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Is Germany Planning To Restrict Medical Cannabis Insurance Reimbursements?

Written by Johnny Green on . Posted in Policy.

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.

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UK Study Finds That Inhaled Cannabis Reduces Pain And Anxiety

Written by Frank Schuler on . Posted in Science.

When it comes to medical cannabis, inhaled consumption methods can be seen as controversial within certain medical and political circles. After all, so much effort has been spent encouraging people to not smoke tobacco cigarettes, and many people see the two products as being one and the same. However, tobacco and cannabis are not the same thing, and studies demonstrate that.

Many lawmakers around the globe seem to be hesitant to legalize medical cannabis in forms that involve inhalation, which is unfortunate. For many suffering patients, inhaling cannabis is the cheapest and easiest way to consume their medicine, and given that inhaled cannabis interacts with the human body quicker compared to ingested cannabis, many patients prefer it for one reason or another.

Suffering patients should be able to consume cannabis in any manner that helps them, including inhaling it. A recent study from the United Kingdom found that inhaled cannabis may help treat pain and anxiety. Below is more information about it via a news release from NORML:

London, United Kingdom: The sustained vaporization of THC-dominant cannabis flowers improves health-related quality of life measurements in patients suffering from chronic pain and anxiety-related disorders, according to observational data published in the journal Biomedicines.

A team of British and Spanish investigators assessed cannabis’ efficacy in a cohort of 451 British patients authorized to consume cannabis flowers for treatment-resistant pain and/or anxiety. Patients in the study were all enrolled with Project Twenty21, “the first U.K. multi-center registry seeking to develop a body of real-world evidence to inform on the effectiveness and safety of medical cannabis.” All of the study’s participants had failed to respond to at least two prescription treatment options prior to obtaining an authorization for medical cannabis. All participants vaporized cannabis flowers for a period of at least three months.

Researchers reported that cannabis inhalation was associated with sustained (6+ months) improvements in both patient populations and that side effects were “minimal.” Investigators reported more significant improvements among those diagnosed with treatment-resistant anxiety.

“Our results indicate that controlled inhalation of pharmaceutical grade, THC-predominant cannabis flos [flowers] is associated with a significant improvement in patient-reported pain scores, mood, anxiety, sleep disturbances and overall HRQoL [health-related quality of life] in a treatment-resistant clinical population,” authors concluded.

Numerous surveys indicate that patients most frequently self-report using cannabis to mitigate symptoms of pain and anxiety.

Full text of the study, “Controlled inhalation of THC-predominant cannabis flos (flowers for inhalation) improves health-related quality of life and symptoms of pain and anxiety in eligible UK patients,” appears in Biomedicines.

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Plant-Derived CBD Extracts Effectively Manage Symptoms In Autistic Patient

Written by Frank Schuler on . Posted in Science.

Cannabidiol (CBD) is arguably the most popular cannabinoid on planet earth right now. As proof of that, consider the fact that according to Google trends ‘CBD’ was searched for by platform users more than twice as often as ‘THC’ over the course of the last year.

Of course, THC remains extremely popular both as a search topic and as a consumable. However, CBD is often seen as the more favorable cannabinoid between the two from the perspective of lawmakers and researchers, as demonstrated by the growing availability of legal CBD products around the globe and the increasing number of CBD-focused research projects being funded.

A recent study in Canada examined CBD-dominant extracts that were plant derived and their potential effects on autism as part of a case study. Below is more information about it via a news release from NORML:

Toronto, Canada: The twice-daily administration of plant-derived CBD-dominant extracts is “an effective treatment for managing symptoms associated with autism,” according to a case report published in the journal Cureus.

A team of Canadian investigators documented the treatment of a nine-year old patient diagnosed with nonverbal autism spectrum disorder (ASD). The patient received twice-daily dosing of a high-CBD/low-THC extract oil.

Researchers reported, “The child patient responded positively to the introduction of CBD oil treatment with reduced negative behaviors, better sleep, and improved communication.” No adverse side-effects were reported.

They concluded, “With the increasing clinical studies on the use of cannabidiol in treating patients with mood disorders, anxiety, chronic pain conditions, and other behavioral problems, it should be considered as a treatment option in managing symptoms related to autism.”

