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  • Feb 4, 2025

The Cannabis Conundrum: Science, Industry, and the Battle for Medical Legitimacy

  • GCS Team
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Most recently, we saw private cannabis clinics in the UK facing criticism for prescribing and marketing cannabis for various mental health conditions despite claims of insufficient robust scientific evidence. This ongoing dispute highlights a broader challenge—the gap between emerging cannabinoid research and its integration into pharmaceutical medicine.

Disclaimer:
The information provided in this article is for educational purposes only and should not be considered medical, legal, or financial advice. Global Cannabinoid Solutions (GCS) does not endorse or promote any specific cannabis products or medical claims. Always consult a qualified professional before making health-related decisions.

Purpose Statement:

This article aims to provide a comprehensive perspective on the current public media discourse surrounding cannabis by connecting key debate points that are often discussed in isolation but rarely examined within the broader narrative.

Introduction

The debate over medical cannabis rages on! Most recently, we saw private cannabis clinics in the UK facing criticism for prescribing and marketing cannabis for various mental health conditions despite claims of insufficient robust scientific evidence. This ongoing dispute highlights a broader challenge—the gap between emerging cannabinoid research and its integration into pharmaceutical medicine. While scientific understanding of cannabinoids continues to advance, the process of translating this knowledge into regulated, clinically approved treatments remains complex, expensive, and lengthy.

Dueling Interpretations of Science

The controversy stems from two competing perspectives. On one hand, critics argue that cannabis lacks sufficient evidence to support its use in conditions such as ADHD, depression, and anxiety. This view, echoed by leading psychiatrists, stresses that without large-scale, double-blind, placebo-controlled trials, cannabis should not be broadly prescribed outside of strictly regulated conditions. This argument is rooted in the pharmaceutical model, which demands rigorous evidence on a specific formulated product for specific conditions before that product can be authorized and prescribed medically. For this reason, we do not prescribe raw opium but instead fined pharmaceutical extracts.

On the other hand, private clinics and patient advocates point to the growing body of real-world evidence and patient-reported outcomes. They argue that while cannabis medicines may not fit the traditional pharmaceutical framework, they offer significant benefits for many individuals who have not responded to standard treatments. For example, patient-reported relief from chronic pain, insomnia, and PTSD suggests that cannabinoids interact with the endocannabinoid system in ways that may provide therapeutic effects beyond placebo.

"There is a significant need for further research into how different cannabinoids interact with individual patient biochemistry. While RCTs remain the gold standard, real-world evidence should not be dismissed." - Dr. Ethan Russo, neurologist and cannabinoid researcher.

The Challenge of Variability: Plants, People, and Products

One of the primary hurdles in integrating cannabis into mainstream medicine is its variability. Unlike single-molecule pharmaceuticals, cannabis is a complex plant with hundreds of active compounds, including cannabinoids, terpenes, and flavonoids. The interaction between these compounds—the so-called "entourage effect"—complicates standardization and dosing.

Similarly, human responses to cannabinoids are highly variable. Differences such as Age, body weight, metabolic rates, prior exposure, and even gut microbiota can influence how individuals process and respond to cannabis-based medicines. This makes it difficult to measure and uniformly predict efficacy and side effects. It should be noted that this is one of the greater challenges of medicine in general, 

Further complicating the matter is the diversity of cannabis products available. While the NHS offers only three approved cannabis-based medicines, private clinics provide a vast array of oils, tinctures, and flower preparations. The difficulty of standardising in these products leads to inconsistencies in potency, composition, and therapeutic outcomes, making it harder to establish firm guidelines for safe and effective use through traditional infrastructures.

Prescribing Cannabis in the UK

Private cannabis clinics have emerged as an alternative route for patients seeking medical cannabis, offering treatments that remain largely inaccessible through the NHS. However, as the new kid on the block, the sector is far from infallible. Unlike the pharmaceutical industry, which operates within rigid regulatory frameworks and standardized drug approval pathways, private cannabis clinics exist in a rapidly evolving, loosely regulated space that has also been criticised for prioritising patient demand over traditional medical oversight. While pharmaceutical companies are criticized for their profit-driven influence over healthcare, they follow an established system of randomized controlled trials (RCTs), regulatory approvals, and post-market surveillance. In contrast, private cannabis clinics rely on real-world evidence, patient-reported outcomes, and observational data—an approach that, while valuable, lacks the rigorous standardization required for mainstream medical acceptance.

