With the recent news that from the new year in 2020, the Ministry of Health for the Czech Republic will start subsidising payment of medical cannabis from public health insurance, it remains clear that the U.K is lagging behind in terms of medical cannabis provision and ease of access.
To illustrate how far behind the U.K remains in this respect, in this article we’ll be looking at how 3 evolved cannabis markets, the Czech Republic, Germany and Denmark, approach cannabis use and legislation.
Germany, Europe’s largest economy, is the forerunner of Europe’s cannabis industry after the introduction of new medical cannabis legislation in March of 2017 coupled with the creation of 11 product licenses.
Germany permits the sale of many cannabis-based medicinal products including Nabilone, Dronabinol and Sativex. The country also allows the use of cannabis flowers for medicinal use and has done so since 2017, when medical cannabis was concurrently legalised. This legalisation meant that where there were previously only 1000 accepted applications for medical cannabis from patients, in 2018 Cannamedical Pharma (a leading provider for German patients) estimated that 30,000 patients would be served.
Germany’s medical cannabis programmes, which are expected to be amongst the most robust in Europe, are still being developed.
Recreational cannabis use is still illegal in Germany. Nonetheless, with shifting attitudes in the country, punishments have become increasingly lenient in this regard.
To meet the ever-increasing demand for medicinal cannabis from patients, Germany relies upon importing medical cannabis from abroad. Indeed, from September 2017 to March 2018, 2100kg of medical cannabis was imported by the country, which equalled the maximum amount allowed by the initial legislation that was in place at the time. Germany is expected to be importing cannabis until 2020.
Due to a well-established advocacy community and research environment in the country, decriminalisation seems likely in the not too distant future. However, a regulated market for adult use still seems unlikely to be achieved before around 2022.
The Czech Republic
Recreational cannabis use was decriminalised in the country in 2010, with the consumption of cannabis for medical purposes being legally regulated back in April 2013. The pharmaceutical products Dronabinol and Sativex are both available by medical prescription. However, the medical cannabis market in the country has been hampered by a lack of competitive suppliers and supply shortages.
Currently, hemp is regulated as an industrial commodity in the country so the limits on its cultivation and processing are more relaxed than in its neighbouring countries. Both CBD and hemp oil are legal, meaning they can be purchased openly. Due to these more relaxed limits, the country has become a world leader in cannabis-infused products (like dietary supplements and cosmetics). Many Czech products, including those from the Biovita group and CBDex, are on sale in multiple European countries like Germany, Spain and the UK. With the increasing popularity of hemp products, a bright future likely lays ahead for the cannabis industry in the country.
From the new year in 2020, the Ministry of Health for the country will start subsidising payment of medical cannabis from public health insurance, with patients being set to pay just hundreds for their medical cannabis as opposed to the thousands they are currently paying.
The country’s minister of health Adam Vojtěch stated that, due to the current cost of medical cannabis meaning that its use is a significant burden for some patients – making illegal domestic cultivation more likely: “we want to contribute up to 90% of the sale price of cannabis in the pharmacy from public health insurance. The amount of the supplement will be comparable to the supplement for the treatment of chronic diseases.”
The future of the cannabis industry in the Czech Republic seems promising with this recent development in the subsidising of medical cannabis in the country. However, at present, despite the country being a hub for cannabis business activity and research, very few cannabis-based pharmaceutical products are actually available (only Dronabinol and Sativex are available currently). Nonetheless, with the new changes making medical cannabis easier to access in the country and CBD and hemp products already being available for open purchase, it will be interesting to see how legislation changes in the near future in this progressive country.
Despite policies on cannabis use being historically very strict in Scandinavia, Denmark has made notable changes to its approach to cannabis in recent years.
Although the council of Copenhagen’s proposal for the regulated sale of cannabis in the city was rejected at national level in 2011, just 7 years after this, in January 2018, the country legalised the use of medical cannabis by a unanimous vote in parliament. This legalisation was swiftly followed by a national tender for the cultivation of medical cannabis by both international and domestic companies.
Denmark has also approved a number of cannabis-based medicines including Dronabinol, Sativex and Marinol, which are now available to buy with a medical prescription from a doctor.
In November 2017, plans to run a 4-year trial on medical cannabis were announced by the country’s parliament beginning in January 2018. €2.7 million was committed to the trial by the government, with the trial focussing largely upon the quality of life of the patients during the trial as well as the clinical effects of medical cannabis. Initial licences were provided by the government for testing purposes, with the general intention of creating a ‘Danish standard’.
Despite medical cannabis becoming increasingly available, recreational cannabis use remains illegal.
The Danish government has also stated that it will subsidise terminally ill patients’ cannabis expenses in full.
For more in depth information on different regulations in various countries and how this affects pharmacists and patients, we recommend accessing our in depth modules available on our website. Here, you can find up to date information on CBMPs and how best to prescribe them. You can also explore our news section and evidence base for the latest information on this ever-changing area of research.