Prescribing Cannabis: A German Doctor At The Forefront of The Medical Revolution

Here is the first thing you need to know about Franjo, as he is more apt to be known to both patients and others: he is a board-certified German medical artz (physician). 

Here is the second: he is also a doctor with a disability.

As a result of this, he has a unique perspective on the topic of cannabis as medicine that few in either the scientific or medical professions can match in both his medical training and his sympathy for patients.

Because this is not a new avocation, Grotenhermen is one of the leading cannabis doctors in the country right now. Further his voice as a medical doctor is one of the most credible ones on the edge of the giant green reform that is slowly starting to take hold in Deutschland as cannabis as medicine becomes a more accepted reality.

No matter how well you know him, however, is impossible to miss that he is passionate, articulate, and takes no prisoners.

The Voice of Medical Reform

Grotenhermen’s current battle is a very simple one (as all his greatest ones have been so far). “Doctors do not have enough control right now,” he says flatly. “There is currently a 40% refusal rate from insurers even when doctors have determined that cannabis is the right medicine for their patients.” 

His voice is steely when he says that the insurers (and the regional health approvers to whom cannabis approvals are still routinely sent, also known as Der Medizinische Dienst der Krankenversicherung or MDK) are mistaken in their overzealous denials of the drug so far. 

“The MDK are stepping well beyond their legislative mandate set in 2017,” Grotenhermen says determinedly. “They only have the right to turn the medicine down in extraordinary situations – and this high refusal rate is proof that this is not the practice.” 

It is important to remember, as he also points out, that while cannabis at this point is roughly equivalent in price to what is on offer in the United States, health insurance coverage in Germany is not only mandatory, but expected to cover the drug. When it does not, the most vulnerable patients (who exist with about $350 in cash a month) do not have a chance at access. Even worse, the recent agreement between the pharmacies and health insurers which normalizes the compensation price paid to pharmacies by insurers does not apply to private payers who get to a doctor but cannot get the insurer approval. For these people, a pharmacy purchase actually costs about $25 per gram right now (compared to about $12 if reimbursed by insurance).

He is currently lobbying the Bundestag (the German Parliament) to try to put pressure on change this way.

But this is far from Grotenhermen’s first battle. In 2017, when the law mandating that insurers cover the cost of cannabis when prescribed for a doctor, he went on a hunger strike. “Basic access to cannabis should become more of a political issue in Germany,” he says. Not to mention is absolutely working overtime to make sure that it is. “Don’t forget, we have a national election this year ourselves, and what we are working for is a situation where the health insurer should not decide whether a patient gets cannabis. This is a decision that should be left between the doctor and the patient. Of course, this entire issue would not be so problematic if cannabis were not so expensive. This law is causing horrible social inequity. The sick vs those with money. And this is not OK.”

The social inequity he is referring to is a bit less than it was pre-2017. But it is still in the room for most German patients, according to the patients.

If you are unused to hearing such things, also remember this. Grotenhermen is the voice of a cannabis doctor in a country where the access to healthcare and medicine is a supposed guaranteed right. “If you are poor and sick you are left out of this,” he sighs. “It could be so easy. Patients with a medical certificate that they must have cannabis should be able to get it. They should not be treated as criminals. No matter where they get their medicine. Patients should never be treated as criminals for drug offenses.”

He does not add (this time) that neither should doctors. Cannabis doctors including Grotenhermen do face police inquiries from time to time, that are not gentle. In Germany, cannabis is considered a controlled narcotic substance right now.

Grotenhermen is also sometimes controversial (at least in Germany right now) for his unabashed support of home grow for patients. “Not every patient wants to grow their own, of course,” he says. “For some, it is of course not possible. They are too sick. But if you ultimately want to end this issue of cost. Cannabis has to be more accessible than it still is in Germany. Most patients, especially those coming into contact with cannabis for the first time, which will be the vast majority in the future, simply want to have their drug prescribed by their doctor and pick it up at the pharmacy.”