This lack of standardization has led to blurred lines between medicine and recreation, with some clinics prescribing cannabis flowers with brand names that mimic recreational cannabis for conditions like ADHD, anxiety, and depression—areas where robust clinical evidence remains limited. While advocates argue that these clinics fill a crucial gap left by NHS inaction, critics highlight conflicts of interest, aggressive marketing, and inconsistencies in prescribing practices. A quick look at patient forums reveals frustration, complaints about pricing, concerns over product quality, and questions about medical legitimacy, all of which reflect a sector still learning and adapting. 

These conflicts are not unique to the UK. In fact, they are one of the primary reasons why other nations have chosen to decentralize cannabis policy through decriminalization. By removing medical gatekeeping and allowing personal choice in cannabis use, countries like Spain, Portugal, Canada, and parts of the United States have eliminated the blurred lines between medical and recreational cannabis, reducing industry-driven incentives while ensuring safe, regulated access. As the UK continues to grapple with how cannabis fits into its healthcare system, the question remains: should decision-making on cannabis be kept in the hands of corporations and private clinics, or should it be returned to the individuals who need it most?

The Regulatory Barrier: Understanding Drug Development

To provide some context on the complex nature of the drug approval process here is an overview of the process that separates licensed drugs from unlicensed drugs. When we consider the complexities of cannabis variability we can see that there would be some significant challenges surrounding the integration of crude cannabis into this structure. The pathway to pharmaceutical approval consists of several phases, each with significant failure rates:

  • Preclinical Research (Laboratory & Animal Studies) – Determines safety and mechanisms of action (~67% failure rate).

  • Phase 1 (Small-Scale Human Trials) – Tests safety and dosage in healthy volunteers (~37% failure rate).

  • Phase 2 (Moderate-Sized Patient Trials) – Assesses efficacy and side effects in patients (~69% failure rate).

  • Phase 3 (Large-Scale RCTs) – Confirms efficacy in a broad patient population (~42% failure rate).

  • Regulatory Approval & Phase 4 (Post-Marketing Surveillance) – Monitors long-term safety and adverse reactions.

A comprehensive analysis published in Nature Reviews Drug Discovery reported the following probabilities of success:

  • Phase I Trials: Approximately 63% success rate.

  • Phase II Trials: Approximately 31% success rate.

  • Phase III Trials: Approximately 58% success rate.

  • Regulatory Approval Phase: Approximately 85% success rate.

Only about 10% of drug candidates successfully navigate from Phase I trials to regulatory approval, underscoring the rigorous and competitive nature of pharmaceutical development Mullard, A. (2016). 

The financial burden of conducting a full-scale RCT can reach billions of dollars, and the entire approval process can take decades. A study published in JAMA Network Open estimated the mean cost of the clinical phase per drug candidate at approximately $117.4 million (Sertkaya A, Beleche T, Jessup A, Sommers BD (2024). Another analysis by the Congressional Budget Office reported that the average total cost of bringing a drug to market was about $375 million (CBO). The high costs and lengthy timelines associated with randomized controlled trials (RCTs) have led to discussions about alternative approaches to ensure timely patient access to potentially beneficial treatments. 

“ Bridging the gap between research and real-world application remains one of the biggest challenges in drug development. The so-called “valley of death” in translational medicine is fueled by a number of culprits, including weak hypotheses, irreproducible data, ambiguous preclinical models, and statistical flaws that undermine scientific integrity. But beyond these technical barriers, deeper systemic issues are at play. Overcoming these obstacles requires a shift toward greater collaboration, reproducibility, and a framework that rewards real-world impact over publication metrics” (Seyhan, 2019).

While critics argue that the lack of large-scale clinical trials undermines medical cannabis’ credibility, some 30,000 studies exist across the international research world. This knowledge base is comprised of a multiude of different research methodologies that provide valuable insights that contribute to a multidimensional view of cannabis and utility to humans:

  • Epidemiological Studies – Population-based analyses revealing trends in cannabis use and long-term health outcomes.

  • Preclinical Research – Laboratory and animal studies investigating cannabinoid mechanisms of action

  • Real-World Evidence (RWE) – Observational studies and patient surveys highlighting treatment efficacy in practical settings.

  • Case Studies – Individual patient reports detailing unique responses to cannabinoid treatments.

  • Meta-Analyses & Systematic Reviews – Aggregations of multiple studies that form broader scientific consensus.

Understanding the relationships between the NHS & Pharmaceutical sector.

