Answers to the key questions: How to get CBD on prescription? Who's eligible? What products are available? How different are these to CBD supplements? Charlotte’s Story
CBD products are everywhere. But do they work?
By now, you’ve probably run into a product containing cannabidiol, also known as CBD. It’s in everything from drinks and pet products to lotions and chewable gummies. Even major drugstore chains have announced they will start carrying CBD products in certain states.
But many people still don’t really know what CBD is. Is it marijuana? Is it legal? Does it actually work? Is it safe?
The answers to those questions aren’t necessarily straightforward. The only thing that is clear at this point: The marketing has gone way ahead of the science and the law when it comes to CBD products.
That said, CBD is thought to be a safe and effective option for certain conditions. Below, we sort through the confusion by answering some of the most common questions about CBD.
Is CBD marijuana?
Yes and no. Cannabidiol is one of the two best-known active compounds derived from the marijuana plant. The other is tetrahydrocannabinol, or THC, which is the substance that that produces the “high” from marijuana.
CBD does not get you high, but the idea that it’s not psychoactive is something of a misconception in his opinion. It does change your consciousness. You may feel mellow, experience less pain, and be more comfortable. In addition, some CBD products do contain small amounts of THC.
While CBD can come from marijuana, it can also be derived from hemp. Hemp is a related plant with 0.3% or less of THC. This plant is often used to make fabrics and ropes. As of 2018, Congress made hemp legal in all 50 states, and consequently CBD derived from hemp is also legal. The rules around marijuana-derived CBD, however, are far less clear.
Is marijuana-derived CBD legal?
Again, yes and no, depending on where you live. In some states marijuana is legal for both recreational use and medical use. In other states, it’s legal only for medical use. And in some areas, it’s not legal at all.
When it comes to CBD products, the FDA is still trying to get its arms around the issue. The agency is just starting the process of hashing out some rules regarding CBD sales. Officials recently formed a working group to create guidelines that could allow companies to legally market CBD products. Currently, CBD products are considered supplements, which aren’t FDA-regulated, and it is illegal for companies to make health or therapeutic claims about the products in their marketing. In announcing its effort to set CBD marketing rules, the FDA also signaled that it is cracking down on CBD companies that are using “egregious and unfounded claims” to market their products to “vulnerable populations.”
Currently, there is only one CBD product that has FDA approval: a prescription medication called Epidiolex, used to treat some rare severe seizure disorders in children. The bottom line is that in order to understand whether CBD is legal where you live, you’ll need to consult your state health department website or professionals in your community.
Does CBD work?
Yes, there is evidence that CBD works for some conditions, but certainly not all the conditions it is being promoted for these days. There’s no evidence, for example, that CBD cures cancer. There is moderate evidence that CBD can improve sleep disorders, fibromyalgia pain, muscle spasticity related to multiple sclerosis, and anxiety.
People report that oral CBD helps relieve anxiety and pain and also leads to better sleep. However, the same may not be true for a host of other CBD products on the market today, in particular those that are rubbed on the skin. It’s hard to know whether these have any clinical benefit, because they haven’t been tested sufficiently.
Testing also shows that many products don’t contain what’s claimed on the label. For example, they may have less CBD than advertised. So, buyer beware.
Where should you purchase CBD products?
If you are interested in trying a CBD product, it’s best to seek one through a dispensary, which is an establishment legally licensed to sell marijuana, if they are available in your state. Dispensary products must be labeled so you can see exactly how much CBD is in the product and whether it also contains THC. A small amount of THC in a CBD product isn’t typically problematic. But larger amounts could cause a “high” and may present a risk if you are going to drive.
Also, keep in mind that CBD products aren’t standardized and will vary. It helps to keep a journal recording what type of CBD product you took, how much, and your response to it. This will help you track what works and what doesn’t for your condition.
Is CBD safe?
