Patients and healthcare professionals say people are being prevented from accessing NHS mental health services due to their use of medicinal cannabis, despite it being legally prescribed to treat psychiatric conditions.
A number of patients who are prescribed cannabis medicinally in the UK say they have been denied access to NHS mental health services.
Despite medical cannabis being legal since November 2018 and prescribed by specialist clinicians for a range of psychiatric conditions, patients report being labelled as ‘drug addicts’ and refused help when they have disclosed that they use cannabis medicinally.
Healthcare professionals have also revealed that some patients under the care of legal cannabis clinics are not getting the mental health care they need, in some cases being left without access to urgent support from crisis teams.
Discharged without treatment plans
Cannabis activist and podcast host, Simpa Carter, was diagnosed with depression in his teens and was prescribed a number of selective serotonin reuptake inhibitors (SSRIs) medications until his early 20s, all of which he says failed to manage his symptoms of anxiety and depression effectively.
For the last decade, since relying solely on cannabis to treat his symptoms and being open with his doctors about his consumption, he claims he has been unable to access any consistent mental health support through the NHS.
“I have tried a plethora of different pharmaceutical drugs over my lifetime, for various ailments and conditions, and have never found the relief that cannabis gives me every day,” says Simpa.
“I was always honest with any physician about the fact I took drugs, it’s not something I felt I needed to hide. [Doctors] always saw my drug use as a symptom, as part of the problem, rather than something that could potentially be helping.”
He adds: “I’m now approaching the midpoint of my 30s and have been asking for support since my teens, having been constantly bounced from pillar to post to a number of different organisations.”
During the Covid-19 pandemic, like many others, Simpa’s mental health declined to the point where he felt he had to access some professional support. After being diagnosed with ADHD, he ‘felt forced’ into obtaining a legal prescription for cannabis, hoping this would legitimise his preferred choice of treatment.
But even when legally prescribed cannabis for his depression, Simpa says he was refused treatment through the NHS.
“The NHS does not accept that there is any such thing as use of a drug; all use is abuse. They don’t acknowledge that there may be some benefit to what you are doing,” he continues.
“My doctor more or less accused me of gaming the system to get access to cannabis, because of my history of depression. They said I couldn’t be prescribed stimulants for ADHD because of drug contraindications and I was discharged from the service. I have no treatment options unless I take one of their medications.”
Being unable to access any mental health support has had a significant impact on Simpa’s life.
“I want to be a contributing member of society,” he says.
“It’s frustrating and heartbreaking, because all I’m doing is being truthful.”
Labelled as drug addicts
Criminology student, Ella Walsh, has also used cannabis medicinally for a number of years to manage chronic migraines. Like Simpa she tried many different pharmaceutical medications and experienced debilitating side-effects from the age of 10 to 18-years–old when she began to taper off them and treat her symptoms with cannabis.
“As I became an adult I decided to take some autonomy over my health and start using cannabis instead,” she explains.
“I realised that I was able to manage my migraines pretty well. I was not only able to prevent them through cannabis use, but could treat them when they did come on.”
Six years later Ella visited her GP for some help with symptoms of PTSD which were becoming more pervasive. After being referred to her local mental health services team she was told they couldn’t help her and was sent to abstinence counselling instead.
“They instantly told me that I couldn’t access [services] because I used cannabis. I tried to explain I was using it medicinally but at the time it was still illegal. They sent me to abstinence counselling and basically just labelled me as a drug addict,” says Ella.
“My abstinence counsellor recognised that there wasn’t a problem, but I left feeling even more frustrated.”
When cannabis was legalised in 2018, Ella tried to obtain a prescription through her migraine clinic but was told they couldn’t prescribe on the NHS. She continued to consume cannabis illicitly and says she ‘dealt with’ the fact she couldn’t access mental health services, until more recently when she attempted again with the support of her university mental health team.
“Even with them advocating for me, all of the doors were slammed in my face,” she says.
“I had two options: get a private cannabis prescription, something they couldn’t argue with, or get private therapy. I’m a disabled student struggling to get through my degree, I just can’t afford it.
“It doesn’t make sense that I can be prescribed drugs such as opioids or pregabalin, or even things like valium for my mental health, but I can’t use cannabis for my pain.”
At the time Ella spoke to us she was awaiting another referral to the psychology team, having agreed to stop consuming cannabis and try CBD instead, but her health was worsening.
“My condition, mobility and pain have become debilitating, and the only relief I can get from pain is cannabis, which I’m literally risking a shot at therapy to use,” she adds.
