Some days I wonder if I’m going mad – and you don’t need to be a psychiatrist to know that’s not a good sign. I work in a specialist NHS service for people experiencing first episode psychosis – young people at their most vulnerable, teetering on the edge of severe and enduring mental illness, some of them already sliding towards schizophrenia. Day in and day out, I watch how cannabis has destroyed people’s minds. It is, frankly, heart-breaking. So you can perhaps imagine how I feel when those same patients mention, almost in passing, that a private doctor has prescribed them cannabis. Not for cancer pain, not for the muscle spasms of multiple sclerosis, not for the intractable epilepsy of a child for whom nothing else has worked (the conditions where there is at least a credible clinical argument) but for their mental health. For depression. For anxiety.
This is, and I do not use the phrase lightly, a prescription for disaster
I’m sorry, what? We are handing this stuff out on prescription for the very conditions it is known to cause and worsen. It is, and I do not use the phrase lightly, a prescription for disaster. Despite the protests of the powerful pro-cannabis lobby, it has now been proved beyond any reasonable doubt that cannabis use is directly associated with depression, anxiety, psychosis and avolition, a grinding loss of motivation that can hollow a person out completely.
While cannabis can sometimes make a user feel temporary relief and give them respite from depression and anxiety, in the long term it makes them worse. It seems to me a peculiarly bitter irony that just as we as a society are becoming more understanding about mental illness, a drug directly responsible for destroying people’s mental health is not only spreading unchecked but is now being actively dispensed by doctors.
Just recently I had a patient who had a history of psychosis. She’d been watching TikTok and become convinced that cannabis was the answer to her ADHD. A private clinic had given her a prescription without checking her notes, without calling me, and without calling her GP. It came out only by chance, in conversation. I sat there absorbing this information, thinking: a private doctor has prescribed her a powerful drug that is directly contraindicated for her condition, without contacting a single one of the clinicians actually responsible for her care. How is this right?
The latest figures, published in the Times, should alarm anyone who cares about how medicine in this country is practised. Since cannabis was legalised for medical use, just ten private doctors have signed off more than half of all cannabis-based prescriptions in the country. Ten doctors. One consultant alone accounted for one in every ten prescriptions nationwide, getting through nearly 46,000 in the first five months of last year. Do the arithmetic and that works out at roughly one every two working minutes. I’ll leave you to draw your own conclusions about how rigorous those consultations could possibly have been.
To understand how we’ve ended up here, it’s worth remembering that the story of medical cannabis in this country started in a genuinely sympathetic place. In 2018 the government legalised cannabis-based medicines following the case of Billy Caldwell, a severely epileptic child experiencing hundreds of seizures a day, for whom cannabis had worked when almost everything else had failed. The public outrage when his medication was confiscated at the border was entirely justified, and it was right to change the law. Cannabis does have legitimate medical uses for certain rare epilepsies, for chronic pain, and for patients who have exhausted every other option. Nobody sensible disputes this. What nobody could have anticipated was quite how rapidly and recklessly that door would be shoved open. Many doctors said so at the time, of course. When the law changed in 2018, there were plenty of voices in the medical profession warning that this was the thin end of the wedge; that however carefully the legislation was drafted, a private market would find ways to exploit it, that the definition of clinical need would be stretched until it was meaningless, and that the result would be cannabis available on medical prescription to more or less anyone who wanted it. Those concerns were dismissed as scaremongering. They were, it turns out, entirely justified. You can now claim some suitably vague condition, sit through a brief online consultation, and walk away with a prescription for cannabis at a potency you would struggle to obtain from the finest drug dealer in the country. The word ‘medical’ does a great deal of heavy lifting in all of this.
The prescription numbers tell the story. From a standing start in 2018, monthly figures climbed slowly at first, then accelerated sharply, reaching around 10,000 a month by mid-2022 and surging to nearly 100,000 a month by early 2025. Almost none of this growth has been driven by epilepsy or chronic pain. At Mamedica, one of the largest private cannabis clinics in the country, over half of its 12,000 patients are being prescribed cannabis for psychiatric conditions. (Mamedica says that cannabis treatment can be ‘game changing’ for these patients and has led to improvements in mood, hope and functioning. Its CEO says that ‘At Mamedica, every patient undergoes full clinical assessment, shared decision-making and ongoing monitoring under strict governance. This is structured, accountable medicine, not volume prescribing.’)