The safest way to take CBD is orally, as a tablet, chewable, or tincture (a concentrated liquid typically administered with a dropper). Steer clear of any illegally sold synthetic CBD products, sometimes called “spice” or “bath salts.” These products have induced psychotic reactions in some people and pose a major health risk.
For adults, CBD appears to be a very safe product. CBD does produce side effects for some people, including nausea, fatigue, and irritability. It may also interact with certain medications, so always check with your doctor before use.
But for children under age 21 it’s a different story. It’s also not clear if any amount of CBD is appropriate for children.
Evidence regarding CBD is still building. Now that some states have legalized recreational and medical use of marijuana products, including CBD, scientists are finding it easier to conduct research. More will be known in the next 5 to 10 years, including whether there are yet undiscovered problems associated with long-term use.
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Can you get CBD on prescription?
CBD is available on prescription in the UK, but the process can be time consuming and expensive. The latest National Institute for Health and Care Excellence (NICE) guidelines have prevented the NHS from supplying anything but a small selection of licensed cannabis-based products.
However, the introduction of several private cannabis clinics means that a range of CBD and cannabis products can be prescribed if a specialist doctor believes it’s the only practical option.
CBD products on this site are sold as food supplements. They are not intended to assist with the diagnosis, prevention, treatment, or cure of any disease, ailment or medical condition. Any statements provided on this site are for information only and do not constitute medical advice. Read our full legal disclaimer for more information.
What products are available?
In the UK, cannabis-based products for medicinal use in humans’ (CBPM) fall into two main categories.
These are medicines that have been trialled and approved by the MHRA for specified uses. There are three cannabis-based medicines licensed for use in the UK:
- Epidyolex (aka epidiolex) – This is a pharmaceutical preparation of CBD designed for oral consumption. It has 100mg per ml, which is about 10%. The pure CBD is mixed with sesame oil, dehydrated alcohol, strawberry flavour and sucralose. Specialists can only prescribe Epidyolex for seizures associated with Lennox-Gastaut syndrome and Dravet syndrome.
- Sativex – This is a mouth spray produced from cannabis with a 1:1 ratio of THC to CBD. A specialist can prescribe it for moderate to severe cases of the muscle stiffness caused by Multiple Sclerosis.
- Nabilone – Also known as Cesamet, this is a synthetic cannabinoid that can be prescribed by a specialist if other medicines are unable to reduce the severity of the nausea and vomiting caused by chemotherapy.
Because these medicines are licensed, their use is strictly controlled. Unless you’re receiving specialist treatment for one of the conditions mentioned, you won’t get a prescription for them.
An unlicensed medicine hasn’t yet been through the authorisation process, or is being used for a different reason to that outlined in the license. Medications like this will only be prescribed after careful consideration by a multidisciplinary team of specialists. They must look at the evidence available and decide if an unlicensed medicine is the best option.
Despite the slightly worrying term ‘unlicensed’, these products are produced to strict MHRA standards and sourced from pharmaceutical companies. There may not be enough evidence to apply for a license, but they won’t be prescribed unless the prescriber has weighed up all the options.
Unlicensed cannabis-based medications available in the UK include:
- Cannabis flower
- Hemp flower
- Cannabis oil
- CBD oil (doctors can prescribe higher daily amounts than is allowed by the current FSA guidance for CBD food supplements.)
- THC and CBD products for vaporising
If you receive a prescription for an unlicensed cannabis-based medication, the type and cannabinoid content of what you receive will depend on what your specialist doctor thinks is appropriate for your condition. They will write the prescription and the pharmacy will try to source it. With several specialist cannabis clinics opening in the UK, it’s more likely that you’ll be able to find a pharmacy that can fill your prescription.
Who is eligible for a prescription?
You’re eligible for a prescription for a CBPM or CBD oil if a specialist doctor believes that it’s the most appropriate medication for your condition. This is likely to be after you’ve tried several other options and your remaining choices are limited.
