Wonder drug: is the UK ready for the green rush of medicinal cannabis?

You might not quite have noticed, but Britain is in the midst of a cannabis revolution. This one plant, its proponents say, has the potential to reshape modern medicine. It’s happening, quickly and quietly; with scientists and doctors ushering in a new era of hi-tech flower power. As of today, over 60 countries have legalised some form of medicinal cannabis: since November 2018 that’s also been the case in Britain. Some 30,000 of us have already been prescribed cannabis for conditions ranging from arthritis to epilepsy, anxiety to multiple sclerosis. Experts predict the list will soon grow longer and specialist surgeries are springing up nationwide to cater for ever-growing demand.

At the Curaleaf Clinic on London’s Harley Street, I meet Chris Cowan, 47. He was 13 when he first smoked cannabis: one joint with friends, illicit and casual, in early 90s rural Warwickshire. It would be nine years before a doctor would diagnose him with clinical depression and many more until his PTSD would be identified. Medicinal cannabis was decades from legalisation and yet, as far back as then, he knew intuitively its effect on him was more than the hit of a recreational high. “While friends would be giggling or rolling around intoxicated,” he says, “I found a calm I’d never felt before – that’s the only way I can describe it. The older I got, the more I noticed. Cannabis was medicinal, alleviating the traumas in both my body and mind.” Only 30 years later would the British medical and legal system catch up.

In the meantime, Cowan illegally self-medicated, like 1.8 million others across the UK. “There were the practical issues,” he says. “The efficacy of what I could buy from street dealers was hit and miss. The product was totally inconsistent and unregulated.” The illegal market is a wild west, rife with contamination; authorised cannabis medicines, however, are tightly regulated. Worse for Cowan was the stigma. “Into my 30s and 40s, none of my contemporaries still used it. I felt ashamed of my reliance on what I was told was a harmful, illegal substance. My wife hated me breaking the law, it was a constant source of tension.” Twice, he tried antidepressants – neither time able to cope with the side-effects of sertraline.

In the UK, there has been no relaxing of rules for recreational cannabis, the change is purely medical. Cowan receives his prescription much like any other: appointments with specialist doctors, regular checkups, medical-grade heavily regulated products with strict guidelines for consumption. Medicinal cannabis comes in many forms: oils, creams, cartridges and capsules. Some people, like Cowan, are prescribed the dried flower, which he vaporises. The prescription process is stringent. Those referred need to have an existing diagnosis and to have already tried other conventional medical interventions. “Before this,” Cowan says, “as an adult, I’d have to sit in a yard waiting for some kid to turn up on a bike, then drive home paranoid that the police would pull me over, just for accessing medication. When I found this clinic, I went from being criminalised to a normal member of society.”

There are more than 200 CCTV cameras across Celadon’s 100,000sqft, state-of-the-art, cannabis-growing facility: sky-high fencing, airlock doors and number-plate recognition. To visit, an NDA must be signed to ensure no details emerge of its top-secret location. Its vast grey buildings have no exterior signage or branding, ensuring anonymity. The only slight giveaway, the company’s co-founder Paul Allen accepts, is the stench of cannabis wafting out across an otherwise unassuming grey industrial estate. A hi-tech filtration system is due to be installed imminently.

Celadon was set up in 2018 by Allen and two business partners after they read about medical cannabis legalisation. Theirs was one of the first firms in the UK to be granted a cannabis-growing licence. So far, £20m has been invested on top of the £30m value of their site. They’re betting on big returns – market experts estimate the global medical cannabis industry generated US$6.82bn in 2020, a number expected to reach $53.88bn by 2030. At full capacity, this facility will provide medicine for 50,000 patients – that’s roughly 9 tonnes of cannabis produced a year. “We took down our first commercial harvest late last year,” Allen says. “Everything we are currently growing is contracted to a private clinic. Longer term, we’re looking to develop and produce new medicines.”

