Are Sativex and Epidyolex the Only Approved Cannabis Medicines in the UK?

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The conversation around cannabis medicines in the UK is often clouded by confusion. Headlines declare “weed is legal now” or that “cannabis is fully legalised,” leaving many unsure what is actually available and approved for medical use. Despite recent changes, cannabis-based products remain tightly regulated and only a very limited number are authorised for prescribing. Two cannabis-based medicines stand out: Sativex and Epidyolex. But are these really the only approved options? And why does confusion about classifications and prescribing rules persist?

In this article, we break down the key facts about cannabis medicines in the UK, clarify the difference between Class and Schedule in drug laws, explain what changed in November 2018, and why NHS access to these medicines is limited. Alongside licensed manufacturers and distributors like Nationwide Pharmacies, specialists navigate a complex regulatory environment when considering cannabis-based treatments.

Understanding the Legal Framework: Class vs Schedule

One of the most common points of confusion around cannabis medicines in the UK involves the terms Class and Schedule. This reminds me of something that happened wished they had known this beforehand.. These words sound similar but have different legal meanings and implications under the Misuse of Drugs Act 1971 and the Misuse of Drugs Regulations 2001.

What is a Drug Class?

Under the Misuse of Drugs Act 1971, drugs are classified into Classes A, B, and C based on their perceived harm and potential for misuse:

Class A: Most harmful, e.g., heroin, cocaine.
Class B: Less harmful than A but still significant, e.g., cannabis, amphetamines.
Class C: Least harmful, e.g., some tranquillisers.

Cannabis itself remains a Class B drug under the 1971 Act, meaning its unauthorised possession and supply are criminal offences.

What is a Schedule?

Schedules appear in the Misuse of Drugs Regulations 2001 and list drugs that may be lawfully supplied, prescribed, or administered for medical use under controlled conditions:

Schedule Typical Examples Meaning for Medical Use Schedule 1 No recognised medical use, e.g., LSD, ecstasy No prescribing or supply except licence holders Schedule 2 Morphine, fentanyl, Sativex Prescribable but with strict storage and record-keeping Schedule 3 Barbiturates and some benzodiazepines Prescribable with fewer controls than Schedule 2

The important point is that cannabis (the plant or herbal form) is Class B and Schedule 1, meaning it is illegal to prescribe or supply, except under Home Office licences for research. However, cannabis-derived medicines formulated as pharmaceutical products may have different scheduling.

Takeaway: Being *Class B* makes cannabis generally illegal, but specific *Schedules* allow for certain cannabis-based medicines to be prescribed under strict controls.

What Changed in November 2018?

November 2018 marked a significant turning point for cannabis-based products in the UK when the Home Office rescheduled cannabis-derived medicinal products from Schedule 1 (no medical use) to Schedule 2 (prescribable with controls). The key outcomes were:

Legalised specialist prescribing: Doctors specialised in relevant areas could now prescribe cannabis-based medicinal products, with the appropriate controls.
Increased access to licensed cannabis medicines: Licensed products like Sativex, already available for conditions such as multiple sclerosis spasticity, were explicitly included as prescribable cannabis medicines.
Clarification that whole-plant cannabis remains illegal: The rescheduling applied only to specifically licensed cannabis-derived medicines, not herbal cannabis or unlicensed preparations.

Despite this change, all other parts of the Misuse of Drugs Act 1971 remain in force, and possession or supply of herbal cannabis or illegal preparations remain criminal offences.

Takeaway: The 2018 rescheduling allowed cannabis-based medicinal products to be prescribed by specialists, but did not legalise cannabis in its herbal form.

Sativex and Epidyolex: The Two Cannabis-Based Medicines Authorised in the UK

Currently, the only two cannabis-based medicines authorised for use in the UK by the Medicines and Healthcare products Regulatory Agency (MHRA) are:

Sativex (nabiximols): A mouth spray containing a 1:1 ratio of cannabidiol (CBD) and tetrahydrocannabinol (THC). It is licensed primarily for treating spasticity in multiple sclerosis patients.
Epidyolex (cannabidiol): An oral solution used as an add-on treatment for severe, treatment-resistant epilepsy syndromes such as Dravet syndrome and Lennox-Gastaut syndrome.

Want to know something interesting? both products are pharmaceutical-grade, produced to rigorous standards, and supplied via specialist channels. They are manufactured and distributed by companies who work with licensed pharmacies, including Nationwide Pharmacies, known for their expertise in unlicensed and specialist medicines.