However, you’re only likely to receive a prescription from a private specialist doctor or a cannabis clinic. This is because NHS doctors follow the guidelines outlined by the National Institute for Health and Care Excellence (NICE). These currently recommend that:
- Doctors should not prescribe CBD or THC for chronic pain.
- Nabilone may be used for specific cases of nausea and vomiting.
- Sativex is appropriate for some adults with MS.
- Epidiolex should only be used as part of a scientific study.
If you choose to pay for a consultation with a private specialist, they may prescribe a CBPM if you have one of the following conditions:
Cancer-related appetite loss
Inflammatory bowel disease
Irritable bowel syndrome
Autistic spectrum disorder
Alzheimer’s disease symptoms
Chronic fatigue syndrome
Traumatic brain injury
Multiple Sclerosis Neuropathic pain
Functional neurological disorder
Motor neurone disease
Muscular dystrophy symptoms
Degenerative disc disease
Spinal cord injury/disease
Post-operative surgery pain
Sleep disorder Posttraumatic stress disorder
Having a diagnosis for one of these conditions does not automatically qualify you for a CBD or medical cannabis prescription. But, if you’ve unsuccessfully tried conventional medications and there are no more available to you, you may be eligible.
How can I get a prescription?
If you’ve exhausted all other options to treat your condition, you can book a consultation with a private specialist doctor or cannabis clinic. Although any doctor on the special register of the General Medical Council can legally prescribe CBPM, some may be reluctant to and might not have access to pharmacists who can fill the prescription. The best option is cannabis clinics staffed by specialist doctors who can guide you through the process and fill your prescription.
In most cases, the cost of a private consultation, repeat appointments and medication can range from a total of between £200 to £450 per month. The medicine itself is costly because multiple companies are involved from farming to production and delivery. At each stage, extra costs are added, resulting in an expensive end product. However, there are now a small number of companies who own every step of the process so are able to keep the costs down.
Although the process differs with each clinic, these are the likely steps involved:
- Find a clinic. Several options can easily be found on Google.
- Visit their website and complete the online form. They will likely want to collect personal and medical details, including permission to access your records.
- If you’re accepted to the next stage, you should receive information on how to pay for and book an appointment.
- Attend the appointment. This will be with a specialist doctor and may be over the phone or in person. It will likely involve a discussion about your condition and possible treatment.
- If they decide to prescribe you a CBPM, they will talk you through the options, including possible strengths and strains. If you want a CBD-only product such as CBD oil you can discuss this with the doctor at this point.
- Most clinics will now pass your prescription to their pharmacy who will contact you to arrange payment.
You may be eligible for a subsidy with Project 21
Project 21 is an ambitious research project that aims to create a large body of evidence on the effects of cannabis-based medicinal products. To do this, they hope to recruit more than 20,000 participants and offer them a £150 per month subsidy towards the cost of private medical cannabis.
To be accepted, you must have a history of at least two prescribed medications, that failed to manage your condition effectively and a diagnosis of at least one of these conditions:
- Anxiety Disorder
- Chronic Pain
- Multiple Sclerosis (MS)
- Post-Traumatic Stress Disorder (PTSD)
- Substance Use Disorder
- Tourette’s Syndrome
If you’re eligible for Project 21, you’ll still need to make an appointment with a clinic and follow the steps above to be assessed for a prescription. However, there is a list of approved Project 21 partners that are the best place to start.
What is the difference between prescribed CBD and CBD food supplements?
CBD oils and other products with concentrations ranging from 1% to 50% are already legal and available in the UK. There are also many brands whose products undergo third-party lab tests and meet high quality and safety standards.
The difference with prescribed CBD is that a doctor will match a specific product and strength to your diagnosis. Because it’s an unlicensed medicine, they aren’t bound by the same restrictions as retailers are for food supplements. They can prescribe daily amounts that could even be as much as 1000mg if they consider it necessary. They could even prescribe a product with a higher level of THC if they believe that it’s the best course of action for you.
