Are Sativex and Epidyolex the Only Approved Cannabis Medicines in the UK?

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The UK’s relationship with cannabis-based medicines is often clouded by confusion, myths, and misplaced expectations. Since the landmark change in November 2018, many UK residents have asked: are Sativex and Epidyolex truly the only cannabis-based medicines authorised for medical use? And if so, why do misconceptions about “legal cannabis” persist? This article dives into the nuances of UK drug law, clarifies the difference between Class and Schedule classifications, and explains why NHS access remains tightly controlled.

The Two Cannabis-Based Medicines Authorised in the UK

At present, there are indeed only two cannabis-based medicines authorised for prescription in the UK:

Sativex – a mouth spray containing cannabinoids THC (tetrahydrocannabinol) and CBD (cannabidiol), licensed to treat spasticity in multiple sclerosis patients. Developed and marketed by GW Pharmaceuticals, it is prescribed by specialists in neurology or related fields.
Epidyolex – a cannabidiol oral solution approved for treating seizures associated with two rare, severe forms of epilepsy (Lennox-Gastaut and Dravet syndromes). Also produced by GW Pharmaceuticals, Epidyolex’s approval marked a significant milestone for cannabis-derived medicines.

These authorised products have undergone rigorous clinical trials and regulatory reviews by the Medicines and Healthcare products Regulatory Agency (MHRA) and the European Medicines Agency (EMA) before UK licensing.

What Changed in November 2018? The Legal Context

November 2018 was a turning point. Previously, all cannabis-based products, regardless of their purpose or chemical composition, were controlled solely under the Misuse of Drugs Act 1971. This legislation classifies substances by “Class” — for instance, Class A for heroin, Class B for cannabis, and so on — without distinguishing medical from recreational uses.

The confusion often arises between two distinct UK legal frameworks:

Misuse of Drugs Act 1971 (MDA) – regulates the illegal possession and supply of controlled drugs, categorised by Class (A, B, C).
Misuse of Drugs Regulations 2001 (MDR) – schedules controlled substances, dictating legal medicinal use, handling, and prescribing.

Before November 2018, no cannabis-based product was legally prescribable on the NHS. The government's amendment to the MDR added cannabis-based products for medicinal use in humans (CBPMs) to Schedule 2, permitting doctors to legally prescribe them, but under very strict conditions.

Class vs Schedule: Why It Matters

Term What It Means Relevance to Cannabis Medicines Class (A, B, C) Classifies substances by harm and criminal penalties under the Misuse of Drugs Act 1971. Cannabis is Class B, meaning possession and supply without licence or prescription is illegal. Schedule (1–5) Under the Misuse of Drugs Regulations 2001, determines legal controls on medicinal use, prescribing, storage. Sponsored cannabis medicines placed in Schedule 2 (strict medicinal controls), enabling prescription.

In short: “Class” refers to criminal status, while “Schedule” regulates medicinal and professional use. This distinction is often muddled in press reports and public discourse, leading to confusion about what is “legalised” or “decriminalised”.

Why Cannabis Remains Illegal under the 1971 Act Despite Medical Use

It’s important to clarify that the 2018 changes did not “legalise” cannabis as a drug in the recreational or broad medical sense. Cannabis itself remains a Class B controlled drug under the 1971 Misuse of Drugs Act. This means:

Possession, supply, and production outside specified licences and prescriptions remain criminal offences.
Only specific cannabis-based medicines authorised by the MHRA can be legally prescribed.
Non-authorised forms such as cannabis flower, resin, or oils without licence remain illegal.

The government has taken a cautious approach, balancing patient access against concerns about public health, abuse potential, and the lack of large-scale clinical evidence for many cannabis preparations.

Specialist-Only Prescribing and Limited NHS Access

One reason NHS availability is limited is that cannabis-based medicines must be prescribed by specialists only. Primary care doctors (general practitioners) are not authorised to prescribe these products without specialist recommendation.

The National Institute for Health and Care Excellence (NICE) and NHS England have been slow and cautious in recommending widespread NHS use, mainly because of:

Limited high-quality clinical evidence for many conditions beyond the licence specified indications.
Concerns about long-term safety and effectiveness.
High costs and commissioning complexities.

Consequently, many patients turn https://www.tntmagazine.com/leisure-entertainment/leisure/why-is-cannabis-still-illegal-in-the-uk-the-history-behind-medical-cannabis-law/ to private clinics or suppliers such as Nationwide Pharmacies, which specialises in sourcing medical cannabis products legally prescribed or imported under strict controls. These private routes may be more accessible but come at significant out-of-pocket cost and do not offer NHS-funded prescriptions.

The Role of Nationwide Pharmacies in Medical Cannabis Access

Nationwide Pharmacies is one of the UK’s well-established private companies focusing on cannabis-based medicines. They provide:

Access to authorised medicines like Epidyolex and Sativex, as well as specialist products imported under Home Office licences for unlicensed cannabis-based products where appropriate.
Support services for patients navigating complex legal and clinical pathways.
Collaboration with medical professionals to ensure compliance with UK drug laws and regulations.

While not part of the NHS, companies like Nationwide Pharmacies fill an important role for those patients who cannot get NHS prescriptions or require treatment options outside licensed indications.

Summary: What You Need to Know About Cannabis Medicines in the UK

Only Sativex and Epidyolex are currently MHRA-authorised cannabis-based medicines in the UK.
The November 2018 change added cannabis medicines to Schedule 2 of the Misuse of Drugs Regulations, allowing legal specialist prescribing but did not decriminalise cannabis or legalise recreational use.
The Misuse of Drugs Act 1971 still classifies cannabis as a Class B drug; possession and supply outside licences remain illegal.
Specialist doctors must prescribe cannabis medicines; NHS access is highly restricted and only provided under strict conditions with NICE’s cautious guidance.
Private providers like Nationwide Pharmacies offer alternatives but at private cost, helping patients access cannabis medicines legally within regulatory frameworks.

Understanding these nuances helps clear up common misunderstandings. Cannabis medicines are not “legalised” in a broad sense; rather, the legal framework permits medicinal use of specifically authorised products under stringent controls.

Takeaway:

Sativex and Epidyolex remain the only authorised cannabis-based medicines in the UK, prescribed only by specialists under strict legal and clinical rules — cannabis itself remains illegal for general use.

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