Author: Johnny Green

Germany is home to Europe’s largest medical cannabis market, which is not surprising given the size of Germany’s population and economy. Since 2017, doctors in Germany have been permitted to prescribe medical cannabis products to suffering patients, and the cost of those products is often reimbursed by insurance companies. Having medical cannabis covered by insurance is a concept that medical cannabis advocates push for all over the globe, with Germany being somewhat of a rare success story. Unfortunately, things may be changing in Germany on this front, at least for some patients.

The Gemeinsamer Bundesausschuss (G-BA), which belongs to the Bundesministerium der Gesundheit (Ministry of Health), is tasked with reevaluating the GKV (statutory health insurance) reimbursement for cannabis medications following the finalization of the 5-year observational analysis after the medical cannabis law was initially adopted in 2017. Conclusions will rely heavily on the results of the BfArM 5-year observation.

How Will Changes Affect Germany’s Medical Cannabis Program?

One of the more restrictive changes being proposed in Germany includes general practitioners no longer being permitted to prescribe cannabis to patients whose costs are expected to be reimbursed by GKV. Such prescriptions would be reserved for specialists with additional qualifications. The policies regarding use of cannabis as a last resort could also be overhauled.

Currently, German doctors can prescribe cannabis flower instead of cannabis extracts if they feel that it’s a more suitable form of treatment. However, ‘special justification’ would be required for a cannabis flower prescription if proposed changes are adopted. Many of the proposed changes would directly increase the burden of documentation for doctors, particularly during first 3 months of treatment. For instance, doctors would also need to explain in writing why THC-dominant strains are being prescribed versus CBD-dominant strain.

All of this increases pressure on doctors to prescribe extracts instead of flowers, regardless of what is best for the patient, in addition to driving up costs for insurance companies. The process of considering proposed changes is already underway and ends at the end of this month, with a final decision on the matter possibly being rendered by early next year.

Legalization Is A Factor

What is going on right now in Germany regarding medical cannabis policy is not occurring in a vacuum. Obviously, the medical cannabis policy discussion is running parallel to the ongoing adult-use legalization discussion that is also occurring in Germany. For insight regarding how one may affect the other, I reached out to Dr. med. Julian Wichmann, Geschäftsführer/CEO of Algea Care.

“Lacking scientific evidence on the efficacy of medical cannabis remains a big issue in Germany. This is now starting to negatively impact healthcare politics and therefore reimbursement. Academic institutions and companies need to work closer together to fill this gap.” Dr. med. Julian Wichmann stated.

Algea Care has established multiple research collaborations with German university hospitals, with the first positive results recently being presented on outcomes in treating neuropathic pain with cannabis flowers.

“Increasing healthcare cost pressure and already implemented insurance premium increases have insurers looking for opportunities to reduce expenses. In pharmacies, manual work associated with cannabis prescriptions remains high due to extensive documentation duties. The plans for removing medical cannabis from the narcotics law (BtmG) could therefore lead to substantial cost savings and make medical cannabis more affordable for insurances and patients.” Dr. med. Julian Wichmann concluded.

As the month of October draws to a close it is safe to say that it was one of the most eventful months for cannabis policy in Germany’s history. Unless you have been living under a rock without WIFI, then you are obviously aware that Germany’s Health Minister Karl Lauterbach made a formal cannabis legalization presentation to the federal cabinet last week. The presentation came a week after points of a prior version of the legalization plan were leaked to the public, with the leaked version resulting in various levels of pushback from the public and some lawmakers.

Multiple components of the legalization plan were improved upon as October progressed, including the apparent scrapping of THC percentage limits for products sold to people 21 and older, as well as a 50% increase in home cultivation limits (from 2 plants to 3 plants). As we previously pointed out, the current legalization plan involves removing cannabis from Germany’s narcotics law entirely.

Minister Lauterbach’s presentation to the federal cabinet was truly historic and cause for celebration inside and outside of Germany. Now that the ‘excitement dust’ is settling a bit, many within the global cannabis community are wondering where things go from here?

What Happens Next?

One of the biggest takeaways from last week’s presentation comes at the macro level in the form of Germany’s government making it clear that cannabis legalization is inevitable. It’s not a matter of if, but when.