It is important to remember that this public cannabis discussion is a huge domino in the center of a multi-billion dollar market which could be heavily disrupted in the regulatory barriers around cannabis are loosened.  The House of Commons Health Committee's report, The Influence of the Pharmaceutical Industry, examined how pharmaceutical companies shape healthcare policy, research priorities, and drug accessibility, raising critical questions about transparency, regulatory oversight, and patient welfare.

“About 650 million prescriptions are written each year by GPs alone. Medicines cost the NHS in England over £7 billion every year, 80% of which is spent on branded (patented) products. The industry which has produced these drugs has understandably been described as “world-class and a jewel in the crown of the UK economy”. It is the third most profitable economic activity after tourism and finance.”

“Drug companies are criticised for giving hospitality and recruiting ‘key opinion leaders’, but the prescribers must be equally to blame for accepting the hospitality and some ‘key opinion leaders’ for lending their names to work they did not produce, often for very considerable sums. The Government, like the MHRA, has tended to assume that all is for the best. It states that there is no better alternative system. We agree: pharmaceutical companies will inevitably continue to be the dominant influence in deciding what research is undertaken and conducting that research, publishing it, and providing information to prescribers. This does not, however, mean that no changes are required.”

Recent Parliamentary Debate & Lessons from Global Decriminalization Efforts

Recent parliamentary discussions have underscored the government's limited interest in addressing the pressing issues faced by patients and their families. A debate held by the Backbench Business Committee highlighted the ongoing barriers to cannabis-based medicines and the reluctance of policymakers to implement meaningful change.

While the UK continues to enforce strict cannabis laws, other countries have taken a more progressive approach to regulation and decriminalization. In Canada, full legalization of recreational cannabis has not only dismantled the black market but also redirected law enforcement resources towards more pressing criminal activities. Additionally, patients now have regulated, affordable access to medical cannabis through licensed dispensaries. Germany, which previously had restrictive policies, is moving towards partial legalization, allowing for controlled distribution while keeping public health concerns in focus. In the United States, a growing number of states have legalized cannabis for both medical and recreational use, demonstrating that public access to cannabis can be safely integrated into the public domain. These examples illustrate that a well-regulated system can support public health objectives, reduce crime, and generate significant economic benefits. The question remains—will the UK follow suit, or continue to lag behind global trends?

Case Study: Canada’s Approach to Medical Cannabis

A comparison with Canada, where medical cannabis has been legal since 2001, provides useful insights. A 2021 study published in The Journal of Pain reported that:

  • 72% of chronic pain patients experienced significant relief with medical cannabis.

  • 43% of patients reduced their reliance on opioids.

  • Variability in chemical constituents in cannabis formulations led to highly individualized responses, highlighting the need for personalized treatment approaches.

Despite these positive findings, Canadian regulators continue to grapple with balancing patient access and medical oversight—challenges that closely mirror those faced in the UK’s private cannabis sector. Canada’s move to loosen the penalties around cannabis brought additional benefits to the nation in the form of reduced youth crimes relating to cannabis.

A study published in 2024 investigated Canada’s cannabis legalization and police-reported cannabis-related criminal incidents among youth between 2015–2021. Legalization was associated with 50–60% decrease in youth cannabis crimes. Secondly the study found no evidence of associations between legalization and property or violent crimes. Results suggest that the impact of the Cannabis Act on reducing cannabis-related youth crimes is sustained, supporting the Act’s objectives to reduce cannabis-related criminalization among youth and associated effects on the Canadian criminal justice system (Callaghan et al., 2024).

The Human Cost: Families in Crisis

Lost within this health system are, patients—particularly children with severe medical conditions—who face significant barriers to accessing life-saving cannabis-based treatments. Despite the rescheduling of cannabis in the UK in 2018, access through the National Health Service (NHS) remains extremely limited. As a result, many families are forced to seek expensive treatments through private clinics, often at great financial cost and emotional hardship. As an example, the average monthly cost of CBMP for children in a 2020 cannabis study was £1,816 per patient (Zafar et al. 2020).

Parents of children with treatment-resistant epilepsy, for example, have resorted to selling their homes, depleting their savings, or making other financial sacrifices to afford cannabis-based medicines. Advocacy groups such as Intractable and End Our Pain continue to campaign for expanded NHS access, emphasizing the ethical and moral failings of a system that grants access to medical cannabis for while keeping it out of reach for those who need it most. 