The findings are consistent with several other studies similarly reporting improvements in pediatric patients’ ASD symptoms following the use of cannabinoid products, particularly CBD-rich extracts. Survey data published in 2021 by the publication Autism Parenting Magazine reported that 22 percent of US caregivers or parents have provided CBD to an autistic child. Survey data from the United Kingdom recently reported that autistic adults were nearly four times as likely as controls to report having used CBD within the past year.

Full text of the study, “Cannabidiol in the treatment of autism spectrum disorder: A case study,” appears in Cureus. Additional information on cannabis and ASD is available from NORML.

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Argentina’s Minister Of Health Urges Doctors To Prescribe Medical Cannabis

Written by Hazel Norman on . Posted in Policy.

A medical cannabis program is only as good as the number of suffering patients that it helps, and that fact that is applicable anywhere that medical cannabis is legal in one form or another. After all, the whole point of legalizing medical cannabis in the first place is to boost safe access.

Unfortunately, many medical cannabis programs around the globe, while perhaps well intended, largely miss the mark. One of the largest barriers to safe access comes in the form of a doctor referral, with many patients that suffer from a qualifying condition still being unable to access medical cannabis because their doctor is unwilling to sign off for whatever reason.

As we previously reported, there’s a huge gap between the amount of medical cannabis information readily available to doctors and the level of comfort that doctors have when dealing with medical cannabis. A peer-reviewed study out of Canada found that only 6% of doctors indicated that they had some type of medical cannabis education or training.

To be clear, there is no valid excuse for doctors to be unaware of the cannabis plant’s wellness properties and how it may help treat suffering patients. The results of tens of thousands of peer-reviewed studies are available to anyone with internet access, including doctors, and clearly many suffering patients are using medical cannabis or want to. For doctors to refrain from learning more is negligent in many ways.

One country that is struggling with this issue is Argentina, which is home to an emerging medical cannabis program. The country’s Minister of Health recently issued a call to action of sorts to Argentina’s doctors, urging them to embrace medical cannabis more than they have been. Per La Voz (translated to English):

The Minister of Health, Carla Vizzotti, toured the Expo Cannabis fair on Friday afternoon, which takes place in the rural area of ​​the Buenos Aires neighborhood of Palermo until next Sunday, where she pondered the participation of growers, families and activists in the regulation of the medical cannabis , and pointed out the need for more and more doctors to become familiar with its properties and prescribe it.

Vizzotti pointed out that “it is very important that there are already nine authorized seeds, that it is already possible to travel by plane with cannabis oil or with flower jars, and that there are already more than 50 research projects authorized by the Ministry of Health; in the Reprocann there are 180,000 people registered, of which 120,000 are already registered, but there are about 40,000 who are not yet referenced in a health professional”.

Doctors need to base their decisions on science and compassion, and not on harmful political views. Not that it was ever a valid excuse, but any doctor that tries to claim in 2022 that ‘there needs to be more researched conducted before prescribing cannabis’ is making that claim based on something other than science, as there is clearly enough research already out there to be able to know that cannabis is indeed medicine.

Furthermore, doctors need to recognize the number of patients that are already using cannabis to successfully treat their conditions, including outside of a medical cannabis program. Suffering patients are going to use cannabis whether they have a prescription/referral or not. If a doctor truly believes in compassion and helping the suffering, then they will do their part to help ensure that suffering patients don’t have to fear prosecution for using their medicine.

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Costa Rica Authorizes First Hemp Project

Written by Hazel Norman on . Posted in Business, Policy.

Cannabis reform may be spreading across the globe at an ever-increasing pace, and with it, the emerging international cannabis industry, however, the process has moved slower in some countries compared to others, with Costa Rica being a great example of that.

In the Western Hemisphere, cannabis reform has spread faster than its Eastern Hemisphere counterpart. After all, Uruguay was the first nation to legalize cannabis for adult-use, followed by Canada becoming the first G-7 nation to do so. Significant cannabis reform can be found elsewhere in the hemisphere as well.

Yet, cannabis policy reform and standing up a regulated industry has proceeded at a slower rate in Costa Rica. As we previously reported, lawmakers in Costa Rica passed a cannabis reform measure in 2021 and sent it to the President for sign off. That sign off never occurred, and instead, Costa Rica’s president issued a veto and sent the measure back to lawmakers instructing them to make the measure more strict.

