While it may be nominally legal, medical marijuana needs to be far more easily available and its use encouraged by treatment services, says Nick Goldstein. The curse of COVID makes writing about substance misuse treatment virtually impossible. Not only has localism fractured treatment policy and practice over the years, but now COVID has completely overshadowed everything. Who knows what\u2019s going to come out the other end? We\u2019re seeing society unalterably changed and it\u2019s happening at breakneck speed. Only a fool would claim to have an overview of this chaos and although I\u2019ve been called many things, \u2018fool\u2019 was never one of them \u2013 yet, anyway. Nil desperandum though, guys. There are some things that are so large that whatever happens with COVID they will make a significant impact on arrival, and one of those is medical marijuana. Medical marijuana is the use of the cannabis plant and its derivatives for their healing properties. These medicinal effects aren\u2019t exactly hot news. In fact we\u2019ve been using medical marijuana for thousands of years \u2013 it\u2019s mentioned in Chinese medical texts from around three thousand years before Christ put in an appearance. The list of ailments it can alleviate and treat is far too long to get into here but it includes many serious conditions and illnesses that really have no other treatments. Medical marijuana\u2019s benefits are great enough for its use to be an accepted treatment in many countries \u2013 despite the demonisation and prohibition of cannabis for decades \u2013 and even America has seen the light and offers medical marijuana as a treatment choice. For those who\u2019ve been living in a dark cave, marijuana was made available on prescription in the UK in November 2018. But before we all rush off to the doctor\u2019s I should point out that \u2013 as is sadly far too often the case \u2013 our medical profession wimped out. I guess after all those years at medical school they\u2019re reluctant to risk the ire of the tabloids and the BMA disciplinary committee and have consequently sat on their prescription pads and used the hackneyed excuse that there\u2019s not enough evidence medical marijuana is worthy of treatment on the NHS. They\u2019re right in that there is a shortage of research \u2013 drug companies believe medical marijuana will cost them money rather than make it. So, no money, no research and no research, no prescription \u2013 we\u2019re back at square one. But to add insult to injury medical marijuana is now legal and available \u2013 in theory. You gotta love doctors. What was it, guys? Ah yes, \u2018first, do no harm.\u2019 And this deeply ironic state of affairs is how things have been stumbling along for the last couple of years \u2013 until recently. At the end of 2019 Professor David Nutt\u2019s Drug Science started the Twenty21 project, the aim of which is to sign up 20,000 patients by 2021. Hopefully this will not only offer relief to the 20,000, but also provide the evidence to enable medical marijuana to be offered universally on the NHS whilst saving the medical profession from requiring a spine. Carly Barton, a medical marijuana campaigner, has recently produced the \u2018Cancard\u2019 which would allow anyone stopped while in possession of cannabis to prove their cannabis was medicinal and not for recreational use and so avoid prosecution \u2013 an approach supported by none other than the Police Federation and National Police Chief\u2019s Council. The Cancard aims to reach over a million people who will benefit from medical marijuana by November 2020. One way or another, like it or not, medical marijuana will soon be a fully integrated medicine and then it\u2019s going to come into contact with substance misuse treatment. A civilised country with a good substance misuse system would see medical marijuana as a boon and encourage suitable users in need to access it, but we don\u2019t have a good treatment system \u2013 and, to be honest, I\u2019m not sure how civilised the country is these days. Anyway, it should be seen as a boon because medical marijuana could play several roles in treatment. Firstly, it can help in recovery. Apologies to all the NA crew, but it\u2019s perfectly sane to encourage those in post-acute withdrawal to take marijuana to relieve the minor aches and pains and, more importantly, offer significant help with the psychological aspects of withdrawal. Secondly, marijuana can also play a role for those on longer term maintenance treatment where it can be used in conjunction with OST to improve compliance. It\u2019s also worth pointing out that after a decade of sub-optimal dosing many users are struggling on too low a dosage and quietly making the difference up with benzos and booze, which is the most dangerous drug combination out there. Marijuana offers a much safer alternative than central nervous system depressants for those desperately trying to maximise their under-prescribed dose. On top of the specific benefits, service users are people too. So, all the general advantages that everyone else derives from medical marijuana also apply to them, and considering service users are an ageing group with a whole range of aches, pains and illnesses will only mean a larger intersection between service users\u2019 needs and medical marijuana use. So, medical marijuana will be a boon, right? Well, maybe \u2013 if service users are allowed to use medical marijuana, but that is by no means certain. Maybe I\u2019m paranoid to question treatment providers\u2019 approach to medical marijuana, but history suggests that while I might be paranoid, but they really are out to get me. I won\u2019t be surprised to see treatment providers disapprove of service users also using medical marijuana. Let\u2019s face it, many doctors, key workers and others have a negative, black and white view of drug use. So, perceiving cannabis as medication rather than kicks might be a step too far. This has happened before. America is years ahead of the UK in regards to medical marijuana and many American substance misuse clinic users are prohibited from using medical marijuana. They face being booted from treatment (even if they pay for it) for using what is essentially a legal medication. I appreciate America is a different land but it would take a brave man to bet against the same blinkered approach happening in treatment services here. In rising Spice use we already have an example of what can happen when marijuana is poorly classified, and its use punished rather than accepted and even valued. Personally, I\u2019m going to use weed anyway, but as I age my reasons for using change and now I often use to relieve assorted aches and pains. It would be sensible, not to mention compassionate, to let me access medical marijuana legally and openly. To be clear, encouraging medical marijuana use for clients in need should be seen as best practice. Sadly, sense and compassion are in short supply these days.