Does the UK Medicines Regulator Approve Most Cannabis Products?

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Recent years have seen growing public interest and media coverage about cannabis-based medicines in the UK. Headlines often give the impression that cannabis is now legal and widely available on the National Health Service (NHS). However, the reality involves complex legal frameworks, regulatory processes, and prescribing restrictions that many find confusing — especially when it comes to understanding Class versus Schedule status, and what changed in November 2018.

In this explainer, we’ll unravel:

How the UK medicines regulator approaches cannabis products, including Sativex and Epidyolex — the only licensed cannabis medicines currently available.
The difference between being a controlled drug under the Misuse of Drugs Act 1971 and a licensed medicine under the Medicines Act 1968.
Why cannabis remains illegal except in specific medical circumstances despite regulatory changes in 2018.
Why NHS access is limited and restricted to specialist-only prescribing, and how companies like Nationwide Pharmacies provide unlicensed cannabis medicines based on clinical judgement.

Class vs Schedule: Clearing up Common Confusion

One of the biggest stumbling blocks in understanding UK cannabis laws is mixing up Class and Schedule categories. These relate to two different yet overlapping sets of legislation:

Class – This refers to the classification of controlled drugs under the Misuse of Drugs Act 1971 (MDA). Cannabis, for example, was classified as a Class B drug until 2004, when it was downgraded to Class C, then returned to Class B in 2009. Class dictates penalties and enforcement.
Schedule – This is linked to the Misuse of Drugs Regulations 2001 and defines how controlled substances are handled in medical contexts and licensing. Cannabis-based products are mostly Schedule 1 (no recognised medical use) or Schedule 2 (restricted medical use).

For example, cannabis in plant form remains a Schedule 1 drug — meaning it is not recognised for medicinal use except under special licences — making it illegal for general medical prescribing. Some cannabis-derived medicines are Schedule 2, allowing hospital use under strict controls.

Takeaway: Class B refers to legal penalties; Schedule 1 or 2 refers to medical licensing and how the drug can be prescribed and stored.

What Changed in November 2018?

Before November 2018, no cannabis-based product had any formal medical approval in the UK, and all forms of cannabis were Schedule 1 substances, meaning recognised as having no https://dlf-ne.org/is-cannabis-legal-in-the-uk-or-not-in-2026-clearing-up-the-confusion/ medical value and barred from licensed prescribing.

In https://bizzmarkblog.com/is-cannabis-decriminalised-anywhere-in-the-uk/ November 2018, the UK government made a significant change to the Misuse of Drugs Regulations 2001 by reclassifying cannabis-based products for medicinal use (often referred to as "CBPMs"). This allowed specialist doctors to prescribe cannabis-based medicines under very restricted conditions, mainly for patients with exceptional clinical need and after exhausting other treatments.

Specifically, CBPMs were moved from Schedule 1 to Schedule 2 or Schedule 4 depending on the product, enabling licensed medical professionals to prescribe these products legally as medicines.

This did not mean cannabis was “legalised” in the way people often expect — recreational use remains illegal, and only licensed products with clinical oversight benefit from the new status.

One of the first UK-licensed cannabinoid medicines to be formally approved by the Medicines and Healthcare products Regulatory Agency (MHRA) was Sativex, a mouth spray containing THC and CBD, licensed in 2010 for multiple sclerosis spasticity symptoms. Another is Epidyolex, licensed in 2019 for certain severe epilepsy syndromes.

Takeaway: November 2018 allowed cannabis-based products to be prescribed by specialists but did not legalise cannabis broadly.

Licensed Medicines Only: Sativex and Epidyolex

Currently, the MHRA (Medicines and Healthcare products Regulatory Agency) only licenses a very small number of cannabis-based medicines for specific indications:

Medicine Active Ingredients Licensed Indication(s) Prescription Type Sativex (Nabiximols) THC and CBD (cannabis extracts) Muscle spasticity in multiple sclerosis Specialist-only prescribing on NHS or private prescription Epidyolex (Cannabidiol) CBD (cannabidiol) Rare forms of epilepsy such as Dravet syndrome and Lennox-Gastaut syndrome Specialist-only prescribing supported by clinical guidelines

Both are carefully regulated to ensure safety, quality, and efficacy based on rigorous clinical trials — the gold standard expected from all licensed medicines in the UK.

Many other cannabis products sold online or supplied by specialist companies like Nationwide Pharmacies are unlicensed. This means they have not passed the same MHRA approval processes and can only be prescribed on an "unlicensed prescribing basis." This requires explicit clinical justification and full informed consent from the patient.

Takeaway: Only Sativex and Epidyolex are licensed by the UK regulator; all other cannabis medicines remain unlicensed.

Why Does Cannabis Remain Illegal Under the 1971 Act?

Despite the change in 2018 allowing specialist prescribing, whole-plant cannabis remains a controlled substance under the Misuse of Drugs Act 1971. The Act classifies cannabis as a Schedule 1 drug, defined as having “no recognised medicinal use.”

This creates a legal paradox:

Whole cannabis and many cannabis extracts cannot be legally prescribed outside of Home Office special licences.
Manufacture, supply, and possession without a licence remain criminal offences.
This preserves the prohibition on recreational cannabis use but allows limited medical exceptions.

The government’s position is that more clinical research and regulatory approvals are needed before cannabis can be recommended widely. Until then, access remains complicated, restricted, and reliant on specialist doctors’ clinical judgement.

Takeaway: Cannabis stays illegal except for specific medical uses under strict licensing because of the 1971 Act.

Specialist-Only Prescribing and Limited NHS Access

The 2018 regulatory change enabled only consultant specialists on the General Medical Council (GMC) Specialist Register to prescribe cannabis-based products for medicinal use. This excluded GPs and general practitioners from initiating treatment themselves.

Why such restrictions?

Cannabis medicines are complex, with variable responses and potential side effects needing expert oversight.
There is limited long-term clinical data, so specialists are best placed to decide on risk versus benefit.
NHS England has published prescribing guidelines that are very restrictive, so NHS funding is only approved in rare, exceptional cases.

This explains why many patients cannot easily obtain NHS prescriptions and turn to private routes. Companies like Nationwide Pharmacies specialise in supplying cannabis medicines on private prescription, often unlicensed products after thorough clinical assessment with specialist doctors.

Unlicensed prescribing, permissible under UK medical law, allows doctors to prescribe medicines without marketing authorisation if they judge it essential for patient care. However, these carry additional responsibilities and legal risks.

Takeaway: NHS access is limited to specialist prescribing and exceptional cases; private clinics and pharmacies fill the gap through unlicensed prescriptions.

Summary: What You Need to Know

Most cannabis products are not approved by the UK medicines regulator; only Sativex and Epidyolex are licensed.
Cannabis remains illegal under the 1971 Act except for very limited medical exceptions.
Class (crime law) versus Schedule (medical licensing) classifications are often confused but are distinct legal categories.
Since November 2018, specialist consultants can legally prescribe cannabis medicines, but NHS access remains tightly restricted.
Unlicensed prescribing allows companies like Nationwide Pharmacies to supply cannabis medicines outside MHRA licensing under specialist oversight.

Understanding these nuances helps cut through misleading headlines and sets realistic expectations about cannabis medicines in the UK.

For patients considering cannabis-based medicines, consulting a specialist doctor and engaging with reputable providers like Nationwide Pharmacies is crucial to ensure safe, legal, and appropriate treatment choices.

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