“The presentation of the key points paper by Health Minister Lauterbach was a historic date. The German government leaves no doubt that cannabis legalization is politically desired by it and will also be pushed through against all odds.” points out German cannabis policy expert Kai Friedrich Niermann.

Kai and his law firm KFN+ advise major CBD and medical cannabis companies around the globe. Kai is also legal advisor to the European Industrial Hemp Association (EIHA), and a regular speaker at International Cannabis Business Conference events.

It is expected that early next year legalization legislation will be formally introduced in Germany. However, prior to a legalization measure being formally submitted, the nation’s government will continue to seek approval from the European Union. With that in mind, the conversation regarding cannabis legalization in Germany will now shift focus beyond Germany’s borders towards the larger continental discussion.

Will The European Union Prevent German Legalization?

It is no secret that Germany is a party to various treaties, both at the continental and international level. As I have previously stated, I do not think that international treaties will be an issue, if for any reason because Uruguay and Canada have both passed legalization measures and the sky is still in place over both of those countries the last time I checked.

Just as pushback from the international community and international treaties did not derail legalization efforts in those two countries, the same will presumably prove to be true when Germany legalizes. The European Union is a somewhat different matter, although, the final result will likely prove to be the same in that the German legalization effort will ultimately prevail.

“In order to comply with its obligations under international drug treaties and EU law, Germany has opted for an interpretative declaration to the monitoring bodies of the UN treaties, referring to its own constitutional principles, the case law of the Federal Constitutional Court and the interpretative declaration already issued on the 1988 treaty. According to the German government, the plan to legalize cannabis in Germany is in line with the purpose and legal requirements of the conventions, as the focus of the reform is the protection of health and young people, and not the promotion of cannabis consumption.” stated Kai Friedrich Niermann.

“The EU Commission and the other EU member states are to be informed of this in a notification procedure. Minister Lauterbach assumes that the EU will comment on this approach in the short term, so that the legislative project can be introduced in the Bundestag as planned from January.” Kai went on to say.

“I assume that preliminary talks have already been held with the European Commission, and that no fundamental reservations are to be expected in this respect. Particularly in view of the fact that a number of member states are also already making preparations for a reform of their national cannabis policies. Minister Lauterbach also assumes that if the EU Commission gives its approval in principle, lawsuits from other member states pursuing a more restrictive cannabis policy will have no chance of success.” he concluded.

Cannabis legalization efforts in Germany received a huge boost yesterday, with the nation’s Health Minister Karl Lauterbach (SPD) making a formal presentation to the federal cabinet regarding the most up-to-date plan for a German adult-use cannabis legalization measure. The presentation was truly historic, in part due to the fact that it happened in the first place, and also in part due to what was included in the plan itself.

As we previously reported, points from the plan were leaked last week, including some points that yielded significant pushback from the public and even some lawmakers. Many felt that some of the provisions, especially provisions involving THC percentage limits, were too restrictive. Fortunately, the plan that was presented yesterday by Health Minister Lauterbach addressed many of the components that were largely the focus of negative feedback.

One provision of the current legalization plan in Germany will no doubt prove to be extremely significant if/when it is implemented. Point 5 on page 4 of the Eckpunktepapier contains a key sentence, “Genusscannabis, Medizinalcannabis und Nutzhanf werden vollständig aus dem Anwendungsbereich des BtMG ausgenommen und die jeweiligen rechtlichen Rahmenbedingungen werden in einem gesonderten Gesetz festgelegt.”

That sentence can be translated to English as, “Recreational cannabis, medical cannabis and hemp will be completely removed from the domain of the narcotics law (BtmG) and the individual legal frameworks will be determined in a separate law.”

Minister Lauterbach was specifically asked about this provision of the plan during his presentation to the federal cabinet, as described below:

Third question was something along the lines why not legalization. Lauterbach says the intention is indeed legalization for adults 🢀, and cannabis to be removed from the narcotics law.

— Alfredo Pascual 🥀 (@alfrep28) October 26, 2022

Obviously, removing cannabis from Germany’s narcotics law would have enormous ramifications, and would affect nearly every aspect of cannabis policy, industry, and research. The benefits of removing cannabis from Germany’s narcotics law would not only benefit adult-use cannabis efforts; it would also benefit the nation’s emerging medical cannabis patients, program, and industry.