The reason for that, as Grotenhermen explains, is that from a regulatory perspective, there are two categories for medicine – either finished medicines or those prepared at the pharmacy. As a result, cannabis falls into a category where there must be an interaction by the pharmacist, and this adds to the cost. While this is a basic retail mark-up strategy required as the life blood of any business, and required by German law, it creates a lot of casualties in the way it is currently being implemented.

But Grotenhermen is also convinced that without the industry, the issue of full and final reform, including of the medical kind, will never happen. “This is also a market and the industry must be able to give patients access to the cannabis-based medicines they need.,” he says. “ Germany is a big market. That is OK, if prices are fair. Companies can exist together with home grow. There is enough money to earn.”

He is also very clear in what his real beef here is. “Stop the health insurers rejecting prescriptions from doctors, reduce prices even for self payers, and do not continue to treat cannabis patients with medical certificates as criminals.”

Impacting the Science of The Industry

Beyond his own practice and political advocacy, Grotenhermen is influential in another way – and increasingly far beyond Germany. He is also the co-founder, along with American Ethan Russo, of the International Association of Cannabinoid Medicines (IACM). Their medical conferences have drawn the top cannabis doctors and medical researchers to Europe for more than two decades. Now they are also turning their sites to other continents, including the U.S.

It is also an accomplishment of which Grotenhermen is justifiably proud. “The IACM is now 20 years old as of last year, and I am very happy that this has developed so well so far. With so many projects. In the first 15 years, the conference was a family meeting, maybe 100 to 120 people every two years. It has dramatically increased recently. We will be back after the Pandemic. I think we had a good online meeting in 2020. We are starting to plan for in-person meetings again. And we have just agreed to start including the American hemisphere as a gathering point for our conferences. We want to be more international than just Europe.”

One of the crown jewels of all these initiatives is the IACM’s Patient Council, which is exactly what it sounds like. “Carola Perez, the head of the initiative, is from Spain. She tries to bring patient groups together to see how we can bring in their experience and be part of the movement. It is under the umbrella of the IACM, so patients know there is no financial interest.”

If this does not sound far beyond the normal one taken by more formalized medical and scientific conferences, it is. How many other medical conferences feature the voices of patients? Understand this and you begin to understand the huge impact the IACM has already had and is beginning to develop globally.

The IACM will hold its next free online conference on October 14-16. “We have a 5-hour program on each of 3 days,” Grotenhermen wants to mention. “You can participate anywhere in the world, and we are staggering the time so we can accommodate speakers from wherever you are in the world, although sadly, Australia, it will still be a bit late for you,” he jokes.  Last year’s presentations are available online on the IACM website, where future presentations can also be viewed.

Ongoing Issues of Note

It is also easy to understand that for Grotenhermen, cannabis will always have a “next” issue. It is still too early in the medical cannabis revolution. But here are a few of note. “We are moving towards training as well as research into many kinds of things. Many people are very interested in Covid-19 and cannabis. People are also interested in practical issues.”

When asked to compare the differences between the U.S. and German cannabis market he responds thoughtfully. “The US and German health insurance discussion is different. People in the US are more used to paying for health costs themselves. Nobody here is used to that. For decades, necessary health costs were covered. Cannabis is falling out of that and is the great exception. For many conservatives in the US this is ‘Socialism.’ So there is no direct comparison.”

However, he is clear that the two countries are influencing each other right now. “Of course, we might influence each other. We here in Germany look to the US. But at the same time, it is an apples and oranges comparison. What can be transported is the idea that someone that needs treatment should get access, even without money. But the answer on how to realize this in two different countries are very different. The solution might be different. But everywhere access to cannabis is an access issue. Whether it is the Netherlands, or Israel or Mexico, or the US., patients should be able to get it and doctors should be able to recommend it. When a doctor says a patient needs this, it should be realized. Civilized society should not deny access to a medicine to a patient when a doctor says he needs it.”

A medical voice for change, indeed, which is being more and more loudly heard, if not echoed, globally right now.