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In the UK, most medical cannabis, legally termed cannabis-based medicinal products (CBPMs), is prescribed by clinicians with specialist expertise, often in the private sector due to limited NHS commissioning. With this reality, issues around prescription direction, where patients are steered toward specific pharmacies or limited product lists, have become important ethical and professional considerations. This guidance aims to clarify what prescription direction means, how it relates to CBPMs, and how clinicians and patients should approach it, grounded in clinical, regulatory and prescribing standards. What Is “Prescription Direction”? ‘Prescription Direction’ refers to any practice in which a healthcare provider influences or obligates a patient to use a particular pharmacy or dispensing service to fulfil their prescription, or restricts which products may be prescribed based on a clinic’s internal formulary rather than clinical considerations alone. For standard prescription-only medicines, and CBPMs alike, once a valid prescription is issued, the patient, not the issuing clinic or prescriber, owns the prescription and has the right to have it dispensed at any appropriate pharmacy. Professional guidance makes no provision for locking prescriptions to a particular dispensing outlet on non-clinical grounds. [1] Legal and Regulatory Framework for Medical Cannabis Prescribing Who Can Prescribe CBPMs In the UK, medical cannabis products (excluding those with a marketing authorisation such as some formulations of Sativex®) are predominantly unlicensed medicines (‘specials’). The law restricts their prescription to doctors on the General Medical Council’s (GMC) Specialist Register. Specialist doctors must also only prescribe within their area of competence and clinical training. [3] NHS England guidance echoes this: while subsequent prescriptions may sometimes be made under shared care arrangements, initial prescriptions must be authorised by a specialist clinician. [2] Regulation of Clinics Prescribing Medical Cannabis Independent clinics that prescribe cannabis-based medicinal products (CBPMs), including those operating solely in the private sector, are regulated by the Care Quality Commission (CQC). The CQC sets out clear expectations for providers prescribing CBPMs, including requirements around clinical governance, prescriber competence, patient safety, informed consent, and compliance with controlled drugs legislation. The CQC guidance confirms that providers must ensure prescribing decisions are clinically justified, appropriately documented, and made in the best interests of the patient, with systems in place to manage risk and avoid conflicts of interest. This includes ensuring that organisational or commercial arrangements do not compromise professional judgement or patient choice in prescribing or supply pathways. [4] Unlicensed Medicines and Clinical Responsibility Unlicensed medicines entail additional responsibilities for prescribers because they have not undergone the full range of regulatory assessments for safety, quality and efficacy. Prescribers must therefore be confident that the product is appropriate for the individual patient, and explain to patients the unlicensed nature of the treatment as part of informed decision-making. [1][5] Supplier and Pharmacy Regulation Although there is no single official UK “list” of pharmacies that can dispense CBPMs, any pharmacy that is properly registered and complies with regulatory standards may dispense them once presented with a valid prescription. Guidance from pharmacy regulators emphasises compliance with controlled drug legislation and safe supply standards for these products. [5] Prescription Direction: Clinical and Ethical Considerations Patient Autonomy and Choice Once a specialist prescriber has written a prescription for a CBPM, the patient retains the right to choose where that prescription is dispensed. Professional standards require clinicians to respect patient autonomy and avoid practices that could restrict choice without clinical justification. The GMC’s prescribing guidance reinforces that clinicians must prescribe only within their professional competence and on clinical grounds. It does not support practices that direct patients to specific suppliers for non-clinical reasons. [1] Clinic Formularies and Product Restrictions Many private medical cannabis clinics operate internal formularies — lists of products they commonly prescribe based on clinician familiarity, supply arrangements, or existing protocols. There may be legitimate clinical reasons to prefer certain products (e.g., formulations with established pharmacological profiles or evidence bases), but clinicians must never refuse to consider other products solely because they are not on an internal clinic list, without clinical reasoning. Clinical judgement during prescribing must focus on the patient’s individual needs rather than operational convenience or commercial preference. This is consistent with all prescribing guidance for individualised care. [1] Responsibilities for Clinicians Do’s for Clinicians Respect patient choice of pharmacy: Once a valid prescription is issued, patients should be informed they may take it to any appropriately registered pharmacy capable of dispensing CBPMs. This respects patient autonomy in clinical care and supply. Provide balanced information on products: Clinicians should discuss the evidence, risks, benefits, and availability of relevant CBPMs to enable informed decision-making. Explain formulary limits transparently: If a clinic’s prescribing experience is concentrated on certain products, explicitly clarify this and discuss why other products may be considered clinically appropriate, if relevant. Follow GMC standards: Ensure prescribing decisions are based on clinical evidence and patient needs, not influenced by commercial relationships or assumptions about pharmacy supply. [1] ✔ Operate within robust clinical governance arrangements: Clinics prescribing CBPMs must meet CQC expectations for safe, effective and patient-centred care, including transparency in prescribing practices and avoidance of commercial influence on clinical decision-making. [4] Don’ts for Clinicians Do not require patients to use a particular pharmacy for non-clinical reasons. Do not imply that prescriptions are “owned” by the clinic or that patients must dispense through a preferred partner. Do not limit prescribing to products on an internal formulary if other products are clinically suitable and available. Any practice that restricts patient choice on non-clinical grounds may undermine professional ethics and patient trust. Rights and Actions for Patients Your Rights as a Patient You have the right to choose the pharmacy that dispenses your prescription, provided it is registered and authorised to supply controlled drugs and CBPMs. [5] A prescription is your legal document and may be taken to any suitable pharmacy. Clinicians must explain the clinical basis for any recommended product, including risks and benefits, to support informed consent. If You Experience Undue Direction If a clinician or clinic appears to restrict your choice of pharmacy or product without clear clinical reasoning: Ask

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