Medical cannabis in Germany and Holland
Since March 2017 medical cannabis is legal in Germany and insurers are required to cover the costs of cannabis products when prescribed for “severe conditions”. Meanwhile, Dutch insurance companies have stopped covering medical cannabis, although it has been legally available through pharmacies since 2003.
So why are the two neighbors moving in different directions?
Whichever way you look at it, the legalization of medical cannabis in Europe’s biggest and richest countries is a momentous occasion. German activists rightly criticize the fact that there is no provision for home-growing and also point out the risk of a few big players monopolizing the market. German doctors respond positively. Josef Mischo from the German Medical Association told TheLocal.de [https://www.thelocal.de/20170303/doctors-rejoice-as-germany-kicks-off-medical-marijuana-prescriptions] predicts “a certain increase of this therapy, though to what extent is unclear”. “As a medical community, we welcome the fact that therapeutic possibilities have now been expanded.”
Before the new law went into effect only about 1000 German patients had permission to purchase and use medical cannabis, at their own expense and at very high prices. Doctors can now prescribe cannabis to anyone and the list of conditions isn’t exactly defined. “It is good that the legislators largely left it up to the doctors to decide if cannabis should be used”, said Mischo. “Right now I can already imagine that many doctors will now, for one thing, test to see if their chronic pain patients get better with cannabis.”
It would be quite difficult to find a Dutch doctor with such a positive and constructive approach to medical cannabis. The Netherlands legalized medical cannabis back in 2003, but for years the number of people who bought their cannabis at the pharmacy was very low.
There were a few of reasons for this. All Dutch medical cannabis is produced by one company, Bedrocan. For years, they only produced one variety, these days they offer five different strains.
Prices have gone down and are now below those at coffeeshops, around €31 for 5 grams. The number of “official patients” buying cannabis at the pharmacy has risen considerably in recent years.
But this number is likely to go down again after the few Dutch Insurance Companies that covered medical cannabis decided to stop paying for it at the end of 2016, claiming there is “not enough scientific proof that medical cannabis works”.
One thing that has hardly changed over the years is the unwillingness of most Dutch doctors to prescribe medical cannabis. It’s one of the complaints that the Patient Group Medicinal Cannabis Users (PGMCG) receives most often.
The PGMCG is based in the Southern Dutch city of Tilburg and was founded in 2014 by Marian Hutten, who uses cannabis against COPD, fibromyalgia and osteoarthritis. She had to go to great lengths herself to obtain a prescription. It’s a sharp contrast with the situation in the United States, where it’s very easy to get a prescription if you live in one of the many states that have legalized medical cannabis.
Another pressing problem in the Netherlands is the harsh prosecution of patients growing their own medicine. The PGMCG achieved a remarkable success on this front: they negotiated a formal agreement with local authorities not to persecute medicinal home growers, as long as they have a prescription and adhere to clearly defined requirements. This “Tilburg” approach has attracted a lot of attention and some cities are ready to copy it. It proves how real change often starts at the local, grass roots level. And it also seems to demonstrate the main difference between what has been happening in Germany and the Netherlands. The Germans are regulating medical cannabis top down, while continuing to criminalize recreational use and any form of home growing. In the Netherlands, local initiatives push the much needed change in cannabis policies from the bottom up.
A lot of work remains to be done in both countries, but one thing is certain: medical cannabis is firmly on the agenda and won’t go away anytime soon.
