This is an edited version of Dr Pemberton’s article in the Spectator Magazine, 4 April 2025.
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.
Remember Where it All Started
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.
Volume Prescribing Has Become the Name of the Game
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.’)
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 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.
Cynical Approach to Treating Real Mental Health Issues
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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