Intended for healthcare professionals

Feature Essay

Why doctors have a moral imperative to prescribe and support medical cannabis—an essay by David Nutt

BMJ 2022; 376 doi: (Published 26 January 2022) Cite this as: BMJ 2022;376:n3114
  1. David Nutt, professor of neuropsychopharmacology
  1. Imperial College London
  1. d.nutt{at}

Medical cannabis has been legal to prescribe since 2018—yet just a handful of prescriptions have been made in three years. The reasons: stigma, fear, and an entrenched resistance in the medical profession that is harming patients, writes David Nutt

The field of medicine developed empirically with doctors doing what they could to help reduce the suffering and improve the health of their patients. Medicines were what doctors gave patients to assist this process. Medical cannabis presents a novel challenge to current medical practice—many patients reporting large benefits from self-medicating with illicitly sourced products would dearly like to have them prescribed on the NHS but are unable to do so.

Cannabis has been classed as a medicine in the United Kingdom since November 2018 (box 1). The decision to make it available as a medicine was precipitated by the case of Billy Caldwell, a boy with severe epilepsy who nearly died after returning from Canada when his medical cannabis was confiscated by custom’s officers. Sally Davies, then the chief medical officer, recommended the government move plant based cannabis extracts from schedule 1 to schedule 2 of the 1971 Misuse of Drugs Act, at the request of the home secretary.2

Box 1

Medical cannabis in the UK

National Institute for Health and Care Excellence guidelines recommend four licenced cannabis based medical products that can be prescribed in the UK1:

  • Two tetrahydrocannabinol (THC) based medicines: dronabinol, licensed for appetite loss in AIDS and as an antiemetic in chemotherapy, and nabilone, licensed for nausea in people receiving chemotherapy

  • Sativex, a combined THC and cannabidiol medicine for muscle spasticity in multiple sclerosis

  • Epidyolex (99.8% cannabidiol with less than 0.1% THC) for two rare childhood epilepsies (Lennox-Gastaut and Dravets syndrome)

A multitude of other unlicensed cannabis based products (such as oils and herbal cannabis) are produced to good manufacturing practices …

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