‘Longer term, we’re looking to develop new medicines’: a scientist at Celadon’s medicinal cannabis factory. Photograph: Dan Burn-Forti/The Observer

Beyond the secure doors is the growing space, cavernous rooms connected by a maze of concrete corridors. Plants and cuttings are moved from room to room through their lifecycle, each stage monitored to maximise quality and efficiency: nutrients, oxygen levels, humidity, light exposure. Celadon hopes to produce up to six harvests a year through nine-week cycles of flower growth. Donning full-body scrubs, I’m shown the current crop – mammoth cannabis plants growing under fluorescent lights in futuristic surroundings. “All our plants are QR coded through their lifetime,” Allen says. “Everything is logged. There’s a full audit trail.” This helps ensure the occasional bud can’t go missing. “But it’s also for research purposes. As insights into medical cannabis develops, this data will help us identify which individual plants and compounds are most suited to treating different health conditions. The possibilities seem endless.”

Still in its early infancy, access to medicine derived from cannabis remains highly restricted on the NHS. It is limited to people with specific rare and severe forms of epilepsy; adults with vomiting or nausea caused by chemotherapy, and those with certain multiple sclerosis symptoms. Private practices, however, have a far wider scope for prescriptions, including for chronic pain, certain psychiatric disorders and various neurological conditions.

Quite what long-term role cannabis might play in medicine is a topic at the forefront of drug development. That’s not to say it’s a novel idea. “In fact,” says Professor David Nutt, a world-renowned neuropsychopharmacologist and former government adviser on drugs policy, “cannabis is probably the planet’s oldest medicine. The evidence comes from China: the world’s first-known pharmaceutical encyclopedia describes cannabis use for more than 100 conditions, including gout and rheumatic pain.” In his book Cannabis: Seeing Through the Smoke, Nutt retraces this rich remedial history through ancient India, into Persian and Arabic medicine, across Africa and South America via Britain. In the 1800s, cannabis became a staple of British medicine, after Irish doctor Brooke O’Shaughnessy, an army surgeon, witnessed its use while serving in colonial India. “It remained in medicinal use here until 1971,” says Nutt, “coming to an end, we think, due to American pressure.” After alcohol prohibition in the US ended in 1933,” he says, “American law enforcement needed a new bogeyman. They invented the cannabis scare.”

Nutt confronts concerns about negative health impacts of using cannabis. In his book, the question of whether there’s a link with schizophrenia gets a dedicated chapter. (“The short answer is no,” he writes.) Certainly, evidence is inconclusive. And while strong strains in high doses can cause temporary psychosis – some tripping out – that’s also true of alcohol, and plenty of other drugs used regularly in medicine. “Of 4,000 UK cannabis patients we are monitoring,” Nutt says, “we’ve had zero psychosis or paranoia cases.” Only when smoked has it proved carcinogenic. Regardless, these fronts are more relevant to debates about unrestricted recreational use, not targeted medical treatment. Of course, as with any drug or medication, there are risks associated with consumption: those with heart conditions, for example, are advised to take caution. You’d need to take 1,000 times the recommended amount to fatally overdose on cannabis; that figure is only two to four times with opiates and alcohol. Under US pressure, Nutt says, most of the world restricted its use as medicine. The UK followed suit in 1971, with the Misuse of Drugs Act. Scientific research into cannabis declined rapidly. The collateral damage, Nutt argues, remains far-reaching: “To this day, our knowledge and understanding of how to treat patients with the plant remains stunted.”

‘That children with various forms of epilepsy respond brilliantly to whole-plant cannabis extracts is crystal clear’: Professor David ~Nutt. Photograph: Alicia Canter/The Guardian

Still, we know the basics. The cannabis plant contains two main ingredients: THC and CBD. In recreational use, the former gets you stoned; the latter acting as a relaxant. Together, they balance. The levels of both are carefully controlled in medication. Many medicines contain no THC – that ‘high’-producing compound, and those drugs which do use some THC have it in limited doses. Curaleaf monitors all adverse-effects from patient prescriptions: euphoria, as it’s referred to medically, doesn’t feature in the top 10 most common side effects.