Currently, prescription CBD oils are likely to be slightly more expensive than food supplements and they have the additional cost of private doctors’ appointments. However, clinics and suppliers are working together to bring the prices down and make it more accessible for those who need it.
Since the legalisation of medical cannabis in 2018, it’s taken a disappointingly long time for genuine patients to be able to access the treatment they need. However, now things are moving faster. If you go private, you can get an appointment with a specialist doctor with the ability to prescribe CBD oils and cannabis-based medications.
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Tom Russell writes extensively about CBD oil and other groundbreaking food supplements. He and his wife share their home with two daughters and a lifetime’s collection of books.
AMA Journal of Ethics ®
After attempting to treat their daughter Charlotte’s daily seizures for three painful years to no avail, the Figi family was nearly out of options and hope. Five-year-old Charlotte suffers from Dravet Syndrome, a rare and severe form of epilepsy that cannot be controlled by medication . The Figis had tried nearly every treatment short of brain surgery or a medically induced coma to alleviate Charlotte’s seizures, including a variety of medications that did little to reduce the seizures, left Charlotte “doped out,” and had the potential to become addictive. By the age of five, Charlotte was experiencing nearly 300 seizures a week and had lost the ability to talk, walk, and eat. The Figis, who had been against marijuana use, discovered an online video of a California boy who had a severe form of epilepsy like Charlotte’s. The video showed the boy receiving a marijuana concentrate (oil) which seemed to alleviate his seizures . The oil was high in cannabidiol (CBD), the therapeutic agent in marijuana, rather than delta-9-tetrahydrocannabinol (THC), the psychoactive agent that produces the “high,” so the oil could be used therapeutically while intoxicating the user no more than the medications Charlotte had already tried [1, 2].
The Figis contacted hundreds of doctors who refused to recommend marijuana for Charlotte, either because of her age, their opinions of the plant’s efficacy, or fears of violating federal law . Finally the Figis found two doctors, Margaret Geddy and Alan Shackelford, who were willing to recommend marijuana for Charlotte. Though both had reservations about administering such a powerful and federally illegal substance to such a young child, the alternatives seemed far worse. Dr. Geddy explained that it was a rather easy decision to give marijuana to a developing child when she had suffered so much brain damage and multiple brushes with death from constant seizures. The Figis received the recommendation and obtained the oil. The first time Charlotte received the oil, she went from having 300 seizures a week to having just one . Unfortunately, high-CBD plants were in short supply—CBD has been bred out of marijuana plants over the past several decades, as growers sought to increase THC levels to produce a more powerful high [1-3].
That’s when the Figis met with the Stanley family, owners of one of the largest marijuana dispensaries in Colorado. The Stanleys had a strain that was high in CBD and low in THC and thus unpopular with regular patients because it lacked psychoactive effects. After hearing Charlotte’s story, the Stanleys modified their existing strain to create one extremely high in CBD, naming it Charlotte’s Web. Charlotte still receives the oil twice a day. She has only a few seizures a month and is now able to walk and talk again . Since Dr. Sanjay Gupta gave national attention to Charlotte’s story in his CNN program explaining why he changed his opinion on medicinal marijuana, more than 100 families from 43 states have relocated to Colorado to treat their children with Charlotte’s Web .
It’s plausible that if Drs. Geddy and Shackelford had not been willing to recommend marijuana to Charlotte, her life would have been markedly worse, if not prematurely ended, and the miracle strain known as Charlotte’s Web would not exist. Furthermore, if it weren’t for Dr. Gupta’s reporting of the story, many families would not have had the courage or even the idea to travel to another state to treat their children’s seizures .
Possibly the greatest effect of Charlotte’s story was the changing of social opinion on medicinal marijuana. Since Charlotte’s tale was told back in August 2013, eleven states have passed legislation legalizing high-CBD oils, which will give the 9,000 patients on the waiting list a better chance of obtaining it . When such debilitating conditions afflict children, families—and legislators—appear more open to the idea of trying radical, less invasive treatment options [1, 6].