Why Only These Two?

Developing cannabis-based medicines to regulatory approval requires extensive clinical trials demonstrating efficacy, safety, and quality. The complexity of cannabis compounds, legal restrictions, and significant investment barriers mean very few products have successfully obtained MHRA authorisation.

Meanwhile, many patients seek access to other cannabis-based products, but these remain unlicensed, and must be prescribed only when clinicians judge them necessary and benefit outweighs risks, typically under specialist supervision.

Takeaway: Sativex and Epidyolex remain the only fully licensed cannabis medicines, available under controlled specialist prescribing in the UK.

Specialist-Only Prescribing and Limited NHS Access

Even though the legal framework allows specialists to prescribe cannabinoids, NHS England currently restricts routine NHS prescribing of cannabis-based products except in very limited cases. Reasons include:

Limited clinical evidence: For most cannabis-based treatments beyond those authorised, robust clinical trial data is lacking to support routine NHS funding.
Cost considerations: Cannabis medicines can be expensive and prescribing them without clear evidence challenges fair allocation of NHS resources.
Need for specialist oversight: Cannabis medicines interact with other drugs and have complex dosing; specialists with experience in neurology, pain, or psychiatry are best placed to manage treatment.

As a consequence, patients seeking cannabis-based treatments outside licensed products often turn to private consultations and pharmacies specialising in unlicensed medicines, such as Nationwide Pharmacies.1

However, private access comes with higher personal costs and is not covered by NHS prescriptions.

Takeaway: NHS access to cannabis medicines is restricted to specialists and approved indications; wider prescribing awaits stronger evidence and policy decisions.

Why Does Cannabis Remain Illegal Under the 1971 Act?

Despite growing public debate, the UK Government has maintained cannabis’s classification as a Class B drug under the 1971 Act. Primary reasons include:

Potential for misuse and harm: Cannabis is still viewed as having significant abuse potential and risks, especially among younger users.
International treaty obligations: The UK is a signatory to UN drug control treaties that impose obligations to restrict cannabis for non-medical use.
Medical and scientific caution: Authorities point to the need for more evidence before wider relaxation of controls.

That means only carefully regulated cannabis-derived medicines with MHRA authorisation are exempted from the general cbd vs medical cannabis uk prohibition, under strict prescribing and supply rules.

Takeaway: Cannabis remains illegal in general due to abuse concerns and legal obligations; only licensed medicines are exceptions.

Summary Table: Cannabis Laws vs Medicines in the UK

Aspect Description Effect on Cannabis / Medicines Class (Misuse of Drugs Act 1971) Defines drug categories (A, B, C) by harm Cannabis = Class B; illegal possession and supply unless authorised Schedule (Misuse of Drugs Regulations 2001) Lists drugs that may be prescribed/supplied medically Licensed cannabis medicines like Sativex = Schedule 2; herbal cannabis = Schedule 1 (no prescribing) November 2018 rescheduling Cannabis-based products moved from Schedule 1 to Schedule 2 Allowed specialist prescribing of licensed cannabis medicines MHRA-approved cannabis medicines Sativex, Epidyolex Only two fully authorised cannabis-based products, indicated for MS spasticity and epilepsy NHS access Restricted specialist prescribing only Limited routine prescribing; many patients rely on private prescriptions and specialist pharmacies

Final Thoughts

Despite the hype, the reality in the UK remains that Sativex and Epidyolex are the only two cannabis-based medicines authorised for prescribing. The legal framework—rooted in the 1971 Misuse of Drugs Act and its 2001 Regulations—specifically controls access via Classes and Schedules, not always clearly explained in popular media. The November 2018 rescheduling enabled specialist doctors to prescribe cannabis-derived products, but herbal cannabis and most other preparations remain illegal.

For patients and clinicians, this means cannabis-based medicines are a tightly regulated niche within wider UK law. Pharmacies like Nationwide Pharmacies play a critical role in supplying these specialist prescriptions, but access via the NHS is still limited and subject to evolving clinical guidance.

Anyone considering cannabis-based treatments should seek expert advice and be aware of the distinction between licensed medicines and illegal cannabis products.

Footnotes:

Nationwide Pharmacies is one of the UK’s leading suppliers of unlicensed and specialist medicines, providing professional support to clinicians navigating complex prescribing scenarios, including cannabis-based products.

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