When patients first reach out to us, they often have the same questions: am I eligible, what happens next, and what will I be asked? Many will also have read conflicting information online and are looking for clear, honest guidance.
Whilst I expect many readers of leafie will be familiar with the basics of medical cannabis, there is some important context needed for those coming to this article without much knowledge. Medical cannabis, or more precisely, cannabis-based products for medicinal use, is an unlicensed medicine in the UK for most conditions. It can only be started by a specialist doctor on the GMC’s Specialist Register. This is someone who works at a consultant level after completing their medical training. Medical cannabis can only be considered when the usual treatments have not worked well enough or have caused side effects that outweigh their benefit. It is not right for everyone, and the evidence is still developing. That is precisely why eligibility is assessed so carefully.
Eligibility is a clinical judgement, not a checklist
There’s a common assumption that eligibility works like an online form: enter your diagnosis, tick a few boxes, and get an answer. In practice it depends on two things, weighed together.
The first is whether there is a recognised clinical reason to consider medical cannabis for your condition. Specialists may consider it in a range of long-term conditions. These include chronic pain, mental health conditions, epilepsy, multiple sclerosis, movement disorders, and palliative care. However, the strength of the evidence varies from one condition to another.
The second is whether the treatments considered standard for your condition have already been tried without enough benefit, or could not be tolerated.
Neither of these factors can be considered in isolation. Having a condition where medical cannabis is sometimes considered does not, by itself, make someone eligible. Equally, having tried multiple treatments doesn’t mean medical cannabis is appropriate if there isn’t a clear clinical rationale for its use.
What “exhausting prior treatments” actually means
This does not mean trying every possible treatment, at every dose and in every combination, regardless of how you responded. That would be neither realistic nor safe. It means the treatments considered standard first-and second-line options have each had a proper, adequately dosed trial and either did not help enough or caused side effects that outweighed the benefit.
This distinction is important because if you stopped a medication after three days due to a bad reaction, it is clear that trialling that medication again is unlikely to be the right answer. Equally, if you have taken a licensed treatment for years with only partial benefit, that counts too. What we’re looking for is a clear, documented picture of what has been tried, roughly how long for, how you responded and why each treatment was stopped or not continued.
This is why access to your medical records is so important. Understandably, few people can recall every medication and dose they have tried over the years, especially after seeing different GPs and specialists. At Curaleaf Clinic, our access to the NHS Spine means that, where appropriate, clinicians can in many cases review your up-to-date medical information and any specialist letters. Together, these build a fuller picture and support an informed decision.
Why no single doctor decides alone
After the initial consultation, the decision is not made immediately. It goes to a multidisciplinary team (MDT), made up of doctors and other clinical specialists, who review the case independently before any prescription is issued.
This is probably the most misunderstood part of the pathway. The MDT is looking at the case from a broad clinical perspective. This includes: does this person’s history support considering medical cannabis, are there risk factors that need closer attention, and is this a safe and proportionate decision for this particular person? Where there are complicating factors, such as other medications or gaps in the treatment history, the MDT adds a further layer of scrutiny, sometimes requesting more information from the patient’s GP or other clinicians, before a decision is reached.
If a decision is made at the MDT to start medical cannabis, they can then also decide together the most appropriate format and dose to start considering all addressable symptoms and risks. This is the final step in the clinical governance process to maximise the likelihood that medical cannabis is prescribed for the right person, at the right time, and at the right dose.
Preparing for a first consultation
A few things can help the first consultation go smoothly.
Before the appointment, provide as much detail as you can about your treatment history, not just your diagnosis. Think about what you tried, roughly when, how long for, and why it stopped or fell short. Your consultant will usually have access to your Summary Care Record, but it may not capture specialist letters or the exact reasons a treatment ended, so any other documents you or your GP has which provide a fuller picture are helpful.
Be honest about what didn’t work and why, including where side effects or missed doses played a part. Patients sometimes worry that admitting a treatment wasn’t taken exactly as prescribed will count against them, but an accurate history is important. It allows the clinician to understand what has actually been tried and make a safer, more informed decision. The goal is to make sure you understand the next best option for you and your condition. Withholding information, even if done for legitimate reasons, may cause additional risk and may delay you finding the most appropriate treatment for your condition.
Think ahead about what you’re hoping treatment might change, whether that’s pain, sleep, mobility or day-to-day function.That helps define what a meaningful result would look like for you, and what we would track at follow-up appointments.
Treat it as a conversation. Ask about the process, the monitoring, and what happens if treatment does not help. You should feel comfortable asking questions and clear about what to expect before making any decision.
What this means in practice
Whilst many people in the medical cannabis industry talk about eligibility, I prefer to think in terms of suitability. Eligibility, defined through having an appropriate condition which has not responded sufficiently to licensed medications, is just the first step in understanding whether medical cannabis is the most appropriate next step in addressing your health condition.
Suitability, meanwhile, is explored during an appointment and MDT process. It incorporates eligibility of course, but just as importantly takes a holistic view of your entire medical history and lifestyle to understand whether medical cannabis is the best next step for you, or if there are better options to consider at present.
To find out more about the eligibility criteria for a medical cannabis consultation, visit Curaleaf Clinic’s website here.
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