Cannabis plants also contain more than 700 other molecules. At least 120 are similar to THC and CBD, others are called terpenes and flavonoids, many with their own effects on the human body. We know a plant’s strain, growing conditions and processing method results in different molecular makeups. This shapes what happens during human consumption. It’s all down, science suggests, to the unique interaction of cannabis with our endocannabinoid receptors – a little-understood cornerstone of human anatomy, which regulates and controls many of our brain and body’s most critical functions.

Cannabis medicines put these ingredients to work in a variety of applications. Think of cannabis not as a single, catch-all drug, but as the basis of a whole extended family of medicines. Some isolate specific molecules, others – known as “whole-plant” drugs – are made up of ingredients found across the plant’s entire chemical spectrum. That’s the case in Alfie Dingley’s medication.

Hannah Deacon’s son, Alfie, was just eight months old when he had his first seizure. It was May 2012 and Deacon still getting to grips with being a first-time mum. “I was woken around midnight by the sound of his screams,” she says. “He was having a seizure: eyes in the back of head, not breathing, his limbs…” she shakes her arms violently. “I’d never seen anything like it. I was petrified.” Hospital medics suggested Alfie was experiencing febrile convulsions, which is common in babies. “But within the hour, the seizures were back to back. He was dying, basically,” Deacon says, exhaling. “I had a panic attack. It was horrendous. With me for the rest of my life.”

Over coffee, Deacon recounts the traumatic years that followed. The first mention of epilepsy while Alfie was at Great Ormond Street Hospital; regular readmissions; countless cycles of seizures only eased by a cocktail of drugs, including morphine and intravenous steroids.

‘These were incredible results’: Hannah Deacon with her son Alfie, whose epileptic seizures were treated with medicinal cannabis. Photograph: Fabio De Paola/The Observer

At four, the seizures were coming every three weeks. By five, it was weekly. “We worked out what drugs helped,” Deacon says, “but the long-term side-effects sounded horrendous: psychosis, kidney and heart failure. One doctor told me the drugs would eventually kill my son.” Alfie was diagnosed with PCDH19 – a rare, non-inherited genetic condition. In 2016, he was in hospital 48 times. With little more than blind hope, Deacon set about looking for alternatives. While searching online for natural epilepsy treatments, cannabis popped up. “I found Facebook support groups and started talking to other parents who’d used cannabis for similar conditions in their children. Anecdotally, there were incredible results.”

The first paediatric neurologist Deacon raised cannabis with threatened to call social services. Undeterred, she took matters into her own hands. In September 2017, the family headed to Holland where medical cannabis was already legal. Alfie was prescribed Bedrolite – a whole-plant cannabis oil – to be taken alongside his other meds. For six weeks, there was little improvement. “Then,” says Deacon, “he came out of hospital and was seizure-free for 17 days, the first time in 18 months he’d gone for more than three or four days without one. He started to engage with his younger sister, read books and watch telly. It was as if he was suddenly with us again.” When Alfie did have a seizure, the dose of steroids required to treat him was far lower. Soon, he was seizure free for weeks at a time.

Alfie’s treatment was proving effective, but no UK doctor would replicate it.“We had to get back to England to campaign,” Deacon says, “but bringing Alfie’s drugs with us would have been illegal.” Three days after returning, Alfie was back in hospital. She was determined to change the law – there were meetings in Parliament; breakfast TV appearances; open letters; a petition signed by hundreds of thousands. These long-term efforts were amplified when another mother, Charlotte Caldwell, travelled to Canada to source her son Billy’s medication. They were seized at the UK border. Billy’s health deteriorated. He was admitted to hospital with life-threatening seizures, forcing the government to act.

