with a THC content of 27 per cent.
Oliver Robinson
The coroner issued a prevention of future deaths report to Curaleaf, highlighting concerns that its prescribing decisions were made on incomplete clinical information, with no direct communication with other psychiatrists treating the patient.
During the inquest it also emerged that Curaleaf’s prescribing doctor, Dr Urmila Bhoskar, was a child psychiatrist who lacked experience in managing complex adult cases of treatment-resistant depression. She has since been referred to the General Medical Council. Curaleaf said the Robinson case was “truly tragic” and that it would “carefully consider” the coroner’s recommendations.
Regulatory oversight of cannabis clinics has, to date, been limited. The Care Quality Commission has identified general concerns including clinics prescribing for conditions with limited evidence, poor communication with other clinicians, and insufficient time for proper oversight. Yet inspections of major providers have not found evidence of harm sufficient to trigger enforcement action, and there is no indication that data on prescribing volumes has been used in risk assessments.
By contrast, regulators in Australia have adopted a more proactive approach, investigating high-volume prescribers and taking action against dozens of them.
Sir Robin Murray, a professor of psychiatric research at King’s College, London, said: “Usually if a person has a medical condition, they see a doctor who specialises in a particular area of medicine, for example, respiratory or kidney disease. After diagnosis the doctor prescribes from a range of treatments.
Sir Robin MurrayVicki Couchman for the times
“One doesn’t go to a clinic called after the name of a drug. There are no penicillin clinics or steroid clinics. But here we have clinics set up to prescribe what the patients say they want, ie cannabis, irrespective of whether there is any evidence that cannabis can help the complaint.”
Professor Trevor Jones, the former head of research and development at the Wellcome Foundation, added: “We have watched this market double, then double again, then double again.
“What began as an exceptional prescribing mechanism for patients with unmet clinical expectations has become a parallel pharmaceutical market operating without marketing authorisation or a clinical evidence base. The data is no longer ambiguous. The question now is what regulators intend to do about it.”
The Medical Cannabis Clinicians Society, which represents private cannabis clinics, said: “We would caution against drawing conclusions about the quality or safety of care from prescribing volume alone.
“Aggregate figures do not capture the clinical context, models of care, or governance processes in place. An initial specialist assessment may be followed by ongoing prescribing and monitoring supported by wider clinical teams and structured follow-up processes.”
The trade group also defended prescribing high strength THC products to psychiatric patients.
“These are prescribed within a structured, specialist-led framework, with careful titration and monitoring,” it said.
It added that trial data reported in The Lancet was “only one part of the evidence base”. It said: “There is a growing body of observational and real-world evidence suggesting benefit in some [psychiatric] patients, particularly where conventional treatments have been ineffective or poorly tolerated.”
The trade group said that the Robinson inquest had informed a “substantial revision” of its guidelines and that the new version, which will be published shortly, would “strengthen expectations around assessment, prescribing, monitoring, and clinical governance”. It added that it would welcome these guidelines being adopted by regulators.
The Department of Health said: “We expect regulators to crack down on private clinics and clinicians that prescribe without the prior research required.”