The following extract from Discrimination by Design illustrates how the current legal framework creates its own self fulfilling grounds for continued prohibition of certain modes of use for medical cannabis patients. You can view/download the whole briefing document at the link at the bottom of the page.
Using the systemic lens, this section shows how the prohibition manufactures its own justification and blocks prescribing and evidence gathering.
When Parliament amended the Misuse of Drugs Regulations in 2018, the stated aim was to enable patients with serious conditions to access cannabis-based medicines under specialist prescription. Families and campaigners were told that legal access had been created.
NHS prescribing: still extremely rare; only a handful of cases, mainly paediatric epilepsy.
Private prescribing: where most patients obtain treatment, often at significant personal cost.
Specialist barrier: only consultants on the GMC register may prescribe, sharply reducing availability.
Chilling effect: clinicians fear reputational and regulatory sanction, discouraging even those sympathetic to prescribing.
For patients who require smoking for acute relief, the prohibition is not incidental but a systemic exclusion:
Patients: conceal their route of use to avoid losing prescriptions, distorting the clinical relationship.
Clinicians: cannot lawfully recommend or monitor the fastest and most effective route.
Researchers: have no pathway to study smoking in practice, preventing data collection.
Regulators: bodies such as NICE, MHRA, GMC, and CQC are paralysed, unable to develop guidance on a route that the law criminalises.
The regulatory structure creates a self-reinforcing cycle:
STEP 1: Government asserts there is no evidence base to support smoking cannabis.
STEP 2: The law prohibits smoking cannabis, preventing evidence from being gathered.
STEP 3: Clinicians are unable to form a responsible body of opinion because the route is criminal.
STEP 4: Government points to the absence of evidence and clinical consensus as justification for continuing prohibition.
This circularity means that patients are excluded by design.
• Patients: excluded from effective treatment; criminalised if they self manage.
• Clinicians: silenced from developing or voicing professional opinion due to the illegality of smoked consumption.
• Researchers: barred from generating the very data government demands due to the illegality of smoked consumption.
• Policy-makers: rely on absence of evidence that is structurally engineered.
• Equality impact: disabled patients who need the fastest onset of relief are uniquely disadvantaged, compounding discrimination identified in Section 6.
Evidence is demanded but blocked. Prescribing is promised but denied. Clinical judgment is required but prohibited.
The system is self-fulfilling: no evidence, no prescribing, no change.
Patients are left trapped between ineffectiveness and criminality.
A lawful medicine should not operate outside the rule of law. Discrimination by Design examines how this anomaly arose — and how it can be remedied. Click the button below to view and/or download our Discrimination by Design briefing document.