“This system has me living in a state of fear, trying to figure out whether my physical or mental health needs to be prioritised and it’s just horrible.”
Referrals to social services
Simpa and Ella’s stories are seemingly not uncommon. Their experiences are echoed by health professionals in the medical cannabis sector.
Emma Donogue is clinic director at Cantourage Clinic, which prescribes medical cannabis privately in the UK. She told Cannabis Health about occasions when the clinic has had to step in to advocate on behalf of patients who had been refused help with their mental health.
“One patient had several referrals made to their mental health team, including one from a paramedic,” she says.
“He told us the service knocked him back on the basis that he’s using medicinal cannabis. We offered to speak to that service and talk through what a legal cannabis prescription looks like to reassure them that there is medical supervision and risk assessment, but they didn’t come back to us.”
She reports another instance, when a patient called her local crisis team for support and was referred to social services when she told them about her cannabis prescription.
“She told them her medication didn’t work but had a prescription for cannabis-based medicine. Their interpretation was that it was a child protection issue,” says Emma.
“In the end there was no further action taken, but her and her family had to go through the stress of it because they had pegged her as a substance user.”
The need for coping mechanisms alongside cannabis
Not only are the patients in these cases prevented from accessing what could be life-saving support, as a result they may not be getting the full potential out of their cannabis medicines. In psychiatric conditions, these are often best used alongside other coping mechanisms, such as talking therapies, argues Emma.
“Cannabis medicines are really useful for a lot of people, but they’re even more useful when they are used in addition to other supportive wellbeing and therapeutic services,” she explains.
“It’s not a wonder pill, but if you can manage your symptoms or gain a little more control of them and then access other services such as talking therapies, coping strategies and different techniques for managing daily life, that’s a winning combination for a lot of people.”
She adds: “If you take half the puzzle away, it creates a different problem. You then have a group of people asking for increasing amounts of medication because they haven’t got the other coping mechanisms to work alongside it.”
Fear among patients and clinicians
Consultant psychiatrist and cannabis clinician, Dr Niraj Singh, whose patient also had a similar experience, says that just the fear of having their support taken away can exacerbate symptoms.
“Thankfully, the cases where secondary practitioners are reluctant to continue seeing patients on the basis of cannabis is an exception rather than the norm,” he told Cannabis Health.
“Awareness and education is rising in relation to cannabis use in mental disorders, but we all know there’s a long way to go. At the moment there is an inbuilt fear within many clinicians, starting from unbalanced education around cannabis use causing negative effects. We’re having to deal with decades of entrenched thinking and conditioning around cannabis use and this cultural shift.”
Dr Singh continued: “Typically, if someone is determined to be ‘self-medicating’ with cannabis, clinicians certainly won’t endorse this in the main and are more likely to inform patients to stop. Obviously, this puts patients in a big predicament, particularly because they won’t know whether a secondary care specialist has a specific view towards cannabis use, which no doubt will impact on the treatment trajectory. We know that just the fear of having that support taken away can accentuate anxiety and trauma symptoms.”
Both Simpa and Ella said they wanted to be open with their doctors about their use of medicinal cannabis and felt penalised for being honest.
“I’ve always tried to be open with my doctors about it, even though I’ve faced a lot of backlash and stigmatising attitudes,” says Ella.
“It’s very important. I don’t want to be in therapy and have to lie to my doctor or worry about being discharged.”
Simpa adds: “There should be room for honesty and transparency. There has to be a safe space for the patient to be able to openly discuss this with their doctor, not just their prescribing doctor or dispenser, but their GP.”
‘Communication is key’
In order for patients to get the most out of both cannabis and conventional mental health treatments, it is crucial that they feel able to be open with their doctor.
Dr Singh emphasised the importance of clinicians communicating, with ‘constructive dialogue’ needed between the consultant and cannabis prescriber, in order to act in the best interests of the patient.
“Wherever there is a doubt among colleagues in secondary care, it’s important that there is constructive dialogue with the tertiary care provider to work in the best interest of the patient,” he says.
“There is a moral and ethical argument for this, as well as the legal argument in relation to the Equality Act and Disability Discrimination Act.”
Dr Singh adds: “Continuing to provide education and raise awareness is really important, but so is negotiating and having a mutual acknowledgement of roles and responsibilities so patients can continue on conventional medication whilst having medical cannabis alongside this.
“When secondary care clinicians know their responsibility around their prescribing, and cannabis prescribers know their own too, that is a good foundation. As always, communication is key.”
Cannabis Health reached out to a number of NHS trusts for comment regarding the claims in this article but did not receive any responses.
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Author: Sarah Sinclair