Some families have even been forced to leave the UK to seek reliable treatment abroad, traveling internationally at great personal risk to source these medicines. The financial and logistical burden of such journeys adds another layer of hardship to an already distressing situation, highlighting the broader systemic failures in making these treatments available domestically.

The Paradox of Cannabis Prohibition

Despite the strictly worked regulations and laws, cannabis remains the most commonly consumed illicit drug across the UK. In the United Kingdom, the cannabis black market is estimated to be worth £2.5 billion annually, with over 3 million users consuming approximately 255 tonnes of cannabis each year (Snowdon, C. (2022).

Enforcing cannabis prohibition imposes significant financial burdens on the criminal justice system. The police dedicate over 1 million hours annually to enforcing cannabis laws, costing approximately £200 million each year. Additionally, there are currently 1,363 individuals incarcerated for cannabis-related offences in England and Wales, costing taxpayers £50 million annually (Tax Payers Alliance).

Despite these substantial expenditures, the current approach fails to effectively address public health concerns and denies patients access to potentially beneficial treatments. While a few businesses may benefit from the status quo, it remains inhumane for many patients who could otherwise find relief through cannabis-based medicines. Some advocates argue for the right of patients to cultivate their own cannabis for medical use, especially in light of the prolonged processes involved in drug approval. However, the UK continues to adhere to the Misuse of Drugs Act (1971), a framework that has remained largely unchanged for decades, presenting legal challenges for those who choose to self-medicate through home cultivation. 

The Role of Advocacy: Seed Our Future

Organizations like Seed Our Future have been instrumental in supporting individuals caught in the criminal justice system due to legislative gaps surrounding medical cannabis. This national campaign group focuses on legislative research, education, and advocacy for those affected by outdated drug policies. Their work highlights the unintended consequences of the UK's rigid cannabis laws and the pressing need for policy reform.

Addressing the gap between industry claims and scientific validation requires a nuanced, data-driven approach. While RCTs are essential for full pharmaceutical adoption of specific formulations, dismissing real-world patient experiences and emerging evidence outright disregards valuable insights and patient’s perspectives. 

The World Health Organization (WHO) has recognized the right to health as a fundamental human right, emphasizing that individuals should have access to the medical treatments they need without unnecessary restrictions. The science is clear, but legislation on both sides of the debate needs to evolve into the 21st century. Regulatory oversight is essential for safety, but there is so much more that can be done beyond penalising patients who also have a right to relief and access to treatment.

Conclusion: Bridging Science, Regulation, and Patient Access

The debate over medical cannabis is not just about science or regulation—it is about who gets access to relief and under what conditions. The stark divide between scientific inquiry, regulatory frameworks, and patient experience has created a system where those in need face insurmountable barriers, while policymakers remain reluctant to modernize outdated legislation.

For patients in urgent need, the reality of medical cannabis access presents a cruel dilemma. Follow the law, wait potentially years for regulatory approval, endure financial hardship, and risk dying to avoid breaking the law—or turn to unregulated cannabis products and potentially alleviate their suffering. While randomized controlled trials (RCTs) are the gold standard for pharmaceutical approval, patients do not have the luxury of time or sufficient finances for private healthcare. The growing body of real-world evidence, patient-reported outcomes, and international policy shifts show that cannabis medicine can be accessible without being confined to the rigid timelines of traditional drug development. For many, the choice is not about legality—it is about life itself.

The UK’s reluctance to evolve its cannabis policies has left patients, particularly children with severe conditions, in financial and medical limbo. Many families are forced to pay exorbitant costs through private clinics, travel abroad for treatment, or break the law to obtain life-saving medicine—a reality that contradicts the ethical foundations of healthcare. Meanwhile, the pharmaceutical industry's deep influence over regulatory processes continues to shape access, leaving safe, plant-based alternatives locked behind legislative red tape.

Moving forward, science must take precedence over stigma. A balanced approach—one that embraces rigorous research while also acknowledging the value of real-world evidence—is essential. Policymakers must recognize that standardized cannabis-based medicines and patient-centered access models can coexist. Countries like Canada and Germany have demonstrated that a well-regulated system can ensure both safety and accessibility without compromising scientific integrity.

The future of cannabis is being shaped right now, and your voice matters. The disconnect between science, regulation, and patient access has left millions in limbo—people who cannot afford to wait for slow-moving policies while they suffer in financial and medical hardship. The solution? An informed, science-driven community that demands evidence-based progress. 

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