Two cannabis-based drugs have been recommended for use on the NHS for the first time.
Epidyolex is approved for two rare types of epilepsy, Lennox-Gastaut and Dravet syndromes, while the spray Sativex has been recommended for multiple sclerosis (MS) muscle spasms.
Welfare welcomed the move, but said thousands of other people who could benefit from cannabis-based drugs were left in limbo.
A change to the law in 2018 made it legal for doctors to prescribe medical cannabis.
However, many doctors have been reluctant to do so, citing a lack of clear guidance on prescription and drug financing issues.
This has led some families to travel abroad in search of medicines, while some bring them into the UK illegally.
The new guidance from the National Institute for Health and Care Excellence (Nice) looked at cannabis-based products under several conditions.
It found a lack of evidence of their use in managing chronic pain, and people with chronic pain should not be prescribed medications containing THC (delta-9-tetrahydrocannabinol) – the psychoactive ingredient in cannabis.
It also said more research on cannabis-based drugs was needed to treat epilepsy other than Lennox-Gastaut and Dravet.
About 8,0000 to 9,000 people in the UK suffer from Lennox-Gastaut and Dravet syndromes.
Millie Hinton, of the End Our Pain campaign, said the guidelines were "a massive missed opportunity" to prescribe medical cannabis to thousands of people with a variety of conditions.
"It is particularly devastating that there is no positive recommendation that the NHS should allow prescribing of whole plant medical cannabis containing both CBD (cannabidiol) and THC in appropriate cases of indispensable childhood epilepsy," she said
“It is this kind of whole plant extract that has proven to be life-changing for a large number of children, including those involved in the high-profile cases last year, which led to legalization of medical cannabis.
“A number of the families that we represent met senior representatives in Nice just a few weeks ago.
"They explained, first, that they paid thousands of pounds each month for private prescriptions for whole plant extract medical cannabis and that their children showed dramatic reductions in seizure rates and equally dramatic improvements in quality of life."
She said Nice is fully focused on evidence from randomized controlled trials, but medical cannabis is not always suitable for these trials.
She added: "This restrictive guide condemns many patients for having to pay for life-changing drugs privately, going without or considering accessing illegal and unregulated sources."
Simon Wigglesworth, Deputy Chief of Epilepsy Action, welcomed the decision to recommend Epidyolex.
However, he said there were many thousands of people with other complex and treatment-resistant epilepsy who could potentially benefit from cannabis-based medication.
And he said there was a lack of high quality clinical evidence, especially around products containing THC.
He added: "While this is disappointing, we appreciate that clinical research is essential to ensure that any treatment recommended for use in the NHS is safe and effective.
"We are aware of the ongoing efforts to accelerate research into cannabis-based drugs for epilepsy, including those containing THC, in pace."
Nice also recommended Sativex for the treatment of muscle spasms in MS, a common symptom of the disease.
Genevieve Edwards, director of external affairs at the MS Society, said: “We have been campaigning for access to Sativex for years, and it is brilliant that Nice has finally listened.
“These guidelines are an important first step, but do not go far enough. No cannabis-based treatments have been recommended for the treatment of pain, a common symptom of MS.
"Moreover, because Sativex will be funded by local agencies – which may not have the resources they need to prescribe it – even more could be missed."
She said evidence shows that cannabis-based treatments can help about 10,000 people with MS get relief from pain and spasms when other treatments have not worked.
The families of two children, Billy Caldwell and Alfie Dingley – who both have severe epilepsy, have repeatedly struggled for easier access to cannabis medicines in England.
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