Back in 2021 there were a little over 27,000 registered medical cannabis patients in UK, based on numbers registered with the Cancard medical cannabis ID card in 2021 to receive raw cannabis flower or cannabis oil.
This number has already grown materially in the past year and according to some calculations is set to accelerate in the next few years.
By the end of last year this number is estimated to have risen to 32,000 according to cannabis industry research experts Prohibition Partners.
Patient numbers are seen growing to over 47,000 by the end of this year, with Prohibition forecasting this will jump to roughly 70,000 by the end of 2024 and over 163,000 by the end of 2025 on the assumption that more GPs will be allowed to prescribe medical cannabis.
Currently though, apart from just four patients on the NHS, all of whom are children, all medical cannabis patients are private, says Professor Mike Barnes, a neurologist who has set up the Medical Cannabis Clinicians Society and medical cannabis consultancy Maple Tree.
Just over 110 doctors are currently prescribing medical cannabis, says Prof Barnes, who is working on improving that number by educating and trains doctors about prescribing medical cannabis.
“I'm training another eight doctors tonight, so it's going up bit by bit," he adds.
Medical cannabis is mostly prescribed for chronic pain, including for patients with multiple sclerosis, neurological and cancer-related pain. It is seen as an alternative to opioids that is less addictive and with other benefits.
While numbers of patients prescribed raw cannabis flower is still in small but numbers are in the UK going up, “by around a thousand patients a month”, says Barnes.
He and other proponents point to Germany as providing an example of how the market could expand.
Compared to €44mln of sales this year for the UK, according to Prohibition Partners, Germany's 235,000 patients are part of a market estimated to expected to reach €390mln in sales this year. Prohibition forecasts German cannabis sales will rise to €690mln by 2025.
Cultivating an inclusive environment
It’s hard to predict how the UK market will go, with political will potentially a big factor, but some encouragement might be taken from the House of Commons holding its first debate on the potential economic benefits of medical cannabis earlier this year.
With all products currently imported, consistency of supply is a major problem for doctors and patients, says Barnes.
An improvement, therefore, would provide a big boost, with Barnes suggesting that this should be helped by a handful of newly approved UK-based growers expected to come on stream this year and next.
UK-based cultivators include Celadon Pharmaceuticals PLC (AIM:CEL) and privately owned names such as Northern Leaf (currently unlisted but recently raised pre-IPO money), Hilltop Leaf (which is importing some cannabis flower as it builds its own supplies) and Glass Pharms (still in the construction phase).
Medical gatekeepers
Another of the bottlenecks for medical cannabis are the NHS's guidelines from NICE (the National Institute for Health and Care Excellence ), says Prof Barnes.
“NICE said there's not enough evidence to support more widespread prescriptions of cannabis and that there’s not enough double-blind placebo-controlled studies, the classic way of approving new drugs.
“And it’s a brave doctor and NHS trust that goes against them,” he says.
Indeed, the nature of cannabis does not lend itself to being treated like a pharmaceutical pill, he acknowledges.
“Unlike a pharmaceutical product, where you put the ingredients for one pill in the machine and each pill comes out the other the same, cannabis is less precise – the same seed and same genetics affected slightly by endless variables such as the temperature it was grown at, whether it was indoors or outdoors, how it was fertilised and dried.”
While NICE and the NHS retain a conservative approach, there are a small number of pharmaceutical medications derived from the plant to treat one or two conditions, with a much larger number still in clinical development.
Currently in the UK the market for medical cannabis is still much smaller than that for one of the chief chemical extracts derived from the cannabis plant, cannabidiol (CBD).
CBD sales were €344mln in the UK this year, on a par with Germany. This is in large part as CBD can be bought without a prescription as a health supplement or in cosmetics products.
Some might see CBD sales as an indicator of potential demand and growth in medical cannabis.
The UK and wider European cannabis market continues to mature and the companies operating in the sector have had to navigate these changes, which offers an intriguing landscape for investors.