Concerns about Medicinal Marijuana’s Status
There are several barriers to physicians’ prescribing marijuana for medical use. Although it remains illegal under federal law and is classified as a schedule 1 drug under the Controlled Substances Act (CSA) , 23 states and the District of Columbia have decriminalized its use for medicinal purposes . Discrepancies between federal and state medicinal marijuana laws have placed doctors—and patients—in a difficult situation: to provide their patients with medicinal marijuana, doctors must risk violating federal law and, potentially, the revocation of their Drug Enforcement Agency (DEA) licenses . For example, physicians in Massachusetts have been extremely slow in writing recommendations for patients . This delay is partly fueled by visits from DEA agents to physicians who were involved with dispensaries. Several such physicians reported that the DEA issued an ultimatum to them: sever ties with the medical marijuana industry or risk losing your DEA license for prescribing controlled substances .
Currently, it is illegal for physicians (even in states where medicinal marijuana is legal) to prescribe the drug because it is schedule 1, and prescribing it would constitute aiding and abetting the acquisition of marijuana, which could result in revocation of DEA licensure and even prison time . However, in states where medicinal marijuana is legal, doctors can write a recommendation for the plant, after determining and certifying that the patient suffers from one of the conditions that the state’s law deems to warrant medicinal marijuana —generally debilitating conditions such as cancer, glaucoma, multiple sclerosis, and HIV/AIDS . This recommendation “loophole” was upheld by the US Court of Appeals for the Ninth Circuit in Conant v. Walters, which decided that a physician’s discussing the potential benefits of medicinal marijuana and making such recommendations constitute protected speech under the First Amendment . The court reasoned that doctors should not be held liable for conduct that patients might engage in after leaving the office and that open and unrestricted communication is vital in preserving the patient-doctor relationship and ensuring proper treatment [11, 13].
Once the physician writes the patient a recommendation for medicinal marijuana, the patient must register with his or her state’s database to obtain a marijuana patient ID card, after which he or she can pick up medicinal marijuana from a dispensary . In most states, possession of the identification card allows a patient to obtain, possess, or grow medicinal marijuana without violating state law but provides no shield against violations of federal law, which trumps state law based upon the supremacy clause . Federal legislation that would protect patients in states where medicinal marijuana is legal is pending .
Concerns about Evidence
Though many patients seek access to medicinal marijuana, some doctors are reluctant to recommend it due to a dearth of hard clinical data regarding its efficacy in treating certain conditions . Marijuana’s schedule 1 status makes it difficult to conduct research because any cultivation, clinical testing, or research on it must attain the extremely rare approval of the federal government , and only one organization, the National Center for Natural Products Research at the University of Mississippi, is authorized by the federal government to manufacture marijuana . This creates a vicious circle: marijuana is schedule 1 and has no currently accepted medical use in treatment because there is no data on its safety and efficacy; there is no data because marijuana is schedule 1 and clinical testing is restricted .
Aside from the lack of data on efficacy, some doctors are reluctant to recommend a drug whose form, contents, dosage, and type cannot be specified, as they would be in a typical drug prescription . The amount of marijuana the patient can obtain is limited by state law . The type of marijuana and mode of delivery is determined by the recommendations of dispensary employees . Furthermore, because of its dual legal status, the product and its growing and cultivation are largely unregulated and unstandardized. This can lead to safety concerns; there have been incidents of pesticides, molds, and other contaminants, the consumption of which could lead to serious health problems, being found on plants .
Intraprofessional Consequences of Legal Inconsistencies
In states where medicinal marijuana is legal, but a majority of physicians are reluctant to write recommendations, an influx of “pot docs” is often seen, reflecting a commercialization of medical marijuana recommendations . These are physicians who primarily treat a variety of ailments for which marijuana is recommended, and they often advertise their businesses as being centered on medicinal marijuana . This is a concern to some in the states whose medicalization movements were predicated on the belief that medicinal marijuana would only be available to a limited number of people with debilitating conditions and would not facilitate recreational use of the drug [8, 12]. Proponents of medicalization argue that doctors often prescribe drugs for off-label purposes, thus strict limits on ailments warranting recommendations would unduly restrict patients’ access to the medicine .
