In Britain, whether cannabis is treated as medicine or a crime may depend less on medical need than on the ability to pay. In 2018, the UK government changed drug policy, allowing specialist doctors to prescribe cannabis-based medicinal products.
The decision was presented as a move towards evidence-based healthcare, recognising cannabis may have therapeutic value for health conditions such as chemotherapy-induced nausea and vomiting, spasticity in adults with multiple sclerosis and treatment-resistant epilepsy. Nearly seven years later, though, access remains highly restricted. According to NHS guidance, medical cannabis is tightly controlled and usually considered only when other treatments have failed.
In practice, NHS prescriptions remain rare, with most patients accessing cannabis privately at considerable cost. For many others, legal access is simply unavailable.
Cannabis is recognised as medicine, yet people using it therapeutically without a prescription can still face criminal sanctions. The problem is not simply legal inconsistency but structural inequality.
While medical cannabis is legal in principle, the route to obtaining a prescription is narrow. Clinical guidance remains cautious, many doctors are reluctant to prescribe it, and patients find it difficult to navigate the system.
Those unable to afford private treatment are often left with limited options: go without treatment, rely on less effective alternatives, or obtain cannabis illegally.
The result is effectively a two-tier system in which legality is shaped not just by medical need, but by economic means. Those who can pay privately may use cannabis lawfully. Those who cannot may risk criminalisation for materially similar behaviour.
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The financial barriers are significant: private patients must pay for consultations, clinic registration fees, ongoing review appointments and the medication itself. Prescriptions can run to hundreds of pounds a month, with some products priced at around £8.99 per gram.
By comparison, street cannabis typically costs £150-£200 per ounce, making it significantly cheaper – making the illicit market not just more accessible for some, but economically rational.
People who can’t access legal cannabis may be pushed towards unregulated supply chains linked to organised criminal networks. Unlike prescribed products, cannabis bought illegally has no quality checks, no guaranteed strength and no doctor overseeing how you use it. There is no guarantee it is free from harmful synthetic additives.
This creates another policy contradiction. A system intended to regulate cannabis use may, through its own restrictions, be sustaining the illicit markets it was meant to displace.
The inequality can exist even within the same household. Two people may use the same cannabis product for similar health reasons, yet only one is legally protected because they can afford the consultation fees and prescription charges required to access private treatment. The other, unable to absorb those costs, risks criminal sanctions for similar behaviour.
Legal dilemma
People using cannabis to manage chronic pain, anxiety, trauma or other long-term conditions may already be navigating significant health difficulties. Relying on illegal supply introduces additional stress, uncertainty and the fear of criminalisation on top of an already difficult health situation.
For some, the experience of breaking the law while attempting to manage their wellbeing may itself contribute to feelings of stigma, anxiety and social exclusion. This matters because research consistently shows that drug use is often functional – a way of managing pain, stress or trauma – rather than purely recreational.
In this context, self-medication with cannabis may represent a response to unmet medical need rather than deviance. Yet the law rarely accounts for this complexity. Unauthorised possession remains a criminal offence regardless of intent.
Cannabis occupies an increasingly ambiguous position in British society. According to the Office for National Statistics, it remains the most commonly used illicit drug in England and Wales. At the same time, alcohol retains a firmly established cultural and legal status despite its association with addiction, violence and long-term health harms.
One substance remains criminalised despite growing medical recognition and comparatively lower levels of harm. The other is culturally embedded despite well-documented links to addiction, violence and early death.
NHS England recorded over 1 million alcohol-related hospital admissions in 2023-24, alongside more than 22,000 alcohol-related deaths. Cannabis, by comparison, is not associated with mortality at that scale.
None of this means cannabis is without risk. Heavy use can produce dependency and mental health complications for some users, although others report relief from chronic pain, anxiety and related conditions. But the current policy framework appears difficult to justify on the basis of relative harm alone.
The continued policing of low-level cannabis possession also carries a cost to the criminal justice system, consuming police and court capacity at a time of serious backlogs.
A coherent cannabis policy would need to align law, medical evidence and lived reality. At present, UK policy sends contradictory messages. Cannabis is simultaneously framed as both a medicine and a criminal substance, depending less on how it is used than on how it is accessed.
When the difference between a prescription and a criminal record is money, that tells you everything about who a drug law is really for.
Elizabeth Peatfield does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.
