The decision two years ago was a sensation in the German healthcare system: Since March 10th, 2017, patients have been able to access medical cannabis – as long as it’s prescribed by a doctor – on a regular basis. Since then, the drug has experienced a boom.
Foreign companies have come to Germany in the hope of big business, more and more patients are seeking cannabis therapies – and doctors, pharmacies and health insurance companies are experiencing an unabated rush.
Until liberalisation, medical cannabis was a niche in Germany, with only around 1,000 patients using it through a special permit. Since then, demand has risen rapidly, according to figures from the pharmacists' association ABDA and the German Cannabis Association (DHV).
Around 142,000 prescriptions were issued in 2018. The DHV estimates that there are currently 50-60,000 private and statutory health insurance patients – or three times as many as since the first 10 months of legalization in 2017.
The figures suggest significantly more patients are being supplied with medical cannabis, said Andreas Kiefer, CEO of the German Drug Testing Institute. Yet “we don't know whether all patients who could benefit from medical cannabis have access to it,” he said.
According to the DHS, doctors are still often reluctant to prescribe medicines containing cannabis because of the hurdles they face in its approval by health insurance companies, or because there remains a taboo about the use of cannabis, even for medical purposes.
Doctors lack continuing education about the drug, added DHV, and are thus often skeptical about its medical effects or that they could fuel a drug habit.
In 2018, a total of 19,600 applications for reimbursement of the often expensive cannabis therapies were received by the major health insurers alone – AOK-Bundesverband, Barmer, Techniker and DAK-Gesundheit.
Approximately two-thirds of the applications were approved by the health insurance funds, whereas in the remaining cases they were rejected or the companies asked for further information.
A boom for exporters from abroad
Germany has not yet granted licenses for the domestic cultivation of cannabis – which has led to a boom in exporters from abroad looking to sell in the German market.
Critics say it has also resulted in high prices – or three times that of what customers pay for the same products in the Netherlands, according to DHV – and a supply bottleneck at pharmacies.
The Canadian company Tilray recently announced that it would make cannabis flowers available to all local pharmacies in Germany – with immediate effect.
Now Israel – in which medical hemp has a long tradition – has given the go-ahead for the export of medical cannabis to Germany.
The Israeli scientist Raphael Mechoulam discovered back in 1964 that THC and CBD can relieve pain and relieve cramps. The country’s low humidity and the favourable climate make cultivation in the country efficient.
According to the Israeli Ministry of Health, more than 18 tons of medical cannabis are produced each year. But does Israel have enough resources for export?
Dadi Segal, head of the pharmaceutical company Panaxia, is optimistic. “We produce 50,000 products a month, there are three tons of cannabis in the safe, and we are ready for more,” he told DPA.
Should demand from abroad increase, Panaxia, one of Israel's largest producers, could work three shifts a day. The German market is very interesting, says Segal. “We are talking to several companies that would be interested in medical cannabis from Israel.”
An ongoing debate over medical uses
How cannabis works has long been known. It can relieve spasticity in multiple sclerosis or chronic pain, for example.
In some cases, however, the medical effects are poorly documented, for example in nausea and vomiting after chemotherapy or in Tourette's syndrome, as the German Medical Association emphasizes.
This is attracting critics. Although the medical use of cannabis has been known for more than 4,700 years, according to a specialist article by Barmer Krankenversicherung (Insurance), “in many respects it has also remained at a pre-scientific level.”