‘Significant Variation in Standards’ Found Across UK Medical Cannabis Pharmacies as ACMD Review Call Closes

Commissioned by the Home Office on 2 June 2025, the sweeping three-year project aims to re-evaluate whether the UK’s current system for prescribing, supplying, and researching medical cannabis is fit for purpose, and whether it has achieved the objectives envisioned when cannabis was rescheduled from Schedule 1 to Schedule 2 nearly seven years ago.

While the wider report’s findings and recommendations are some way off, this month’s new report from the General Pharmaceutical Council’s (GPhC) provides the most detailed regulatory snapshot yet of how medical cannabis is being dispensed across the UK. 

More importantly, it offers valuable insight into how the ACMD’s review may take shape, coming against the backdrop of major industry crackdowns in markets like Germany, Poland and Australia, and concerns from industry similar restrictions could soon come to the UK. 

While industry stakeholders will be keen to emphasise some of the inherent issues embedded in the current framework, which patients invariably bear the brunt of, serious questions remain regarding the government’s historic response to recommendations by the ACMD. 

While the results and recommendations of the ACMD’s review are some way off, the The General Pharmaceutical Council’s (GPhC) 2025 themed review of pharmacies supplying cannabis-based products for medicinal use (CBPMs) provides the most detailed regulatory snapshot yet of how medical cannabis is being dispensed across the UK. 

Commissioned in parallel with the Advisory Council on the Misuse of Drugs (ACMD)’s wider policy review, the report exposes wide variation in compliance, governance and clinical oversight across a sector still dominated by private prescribing.

The GPhC’s findings will be central to the ACMD’s assessment of whether the 2018 rescheduling of CBPMs has achieved its intended outcomes, and whether new safeguards or system reforms are required.

Published earlier this month, it inspected 25 pharmacies regularly supplying CBPMs, of which 24 were operational at the time, analysing 68 concerns raised about CBPM management and supply.

Governance was the most inconsistent area of compliance. Seven pharmacies failed to meet the GPhC’s standards due to incomplete risk assessments and weak oversight of third-party prescribers.

Some pharmacies ‘had no formal risk assessments in place’ and ‘failed to address CBPM-specific issues, such as setting limits on the supply quantities of unlicensed controlled drugs.’

Safeguarding was another critical focus, with the report stating that ‘CBPMs are often prescribed to individuals with complex medical needs… robust safeguarding measures are essential.’

While most pharmacies provided Level 2 or 3 training, some ‘could not show evidence of regular audits’ or ‘had poor oversight of complaints and concerns made about their services.’

In one severe breach, ‘a pharmacist had inappropriately prescribed controlled drugs to a person with a known history of drug misuse.’ The regulator stressed that ‘all patient-facing staff should complete safeguarding training at a level appropriate to their role.’

Three pharmacies failed to meet standards relating to staff competence and training. The GPhC found that CBPM-specific training was inconsistent and often lacked verifiable quality assurance.

‘Training sources were not always clearly specified… making it difficult to assess the credibility of some learning packages.’

In some cases, unqualified staff dispensed CBPMs, or dispensing occurred without a Responsible Pharmacist present—a serious compliance breach.

Pharmacies demonstrating best practice implemented structured induction programmes, tracked staff training, and held regular multidisciplinary meetings with partner clinics.

A recurring theme in the GPhC’s findings, and of direct relevance to the ACMD’s policy questions, is that many pharmacies lacked access to patient clinical records, severely limiting their ability to perform safety checks.

“One pharmacist had limited ability to carry out meaningful clinical checks… as they had no access to the patient’s medical history or consultation notes.”

Those with data access, however, ‘were able to provide clear examples of clinical interventions.’

The GPhC warned that pharmacies acting primarily as a ‘supply-only’ service posed significant risks and urged closer collaboration between pharmacies, clinics and prescribers to improve information sharing.

Errors and delays in dispensing were among the most common complaints investigated.

“We received 44 concerns relating to the dispensing of CBPMs. Around 60% were due to delays in receiving prescriptions… Other reasons included miscommunication between prescribers and pharmacies.”

In one serious case, a patient was hospitalised following a disease flare-up caused by treatment interruption. Another involved duplicate prescriptions issued a week apart.

The GPhC urged pharmacies to maintain clear lines of communication with prescribers and to ‘support patients in identifying and accessing suitable alternative treatment options when necessary.’

Most pharmacies sourced CBPMs responsibly from licensed manufacturers, but some stocked non-compliant CBD products.

“One pharmacy stocked CBD products classified as food supplements that were not listed on the Food Standards Agency’s approved list for novel food applications.”

Security compliance was generally strong, though not universal, with ‘most pharmacies storing CBPMs in secure CD cabinets… (and) some implemented additional security measures, such as double-lock systems and reinforced brick structures.’

However, several pharmacies failed to meet safe custody standards: “One pharmacy used a cage to store controlled drugs without the required exemption certificate… In one case, dispensed CBPM prescriptions were left unsupervised in the main dispensary.”

Delivery risk management also varied, with one pharmacy delivering dispensed controlled drugs on foot to a postal sorting office over a mile away, posing a security risk.’

While the GPhC found that ‘most pharmacies met the required standards for the safe procurement, storage, and dispensing of CBPMs’, it warned that online and distance-selling models carry ‘significant challenges’ and higher risk.

The report highlights three system-wide needs now under consideration by the ACMD:

The GPhC’s findings have been formally shared with the ACMD as part of its 2025–26 review of CBPMs.

The pharmacy regulator’s evidence will underpin the ACMD’s evaluation of how the post-2018 framework has operated in practice, particularly regarding clinical governance, patient safety and professional accountability.

The report establishes a clear link between frontline dispensing risks and systemic regulatory gaps, positioning the GPhC’s data as essential context for the ACMD’s forthcoming recommendations to the Home Office and DHSC.

While most evidence submitted to the ACMD remains confidential, several organisations have chosen to make their responses public.

In her commissioning letter, Rt Hon Dame Diana Johnson DBE MP, Minister of State for Policing, Fire and Crime Prevention, instructed the ACMD to assess whether the 2018 reforms had ‘had the desired impact’ and to identify ‘any unintended consequences which were not anticipated at the time of implementation.’

She also directed the council to use medical cannabis as a case study for ‘understanding how existing laws may inhibit scientific testing’, in reference to long-standing concerns about barriers to research under the UK’s Schedule 1 licensing regime.

The ACMD’s 2024 report, Barriers to Research Part 2, had already warned that these rules were ‘stifling scientific and clinical progress’, recommending that research on Schedule 1 substances, including CBPMs, be conducted under the same conditions as Schedule 2 drugs.

The Council concluded that the current system is ‘out of step with scientific and clinical needs’ and urged the Home Office to amend the Misuse of Drugs Regulations 2001 accordingly.

This latest review is expected to build on that work, using both regulatory evidence and stakeholder submissions to propose a more practical framework for research, prescribing, and patient access.

The ACMD launched its call for evidence on 17 September 2025, inviting submissions from ‘as broad a spectrum of participants as possible’ before the 17 October deadline.

Alternaleaf’s Medical Director, Nabila Chaudhri, described the review as ‘an important moment for patients, clinicians, and clinics to highlight the significant progress being made through CBPMs.’

She told Business of Cannabis that education remained a key barrier, noting that ‘increasing understanding of the effectiveness and legality of medical cannabis among the public, police, and healthcare community’ would be crucial to improving access.

Other submissions are expected to highlight the lack of NHS uptake, the dominance of private prescribing, and the continued absence of a comprehensive patient registry, something first promised in the ACMD’s 2020 interim assessment that has yet to come to fruition.