These two cases directly led to the 2018 law change. And for Alfie, now 12, the result has been life-changing. He has not had a seizure for over three years. The vast majority of cannabis medicines are only available privately. To date, only three have been licensed by the NHS. Just one of those is used to treat epileptic children and only when they have distinct types of epilepsy. When the law changed, three children, Alfie included, received special NHS funding. Then funding guidelines shifted. Today, neither Alfie nor his type of meds would qualify. In 2021, Deacon and other parents of children with epilepsy set up the Medcan Family Foundation. “It’s the stories of children like Alfie who helped change the law,” Deacon says, “and now these kids are the ones unable to benefit. Those who can afford to have gone private, paying up to £2,000 a month. Others have turned to the illegal market. Now the only two doctors who were prescribing privately have shut their books. Adults can access cannabis. A private industry is booming. In Britain there are 37,000 children with treatment-resistant epilepsy. These kids, who need the medication most, have been abandoned.”

Professor Nutt agrees. “That children with various forms of severe, untreatable epilepsy respond brilliantly to whole-plant cannabis extracts is crystal clear,” he says, “but a perfect storm of complex legislation, funding failures and doctors unable or unwilling to prescribe to children. Wholesale reform is needed. In the meantime, medical cannabis is being denied to these children. It’s a huge scandal and as a result, they’re dying.”

In a statement, a spokesperson for the Department of Health and Social Care told the Observer: “Licensed cannabis-based medicines are routinely funded by the NHS where there is clear evidence of their quality, safety and effectiveness. We are taking an evidence-based approach to unlicensed cannabis-based treatments to ensure they are proved safe and effective before they can be considered for roll out on the NHS more widely.”

‘My oil costs me £130 a month’: Georgie Budd, photographed at her practice in Mountain Ash, Wales. Photograph: Francesca Jones/The Observer

If for patients the march of medical cannabis means major change, for healthcare professionals it could spell full-on upheaval. Back at Curaleaf, between 30 and 40 doctors are employed part-time, working alongside a team of pharmacists. For many, medical cannabis was until recently an unknown entity. That was true for Dr Wendy Holden, a consultant rheumatologist and pain management specialist, who has worked part-time at Curaleaf since 2021. “I qualified in the early 1990s,” says Holden, “and knew nothing about cannabis medicine through most of my years practising.” A specialist in chronic pain and inflammatory arthritis, she was sceptical when first approached by a now Curaleaf colleague. “It’s a whole new language, prescribing cannabis,” she says, “and I’ve been amazed at the difference in the types of patients I’ve been seeing for years. Sometimes literally the very same people. We can only prescribe to people who’ve not had luck with first line therapies, so already these are challenging cases. The results are miraculous.” Of Curaleaf’s 15,000 patients, almost half are chronic pain sufferers. Research shows that when treated with cannabis, one in four will report a 30% or greater improvement in pain severity.

Another cannabis selling point is the resulting reduction in patients taking other medication. That was the case for Georgie Budd, a trainee GP in the Welsh valleys. Following a car accident in 2018, she was paralysed from the waist down. She was prescribed opioids for pain management. “When I was taking them,” she says, “I couldn’t think clearly. My mum used them after hip surgery and as a doctor I’d seen firsthand how easily people got addicted.” In the decade to 2019, the UK was the largest prescriber of opioids globally per capita. Since starting to take medical cannabis, Budd is opioid-free. One study of 1,000 UK cannabis-taking pain patients found over half had stopped taking opioids entirely. Another, in America, saw their use decrease by 64%.

“Many people who would benefit from medical cannabis are disabled,” Budd says, “which means they’re more likely to have limited financial security. Yet we’re forced to go private. My oil costs me £130 a month, which I’m able to afford by cutting back in other areas, but I’m struggling.”

When Holden tells old colleagues about her current world of work, she still gets mixed responses. “Some refuse to listen, she says, “calling it a gateway drug. More and more, however, are reading the research showing impressive results, and are far more open-minded. Making judgments based on evidence not prejudice and preconceptions. It’s just so obviously working.” At least, for those who can access it. “What we do,” Holden is clear, “is incomparable with the illegal market. We monitor to ensure no harm, get people off painkillers and opioids, and improve quality of life with medical-quality, tightly controlled and scientifically backed-up medication. Plus drug dealers? Well, they work in imperial measurements; we do metric.”

The Guardian