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The Future For European Medical Cannabis Reform And Legislation

Written by Marguerite Arnold

Cannabis reform is very much afoot in Europe these days, with the predominant focus being on its potential medical applications for patients in need

While Federal reform is progressing at a fast pace in some ways, it’s still too slow for thousands of patients across the continent who want to use cannabis as an alternative to other chemical medications.

With governments across Europe attempting to implement reform directly into existing medical systems, the process is slowed to a snail’s pace in some instances. At the same time, new technology and steps like digital prescriptions bode well for the future.

Country-by-country, access to medical cannabis varies greatly, as it also does according to regional policies and laws.

So for all those patients in need, what do the next 12 months look like as far as new regulations are concerned?

If the government’s estimations are correct, there will be between 6,000-11,000 medical cannabis patients in Germany next year. There are currently about 1,000, although there are many more who want to be. The biggest issue facing patients right now is overall access.

Theoretically, German doctors are free to prescribe cannabis to any patient they want. Further, the law does not limit the number of grams per month that can be covered under health insurance. However, German doctors are being informed by health insurance companies that for the next two years at least, they may be personally liable for the entire retail cost of the drug they prescribe. This means a potential cost of 24,000 euros at a minimum, per patient.

Patients now in the “legal” system are also facing insurance companies who are refusing to pay the 2,000 euros a month the medication now costs in Germany. Multiple patient law suits are now underway to force reimbursement. For the insurance companies, it is a delaying tactic and nothing more.

By next year, expect things to have smoothed out somewhat, but there may still be issues. This includes who will be prioritized for coverage. It also includes training more doctors on prescribing the drug.

German patients, in other words, are in for a long haul. Even city trial applications for some kind of broader access are basically on hold. The city of Bremen, along with Berlin, has been lobbying hard for decriminalization. The “2-3 plant” experiment allowed in Bremen has now been underway for about 8 months now.

Right next door, Germany’s Teutonic sister is already moving into some interesting waters with its fully taxed, low market entry “low THC” market boom. Next year might be the year this finally turns Geneva into the Boulder of the Alps. This year’s tax haul even on low THC cannabis is expected to be significant. About a quarter of this year’s expected industry revenues of €100 million go to the taxman.

What does this mean for patients? A couple of things; The first is that Swiss law appears to be relaxing again. Some regions allow a home grow of up to four plants for any purpose. The law is actually very unclear about medical use – so it is not covered under health insurance nor is it likely to be any time soon. However, if you can tolerate either Sativex, imported from the UK via GW Pharmaceuticals, or dronabinol, from Germany, you do have access to cannabinoid medication already via the medical system in spray form.

In a year, expect to see a much bigger, better, more established Cannabis Club scene, particularly in Barcelona. The change in the law this summer means that by next year, the existing clubs will have already cleaned up their acts, including with an influx of foreign capital. This means that even though the new legalization initiative in Catalonia isn’t federal, it will have country and even continent-wide implications.

This is good news for patients too. While medical use is still a grey area, the country now hosts a new national observatory dedicated to medical cannabis studies. Further medical conferences held in the country are beginning to create a powerful advocacy network and wide knowledge base. With greater access to the plant, patients can at least treat themselves even if they cannot find a doctor to prescribe or a pharmacy to sell it.

The Cannabis Cup is unlikely to return here anytime soon. That said, the clampdown on the cannabis industry is now receding. Better legislation to protect and regulate the industry will have made an impact by next year, starting with foreign investment.

Sadly, on the other side of the equation, however, the medical access issue appears to have taken a hit this year. As of late 2016 and early 2017, and rather abruptly, the majority of Dutch insurers stopped compensating patients for their medication. Why? They claim there is no medical proof of efficacy. This is also due to a loophole in Dutch law for which there is no easy fix. Medical cannabis specifically has never actually been made legal. Look for efforts well underway by next year to challenge the same domestically. There are many patients here who have been left in the lurch thanks to changes that kicked in this month.

One of the most perplexing, up and down states in Europe right now on cannabis reform is Italy. Forward promise here has been repeatedly scuppered at the last minute and by larger, more impactful political events. Medical use of cannabis has been legal here since 2013. This includes for the treatment of chronic pain, including that caused by MS and spinal lesions, cancer, glaucoma and severe facial movements caused by muscle spasms. Up until now that need had been met via the distribution of Sativex, a whole-plant based spray.

By next year, the Italian military will have entered its second full year of domestic production. Production is expected to reach their goal target of 100 kilograms this year. It is still not decriminalized in Italy, and by 2017, Italy might have passed recreational reform. The odds are, however, that it probably will not have. That is, many hope, what will push medical reform forward faster. In the meantime, the first patient-oriented cannabis café has now opened in Rome.

Getting a prescription for cannabis is still complicated and that is expected to last until greater reform occurs here. There are only eight regions where the cost is subsidized by the government. In other regions, patients have to bear the cost themselves. That said, at 7 euros a gram, this is not as bad as it is in other places. There are only about 300 pharmacies which sell cannabis in the entire country to date.

If Emmanuel Macron keeps his election promise, marijuana might just be decriminalized, finally by next year in France. It is supposed to happen by September according to media reports. Maybe. In the meantime, patients are going to have a hard time with access. As of early June 2013, cannabinoid-based pharmaceuticals have been legal in the country, but remain very hard to obtain. The standard is that patients must be chronically ill and have exhausted other more conventional therapies. This leaves a great deal of room for interpretation and at this point, that is not on the side of patients. Cannabis medicine production itself must be specifically approved here by federal authorities on a case-by-case basis.

Mediterranean, Eastern Europe & The Balkans
Canna reform will continue to move forward here. That much is certain. One of the most interesting countries in this block, the Czech Republic, has long itched to move beyond legal restrictions on drugs imposed by UN membership. Any move at UN level to reschedule or reconsider cannabis may well be felt first in this country for that reason. That is unlikely, however, to happen until next year. In the meantime, patients with qualifying conditions can get up to 30 grams of flower a month – free of charge.  Croatia, with its highly limited medical program that allows patients only 7.5 grams per month, is also unlikely to see much change in the near-term. Both countries still import cannabis– which makes it far too expensive for program expansion any time soon.

Greece, however, has just stepped into the ring on the medical front. By next year look for the beginnings of an established domestic grow program. It might even be that the country has begun to select vendors for a domestic crop growth.

It remains to be seen if Turkey’s decision to grow medical crops will make a dent in the drug war. By next year, hopefully, some of those statistics might even be significant.

The most significant contribution to the overall conversation in this part of the world has been the reliance on digital prescriptions for cannabis. This is also likely to be a trend that spreads to other countries, starting with Germany.

The UK & Ireland
While it does not technically count as part of the EU anymore, Britain will undoubtedly still have influence on this discussion, simply because it is such a large consumer. Cannabis use is high here. By next year, however, the political considerations of Brexit are still very likely to overshadow every other political discussion. Medical cannabis reform, long a pot boiler here, is not likely to be much further along in the next 12 months. Patients will still have to act on their own or join a local cannabis club (which does not protect users from prosecution.)

All-in-all, 2017 promises to be an interesting year for Europe in terms of medical cannabis legislation and reform, among other things. That trend has already been going strong for years in America and Israel, and that is bound to have a knock on effect in Europe in the coming years.

[Featured image credit- Pixabay]

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About the author

Marguerite Arnold