Over-the-counter (OTC) CBD products have become increasingly prevalent in the UK and globally. At the same time, access to medical cannabis for patients who meet appropriate criteria was permitted by law back in November 2018 when prescribed by a specialist clinician. The 2018 law change rescheduled cannabis to allow for the prescription of cannabis-based medicines. But four years after legalisation, access to medical cannabis through the NHS remains incredibly low, with the majority of prescriptions provided by private clinics.
Many cannabis-based medical products (CBMPs) are based on cannabidiol (CBD) and/or tetrahydrocannabinol (THC) – the two most common cannabinoids found within the cannabis plant. However, CBD has also become increasingly found in the food supplement and wellness sectors. Despite the popularity of CBD products in the UK, the industry has faced consistent criticism due to the use of unsubstantiated medical claims. The situation led to the 2019 ruling that CBD products were to be considered “novel foods” under EU law. In 2021, UK regulations were updated, meaning that all CBD wellness products in the UK must conform to European Novel Foods Regulations.
As the popularity of CBD products continues to grow, awareness of medical cannabis rescheduling in the UK appears to be low among the public. A previous UK survey (2020) found that only 54% of respondents knew that CBMPs were available through prescription in the UK. This lack of awareness, combined with a lack of education and a paucity of high-quality randomised controlled trials has likely contributed to the continued barriers to medical cannabis in the UK. A recent survey aimed to “assess the public awareness of the availability, regulations, and barriers to access medical cannabis and over-the-counter CBD wellness products.”
Design and Methods of the Study
A cross-sectional survey analysis was performed of UK residents between March 22nd and March 31st 2021. A public-opinion survey was administered utilising YouGov® public research panels. A total of 10,684 participants completed the survey within the 10-day period. The survey collected demographic data in addition to participant knowledge of medical cannabis and over-the-counter CBD regulations and legislation.
Public Awareness of Medical Cannabis Regulation
The results of the survey revealed that only 51.4% (n = 5,494) of respondents believed that medical cannabis is legal in the UK. Subsequently, 48.6% (n = 5,191) of respondents either did not know medical cannabis is legal (31%) or believed that it was illegal (17.6%). This finding was similar to the results of the previous 2020 survey which found that 46% of respondents were unaware that medical cannabis is legal, indicating that public awareness has not improved in the year between the two studies. Medical cannabis association with recreational cannabis was most frequently reported as the main barrier to access (25.1%), followed by being unsure if it was legal (21.3%) and being unsure what medical conditions it can be prescribed for (17.4%).
The researchers note that this lack of awareness may be, at least in part, due to the rapid process in which the law change came about; however, the lack of change in the 12 months between the two studies indicates that this lack of awareness is multifactorial. The complexity of medical cannabis legislation – for example, the rescheduling process through which medical cannabis was legalised – may also be a barrier to understanding. Demographic data collected from the survey demonstrated that participants who were employed were more likely to know that medical cannabis is legal; however, there was no formal assessment of education level.
The lack of education among physicians has also been repeatedly pointed out as another barrier to medical cannabis access. This may also contribute to the lack of public awareness of the legality of medical cannabis products.
Public Awareness of CBD Regulations
The results of the survey revealed that 6.4% (n = 684) of respondents consumed CBD for wellness reasons while 2.7% (n = 286) were prescribed CBD for medical reasons and 2.1% (n = 222) consumed CBD for another reason. The vast majority (94.3%) of respondents were unaware of 2021 regulations meaning that all over-the-counter CBD products in the UK must conform to European Novel Foods Regulations.
As OTC CBD products are not subject to the same restrictions in marketing as medical cannabis in the UK unsubstantiated claims can often be propagated through social media and other platforms. The findings of this survey reinforce the need for clear education on the differences between these two categories of products, in particular the differences in regulation.
At the time of the study period, almost two and a half years had elapsed since the change in the legalisation around medical cannabis in the UK. Despite this, a significant proportion of the population is still unaware of this change, indicating a significant lack of education and persistent barriers to accessing medical cannabis. The public also remains similarly unaware of the regulations concerning over-the-counter CBD products, leaving consumers at risk of using these products inappropriately or using low-quality products.