Medical cannabis policy and practice in Germany

Dr Franjo Grotenhermen tells MCN about medical cannabis policy and practice in Germany.

Doctor, author and cannabis advocate Dr Franjo Grotenhermen is founder and Executive Director of the International Association for Cannabinoid Medicines (IACM) founder and co-chair of the German Association for Cannabis as Medicine (ACM); and chairman of the Medical Cannabis Declaration (MCD), a charity dedicated to promoting safe access to medical cannabis and evidence-based clinical practice. He tells MCN about the current cannabis landscape in Germany, taking a look at both policy and practice.

What sets Germany’s legislative approach to medical cannabis apart from other EU countries?

Since 2017, under German law every doctor is permitted to prescribe cannabis-based drugs, including cannabis flowers, extracts and individual cannabinoids. Under certain conditions, health insurance companies must cover the costs of therapy. According to the law, health insurance companies may only be allowed to refuse a request for reimbursement in exceptional cases.

What are the main challenges currently facing patients hoping to access cannabis in Germany?

Cannabis and cannabinoids are comparatively expensive in Germany: on average, cannabis flowers cost about €23 per gram. Since health insurance companies very often refuse to cover the costs, many patients cannot afford the appropriate therapy and are forced continue to receive care illicitly even though their doctor supports cannabis-based therapy in principle. The high price also makes cannabis-based treatment unattractive to doctors; as doctors have a limited drug budget which, if exceeded, can lead to a so-called recourse – a penalty payment. This leads to the fact that many patients cannot find a doctor who is willing to prescribe cannabis.

Could patients benefit from being granted the right to grow their own for medical purposes?

This would solve the problems mentioned above for many patients and doctors. We have been demanding it for a long time. We had hoped that the 2017 law would better solve the problems; however, after three years, it turns out that most patients do not benefit from the law.

Many doctors are reluctant to prescribe cannabis due to extensive bureaucracy and the risk of recourse claims. How could the system be amended to make it easier to issue prescriptions, while maintaining patient safety?

Essentially there are four possibilities:

Doctors should be exempted from recourse when prescribing cannabis drugs. Similar exemptions are already in place for prescribing other very expensive drugs, for example in the case of autoimmune diseases treated with biologics; The cost of cannabis could be reduced considerably in Germany. The same varieties of cannabis flowers, which cost €6 to €7 per gram in the Netherlands, cost more than three times as much in Germany. That is completely excessive; Patients should be allowed to grow their own cannabis if they can present a medical certificate after a therapy with cannabis is necessary; and The decision whether treatment with cannabis is necessary should be made by doctors, not health insurance providers.

How do you think German policy on medical and recreational cannabis will evolve in the future?

The law on medical cannabis which was passed in 2017 initially brought about significant improvements. As the law has been applied more and more restrictively, there have been setbacks since then.

In the medium term, however, the situation will improve again. The pressure from patients and the public will be too great to accept these restrictions in the long run. In addition, there is an increasing number of movements in the political parties, especially in the medical field, which are not too restrictive in their approach to the topic.