When a crew trainer at a fast food restaurant told her manager she had recently been prescribed medical cannabis, she came prepared. She explained her condition, suggested that she’d prefer not to work near the grill immediately after medicating, and provided a copy of her prescription. 

Despite her efforts to handle the situation transparently and professionally, her manager questioned the legitimacy of the prescription, a letter detailing what she was taking, why, and every possible side effect.

Another medical cannabis patient was called in for a meeting four months after declaring his medical cannabis prescription to his manager.  They were subjected to a drug and alcohol test and suspended on full pay pending a risk assessment. 

After failing a test for cannabis, he, too, was asked to provide a letter from his doctor explaining what the medication was, what it was for, and how it might affect him at work. In a Reddit post explaining his situation, the patient noted: “First thing to do is contact my union.”

There are myriad similar examples, patients either struggling with whether to be transparent about their prescriptions or facing employment issues for doing so. It’s no surprise that trade unions, which exist to protect workers from exactly this sort of situation, are often the first point of contact in such cases. 

While unions are undoubtedly there to help workers in situations like these, how much help they can actually provide ultimately depends on how much the person on the other end of the phone knows about medical cannabis. 

Plenty of attention has been paid to educating police forces, medical professionals and even employers themselves, but unions themselves are often overlooked when it comes to outreach from the industry on behalf of their patients. 

A Familiar Pattern

According to one of the UK’s largest medical cannabis clinics, Releaf, these cases are all too commonplace. Rupa Shah, Releaf’s Chief Legal and Compliance Officer, told Business of Cannabis:  “A typical case involves a patient who has tested positive in a workplace drug screening, often without realising their lawful prescription would trigger it. 

“They’re placed on suspension or face disciplinary action before anyone considers whether they hold a valid prescription. In many cases, the employer’s drug policy hasn’t been updated since before medical cannabis was legalised in 2018. 

“The patient is left feeling criminalised for following their doctor’s treatment plan. That’s exactly why we built Releaf Protect, so patients can immediately speak to a legal professional who understands the specific interplay between the Misuse of Drugs Act, the Equality Act, and workplace health and safety obligations.”

Releaf Protect was launched earlier this year,  a 24/7 legal support service developed in partnership with Irwin Mitchell specifically to help patients navigate difficult situations like these. 

When the clinic mapped where patients most needed help, employment issues emerged as one of the top categories. The sectors that appear most frequently include transport, logistics, construction, security, NHS and care workers, and teachers. 

“The common thread isn’t the sector,” Shah continued. “It’s whether the employer has a policy that distinguishes between a prescribed medication and recreational drug use. Most don’t.”

On paper, this is exactly the gap unions are positioned to fill, but right now, unions are in the same position as these employers, they’re simply unaware that cannabis is a legitimately prescribed medication in the UK. Once again, due to the unique dynamics of the UK’s industry, the onus to rectify this knowledge gap falls on the industry itself. 

“Through Releaf Protect, our 24/7 legal support service powered by Irwin Mitchell, we already support patients navigating employment-related issues that sit squarely in union territory: workplace discrimination, unfair dismissal linked to prescriptions, and failure to make reasonable adjustments under the Equality Act 2010. The data from our helpline tells us this is where patients need the most help, and unions are a natural ally in that effort.”

Medical cannabis clinics like Releaf, according to Shah, ‘have the data, the legal partnership, and the patient base’ educate union reps. “We’re ready to work with any union that wants to get ahead of this.”

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Six Million Reasons

According to the Department for Business and Trade’s Trade Union Statistics 2024, there are 6.4m trade union members in the UK, representing an overall membership density of 22% of the workforce.

That membership is heavily concentrated in precisely the sectors Releaf’s data suggests medical cannabis patients are most likely to encounter workplace friction. 

Union density in education stands at 45%, public administration and defence at 42.3%, health and social work at 36.5%, and transport at 34.8%. 

NHS England alone employs 2.03m people according to its own workforce statistics, the majority of whom are covered by Agenda for Change, the collectively bargained terms and conditions that govern NHS employment.

Apply a conservative chronic pain prevalence estimate of 15%, drawn from figures published by the British Pain Society, to the total union membership base of 6.4 million, and you arrive at a potential pool of around 960,000 people with union representation who may be living with conditions for which medical cannabis is increasingly being prescribed.

Right now, Prohibition Partners estimates the UK patient population to be around 90,000. With this in mind, Shah believes targeted and meaningful education of workers’ union reps could have a ‘significant’ impact on the ongoing issues faced by patients. 

“If unions began proactively educating their reps on how to support members with medical cannabis prescriptions, and if they pushed employers to update their drug and alcohol policies to distinguish between prescribed and recreational use, we’d see a significant shift. Not just for cannabis patients, but for the broader principle that no one should face professional consequences for following a legal medical treatment plan.

“Releaf’s role is to make that as easy as possible, through clinical expertise, legal support via Releaf Protect, and the kind of employer-facing resources that unions can actually use.

Normalisation is growing 

In February 2025, the CWU’s United Tech and Allied Workers (UTAW) branch passed a motion on cannabis-based medicinal products that represents the most substantive union action on the issue to date.

The motion, proposed by branch officer Sal Aziz and passed with the support of PatientsCann UK, commits the branch to briefing members on the distinction between prescribed and recreational cannabis, training representatives to support members facing discrimination, pushing for drug testing policy reform with employers, and engaging with the Labour Party on the issue at a national level.

It is a template for what proactive union engagement looks like, and came from within the union itself, driven by a rep who understood the issue because they had seen it affect members directly.

Shah says the appetite for this kind of structured engagement is there, but that the there’s still work to be done. 

“The Cannabis Industry Council published its guidance for employers and employees in September 2023, which was an important first step. But what’s needed now is sector-specific, practical and actionable guidance  – something an HR department can actually drop into their policy handbook. 

“Generic principles about the Equality Act are helpful, but an HR director at an NHS Trust would need different guidance to one at a logistics firm or a school.”

The UTAW motion is a start. But one branch motion does not update 6.4 million members’ drug and alcohol policies. That work still needs doing, and right now, the clinics treating those patients are best placed to help.