But many states expand their covered ailments beyond such extreme conditions . Because, for example, California’s law about the conditions for which marijuana use is allowed includes a catchall “or any other illness for which marijuana provides relief” provision , pot docs are able to write prescriptions for problems such as anxiety, insomnia, and chronic pain [3, 8]. Some physicians feel that these pot docs cheapen the profession by acting as quasimedical drug dealers who make money by providing their patient with an easy, accessible high, rather than treating a serious ailment .
Some states are trying to avoid this by requiring that recommending physicians have an existing bona fide clinical relationship with the patient who is seeking the recommendation [9, 14]. Of course, this requirement, while protecting the legitimacy of the recommendation, may create tension within the patient-doctor relationship when patient desires medicinal marijuana but the physician will not recommend it, either for reasons having to do with its therapeutic potential, lack of control over the dosage patients receive, or overall objections to its use .
One last objection that physicians in some states have with medicinal marijuana is the lack of regulation regarding clinical training on the medical and legal aspects of the new laws . Massachusetts was the first state to require that physicians take a two-hour course before they could recommend medicinal marijuana to their patients . Doctors generally prescribe only drugs that have been rigorously tested, their clinical results reported in published articles, and information about indications for their use, the mechanisms by which they achieve results, and their expected side effects available in package inserts or the Physicians’ Desk Reference. None of these resources for information about the efficacy, dosing, or regulations that come from FDA-approved drugs are available for medical marijuana .
A Turning Tide
Stories like Charlotte’s successful treatment and Dr. Gupta’s change of heart have helped shift opinions—especially those of physicians—regarding medicinal marijuana. A study reported in April 2014 by WebMD surveyed 1,544 doctors in 12 specialties and 48 states  and found that 56 percent of those surveyed believed that medicinal marijuana should be legalized nationally and 69 percent believe it can deliver real benefits for certain treatments and conditions. The majority of positive responses came from oncologists and hematologists, probably because of marijuana’s use in treating cancer-related pain, counteracting nausea, and stimulating appetites reduced by chemotherapy . Furthermore, a study published in the Journal of Adolescent Health in 2014 reviewed data measuring drug use and the perceptions of adolescents and found that legalizing medicinal marijuana at the state level causes no measured increase in youth marijuana use, thus addressing a key concern of those who oppose medicinal marijuana . As more states legalize marijuana and others continue to expand and refine their regulations, physicians will likely play an important role as trusted sources for evidence on clinical efficacy and side effects and have a responsibility to be informed on the topic .
In late May of 2014, the Republican-controlled House of Representatives voted to block the federal government and its agencies from interfering with physicians, patients, and dispensaries acting in compliance with state medicinal marijuana laws . Approval from the Senate would help settle conflicts between state and federal law .
Furthermore, the FDA announced in June 2014 that it will begin the process of reevaluating marijuana’s schedule 1 status . This is good news for physicians concerned about the lack of data on marijuana; if its classification were lowered to schedule 2, more studies on its efficacy could be conducted and doctors would have a larger pool of data regarding its potential uses and side effects from which to draw judgments about its use . As more states expand their laws, more patients consume the drug, and more data becomes available, physicians will become more confident about using medical marijuana.
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The viewpoints expressed in this article are those of the author(s) and do not necessarily reflect the views and policies of the AMA.
Joseph Gregorio is a second-year law student at DePaul University College of Law in Chicago and was the 2014 DePaul American Medical Association summer scholar. He is an active contributor to the DePaul Health Law Institute’s E-Pulse Health Law blog. Joseph received his BS in psychology at Western Illinois University. His research interests are public health law, bioethics, and psychology.