Do You Really Need to Try Two Treatments Before a Private Cannabis Clinic?

If you’re exploring medical cannabis as a treatment option in the UK, you may have come across a common claim that you must first have tried—and failed—two other treatments before you can access cannabis-based medicines. Is this rule real, or just a marketing myth? What do the current regulations say about private medical cannabis clinics, NHS prescribing, and the “two prior treatments” requirement?

In this article, I’ll translate the key policy points into plain English, walk through what the 2018 rescheduling changed, and explain how NHS access, private clinics, and prescribing restrictions really work. Whether you’re looking at medicalcannabis.co.uk to compare clinics or want to understand what the Releaf explainer says, this guide has you covered.

What Changed When Medical Cannabis Was Rescheduled in 2018?

Prior to November 2018, cannabis and cannabis-derived products were effectively illegal for medical use in the UK, classified under Schedule 1 of the Misuse of Drugs Regulations 2001. This meant they were deemed to have no medicinal value and could not be prescribed, except in highly exceptional, tightly controlled circumstances.

In November 2018, the UK government rescheduled cannabis-based products for medicinal use to Schedule 2, allowing specialist doctors to prescribe certain cannabis medicines legally. This was a watershed moment, opening the door for patients with severe or treatment-resistant conditions to access cannabis medicines legally on the NHS—at least in theory.

But What Changed in Practice?

The rescheduling:

Allowed specialist doctors (not GPs) or consultants on the specialist register to prescribe cannabis-based medicines legally.
Included specific cannabis-based pharmaceuticals such as Sativex (for multiple sclerosis spasticity) and Epidyolex (for rare severe epilepsies).
Permitted "unlicensed" cannabis-based medicines (CBPMs), which are formulations not authorised by the Medicines and Healthcare products Regulatory Agency (MHRA), to be prescribed in exceptional cases.

However, NHS adoption has been cautious and fragmented. The National Institute for Health and Care Excellence (NICE) has issued strict guidance, mostly recommending cannabis medicines only for ultra-rare, treatment-resistant conditions like severe epilepsy in childhood or terminal cancer symptoms. This means that ambulatory prescribing via the NHS remains rare and highly restricted.

NHS Funding vs Legal Prescribing: What’s the Difference?

One of the biggest misunderstandings in the medical cannabis space is the difference between something being legally prescribable versus being routinely funded by the NHS.

Aspect Legal Prescribing NHS Funding / Availability Can approved specialist doctors legally prescribe cannabis medicines? Yes — under the 2018 rescheduling, when indicated. NHS rarely commissions these medicines outside very limited indications. Is the drug added to NHS formularies and routinely funded? No — only certain licensed products for specific conditions. Usually no — many products remain unlicensed and unfunded. Are private prescriptions required for most patients? Yes — private prescribing makes access possible if the patient can pay. No NHS funding under normal circumstances, so patients pay privately.

In short: being “allowed” to prescribe is just part of the equation. Whether the NHS will pay for the medicine is a separate question — and the answer often disappoints patients hoping for NHS-funded access.

The Specialist Doctor Requirement

The UK rules are clear that only specialist doctors on the GMC specialist register can prescribe cannabis-based medicines. This means a GP cannot initiate a prescription for cannabis medicines.

This restriction stems from:

The novelty and complexity of cannabis medicines;
The lack of long-term robust clinical trial data for most indications;
The MHRA’s and NHS England’s cautious approach to safety and efficacy;
The need for specialist monitoring given potential drug interactions and side effects.

What does this mean in practice? If you want a “medical cannabis assessment UK” at a private clinic, they must have access to or employ a registered specialist doctor who can legally prescribe cannabis products.

Sites like medicalcannabis.co.uk list clinics that partner directly with such specialists, but be sure to https://vergemagazine.co.uk/can-you-get-medical-cannabis-on-the-nhs-a-guide-to-the-uk-system/ confirm the prescribing doctor’s qualifications and GMC registration yourself.

The Myth of the “Two Prior Treatments” Requirement

You may have encountered claims that before you can get cannabis-based medicines, you must first try and fail two other medications or treatment options. This often appears on private clinic websites, sometimes as a strict “rule”, sometimes as an NHS guideline.

What does the official guidance say?

NICE Guidance: NICE does not specify a universal “two prior treatments” prerequisite. Its recommendations focus on cannabis only for particular severe indications, often after other treatments have failed.
NHS England Policy: While NHS England’s limited commissioned indications require that standard treatments have been tried and failed, they do not specify an explicit “two treatment” number for access.
Private Clinics: Many private clinics impose their own cautious protocols, often asking patients to document failure of multiple prior therapies before recommending cannabis medicines. This reflects NHS cautiousness rather than legal or clinical requirements.

In sum, the “must try two prior treatments” rule isn’t a legal or national NHS obligation. It’s more a conservative clinical practice aimed at ensuring cannabis medicines are reserved for when conventional options have not worked. This is a subtle but important difference.

Unlicensed Cannabis-Based Medicines and NHS Caution

Most cannabis medicines available privately are “unlicensed” products. This status means:

They haven’t undergone the full MHRA approval process (licensing) that most medicines do.
Doctors may prescribe them off-label, but only with careful consideration.
NHS England guidance is very cautious about funding unlicensed cannabis-based medicines due to limited evidence and standardised formulations.

This caution means many NHS doctors will not prescribe or fund unlicensed cannabis medicines, even if legally allowed. That’s why you find more private clinics offering access to unlicensed CBPMs — but these come with higher patient costs and variable quality assurance.

How Much Does a Private Medical Cannabis Assessment in the UK Cost?

It’s often difficult to state exact prices because private clinics have varying fees based on packages, follow-up, and formulations.

At the time of writing, no specific prices were widely stated in public sources. If you want up-to-date and exact fees, the best approach is to consult trusted directories like medicalcannabis.co.uk. They frequently provide comparative pricing and transparent listings.

Remember that private prescribing means you pay out-of-pocket not only for the assessment but also for the medicine itself, which can be costly because cannabis medicines are not routinely funded on the NHS.

Summary: What You Really Need to Know

You do not legally have to try two specific treatments before accessing cannabis medicines. The “two prior treatments” requirement is a clinical safety practice, not a hard-and-fast legal rule.
Only specialists on the GMC register can legally prescribe medical cannabis. GPs cannot prescribe these medicines, so private clinics offering assessments usually involve specialist doctors.
Medical cannabis became legally prescribable in the UK in 2018, but NHS funding is very limited and condition-specific. Most patients access cannabis medicines through private prescriptions.
Unlicensed cannabis medicines are prescribed cautiously and are often unfunded on the NHS. This affects availability and cost.
Private clinic prices vary, and no universal fee is fixed. Direct comparison tools like medicalcannabis.co.uk can help you find out current costs.