“Regulating cannabis not as a narcotic anymore has extremely positive implications particularly for medical use. This step opens the door to electronic cannabis prescriptions and immediate transfer to the pharmacy which can then ship the medication to patients. We are already preparing for a fully digital pathway for patients with 24h between video consultation and cannabis medication delivered to your doorstep.” stated Dr. med. Julian Wichmann, Geschäftsführer/CEO of Algea Care. Algea Care is Germany’s leading platform for therapy with medical cannabis.

“We also expect the conditions for cannabis research to be drastically improved. It will probably also be much easier for academic institutions to obtain national or EU-provided funds for specific research projects, as there will be a rapidly increasing demand for research on both medical and recreational cannabis intake.” Dr. Wichmann went on to say.

How countries have historically classified cannabis, including Germany, has created tremendous hurdles for cannabis research and the emerging cannabis industry. That, in turn, makes it extremely tough for patients who are at the mercy of what conditions qualify for medical cannabis and what safe access options they have in their area. Unfortunately, due to limitations in research many patients are left on the outside looking in. Removing cannabis from Germany’s narcotics law would provide a compassionate boost to suffering patients all over the country and increase safe access.

“Our goal is to make medical cannabis treatment as accessible and seamless for anyone with a medical condition suitable for treatment. Deregulation away from narcotics can facilitate that. Research from the U.S. shows that up to 40% of recreational customers are actually trying to mitigate symptoms but often don’t achieve the results they’re hoping for. The different tax treatment may potentially lead to a situation in which medical cannabis is cheaper than at recreational stores and accessible with a better digital journey.” described Dr. Wichmann.

The discussion regarding cannabis’ classification status is not limited to Germany. The United States is currently ‘examining’ the classification status of cannabis at the federal level, per a recent directive from U.S. President Joe Biden. However, unlike Germany, the discussion in the United States involves whether cannabis should be descheduled or rescheduled. Germany’s plan seems to have already landed at descheduling, or as it was more properly described by reporter Alfredo Pascual’s tweet embedded above, cannabis is ‘to be removed from the narcotics law,’ which is effectively the same as descheduling.

The significance of what is being proposed in Germany cannot be overstated. In addition to the expressed desire to remove cannabis from Germany’s narcotics law, it is a welcomed sight to see that home cultivation was not only included in the plan presented yesterday, but also that the home cultivation plant limit was raised from 2 plants that was part of the leaked points last week, up to 3 plants this week.

For perspective, Washington State in the U.S. still prohibits home cultivation for adult-use purposes despite having passed a legalization measure back in 2012. Illinois and New Jersey also prohibit adult-use home cultivation despite having also passed legalization measures. And all the while cannabis remains prohibited at the federal level in the U.S. With all of that in mind, the sensible proposal in Germany is great news for consumers, patients, researchers, taxpayers, entrepreneurs, investors, and just about everyone else in German society, whether they consume cannabis or not.

It was a big day in Germany for cannabis policy, with Germany’s Health Minister Karl Lauterbach making a formal cannabis legalization presentation to the federal cabinet. While the presentation did not involve the formal introduction of legislation, it did serve as the closest thing to a comprehensive status update so far in the German legalization process.

Much of what was presented today was already known via an interesting week of policy leaks and public statements by elected officials. Although, there were some items of note from the presentation, including news that prior to a formal measure being introduced Germany will continue to seek approval from the European Union.

“Berlin will check with the European Union’s executive commission whether the plan approved by the German government is in line with EU laws and would proceed with legislation “on this basis” only if it gets the green light, Health Minister Karl Lauterbach said” according to ABC News.

Per Health Minister Lauterbach, Germany will continue to examine whether regulated social consumption will be allowed, as well as the sale of edibles, however, the current plan does not permit for either of those policy and industry components.

Pending successful movement on the European Union approval front, Health Minister Lauterbach indicated that a formal bill would be introduced for lawmakers’ consideration in 2023, with legalization hopefully becoming law by 2024. Below is Health Minister Lauterbach’s presentation in full (broadcast in German):