Professor Sir Robin Murray of King’s College London, who has spent his career studying the catastrophic relationship between cannabis and psychosis, has been watching all of this with undisguised alarm. He has warned bluntly that certain private clinics are ‘causing harm to the people they are claiming to help’. But it’s another observation of his that really cuts to the heart of the matter. ‘Usually,’ he has pointed out, ‘if a person has a medical condition, they see a doctor who specialises in a particular area of medicine, for example, respiratory or kidney disease. After diagnosis, the doctor prescribes from a range of treatments’. That, of course, is how medicine is supposed to work. A condition is identified, an appropriate specialist assesses it, and a treatment is chosen on the basis of evidence. What is happening in these clinics is the precise opposite: the treatment comes first, the condition barely matters, and the evidence is nowhere to be seen.
A quarter of psychosis cases in South London were associated with skunk, according to Murray’s research at the Institute of Psychiatry. Oxford University has shown it raises the risk of depression in teenagers by 40 per cent. None of this is seriously contested, it is settled science. Last month a major review in the Lancet Psychiatry screened nearly 6,000 studies and found that cannabinoids showed no significant benefit for anxiety, PTSD, psychotic disorders or OCD. For depression – the single most common reason cited for prescription across most legalised markets – there were no randomised controlled trials to look at. None at all. Not a thin evidence base. No evidence base whatsoever. And still these prescriptions keep on coming.
Then there is the question of what, exactly, is being prescribed, because it is emphatically not the careful, pharmaceutical-grade product the word ‘medical’ implies. Many of these prescriptions are for high-potency products with THC content exceeding 30 per cent. One strain, cheerfully named Space Cake, clocks in at 34 per cent THC. Street skunk – the very stuff Sir Robin Murray and colleagues have spent years linking to psychosis – typically contains between 14 and 16 per cent. So we are prescribing considerably stronger products to people who are already mentally unwell, with no credible evidence that it does them any good. If this were happening with any other substance, there would be a public inquiry.
Make no mistake, the human cost of all this is not abstract. Oliver Robinson was 34 years old, a former property developer from Bury in Greater Manchester. He had been struggling with depression, bipolar disorder and anxiety, and was already under the care of NHS and Priory psychiatrists, both of whom were strongly opposed to him using cannabis, when he turned to a private clinic. A video consultation with Curaleaf was all it took. The clinic based its decision on a GP summary that was nine months out of date. It never contacted his other treating psychiatrists. It prescribed him cannabis. What followed was 18 months of deterioration as his dependency took hold, eventually costing him a £1,000 a month, until he could bear it no longer and was found dead at his home in November 2023.
The inquest, concluded in January this year, made for grim reading. Coroner Catherine McKenna ruled that the prescription had ‘probably contributed to his death’ and had ‘acted as an obstacle’ to him receiving appropriate psychiatric care, giving the drug, in her words, a sense of legitimacy that made it harder for him to engage with the clinicians who were actually trying to help him. She issued a Regulation 28 Prevention of future deaths report to Curaleaf, finding that the prescribing doctor was a children’s and adolescent psychiatrist with no experience of treating adults with Oliver’s complex presentation. His brother Alexander said afterwards that he believed profit had been prioritised over his brother’s life. It is thought to be the first time a coroner has formally linked a private cannabis prescription to a patient’s death. It will not, I fear, be the last. Sir Robin Murray, responding to the verdict, was characteristically direct. These clinics, he said, are ‘nothing more than drug dealers for the middle classes’. Some clinics seem almost proud of how easy they make it to get a prescription. The industry, when challenged, responds with the usual blizzard of patient testimonials and wellness language, insisting people have every right to try whatever they believe is helping them. Let’s be honest about what this is: it’s retail with a prescription pad.
Of course, cannabis has over the past decade acquired a sort of halo. It became the anti-establishment option, the natural remedy, the thing your GP would never prescribe because of Big Pharma and vested interests and all the rest of it. It has latched onto the broader conversation about mental health in the same way recreational ketamine has managed to: cynically and with considerable commercial savvy. The moment it put on a white coat, a great deal of critical thinking went out of the window.
To its credit, the NHS has stayed sceptical. There are only around 5,000 NHS prescriptions for licensed cannabis medicines each year, limited to conditions with genuine evidence behind them, and Nice has declined to recommend it for the vast majority of conditions the private clinics are happily treating. So the private market has simply flourished in the gap, turning NHS caution into a marketing opportunity and positioning itself as the enlightened alternative to a stuffy, out-of-touch establishment. It’s a cynical trick and it has worked spectacularly.
I’ve sat with families trying to make sense of how their bright, funny, perfectly healthy child ended up psychotic. I’ve watched patients who started smoking skunk as teenagers and never quite came back. And now I find myself watching those same patients – or patients just like them – being sent home with a prescription for something considerably stronger than what broke them in the first place, signed off by a doctor churning out one every two working minutes. It’s utter madness. It really is.
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