Eventually things moved along a bit, and finally, after a lot of political wrangling and foot dragging, Costa Rica has issued its first hemp project license. Per The Tico Times:

The Minister of Agriculture and Livestock (MAG), Víctor Julio Carvajal Porras, signed the resolution authorizing the first project for the use of hemp this Friday.

Ingenio Taboga S.A. made the request. It is located in Bebedero de Cañas, Guanacaste, developing a hemp cultivation and processing project in a 150-hectare area.

According to the reporting by The Tico Times, there are eight more industry applications being considered – seven for hemp-related projects, and one for medical cannabis. It’s unclear if/when any of those additional projects will gain approval.

According to Statista, Costa Rica’s gross domestic product (GDP) ranked 11th in 2021 out of countries located in the Latin America and Caribbean regions. Any jobs and economic boost that the cannabis industry can provide Costa Rica is surely welcomed.

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United States 2022 Election A Mixed Bag For Cannabis Reform

Written by Johnny Green on . Posted in Policy.

November 8th was Election Day in the United States, and cannabis reform was on the ballot in several jurisdictions, both at the state level as well as at the local level. Voters in five states had the chance to vote on adult-use legalization measures – Maryland, Missouri, Arkansas, South Dakota, and North Dakota. Unfortunately, only two of the measures were approved.

The first state to have a victory announced was Maryland. The measure in Maryland was somewhat unique, in that it was essentially an up or down vote, and after having been approved, it now tasks lawmakers to come up with public policy that implements adult-use legalization.

“State lawmakers have had many years to prepare for this moment,” NORML Deputy Director Paul Armentano said in a press release that I received by email. “Statewide polling had consistently shown that a supermajority of Marylanders support legalizing cannabis, and the outcome of this referendum was never in doubt. Now it is incumbent upon lawmakers to move swiftly to adopt rules to oversee a regulated cannabis marketplace in accordance with voters’ demands.”

The other state that passed a legalization measure yesterday was Missouri. It took a bit longer for victory to be announced, as the results in Missouri were much closer compared to Maryland, however, the result of overall victory was still the same in the end. Missouri became the 21st state in the U.S. to pass an adult-use legalization measure.

“This is truly a historic occasion,” said Dan Viets, co-author of Amendment 3, Missouri NORML Coordinator and Chair of the Amendment 3 Advisory Board in a press release that was emailed to me. “This means that the great majority of the 20,000 people who have been arrested year after year in Missouri will no longer be subject to criminal prosecution for victimless marijuana law violations.”

The measure in Missouri permits adults to possess up to three ounces of cannabis and to cultivate up to six flowering plants, six immature plants, and six plants under 14 inches at home for their own personal use.

“Voters in both red and blue America agree that it’s time to enact sensible cannabis laws that replace prohibition with regulations that protect public health and safety while fostering a vibrant small business sector that can create jobs and new tax revenue for their communities,” said Aaron Smith, co-founder and chief executive officer of the National Cannabis Industry Association about the state victories in a press release that was emailed to me. “With nearly half of Americans now living in a state with legal cannabis, it’s long past time to harmonize federal law with the growing number of popular state cannabis programs across the country. The first step toward realizing that goal would be to enact the bi-partisan SAFE Banking Act.”

Unfortunately, voters in Arkansas, North Dakota, and South Dakota all voted down the legalization measures in their respective states. In the case of South Dakota, the state’s voters previously approved a legalization measure, however, after various legal issues another legalization vote was held and voters apparently had a change of heart.

The State of Texas was a winner from a local perspective, with five jurisdictions (Denton, Killeen, San Marcos, Elgin, and Harker Heights) voting to reduce penalties for personal cannabis possession.

“Texans have shown that they want major cannabis law reforms in Texas via polling, legislative engagement, and now at the local ballot box! This will have a positive impact on the almost half a million people living in these cities. While these local advancements are important in mitigating harm on citizens and reprioritizing law enforcement time, they result in a patchwork of differing marijuana enforcement policies based on location. It is time for lawmakers to take steps to enact statewide reform when they convene in January 2023,” Texas NORML’s Executive Director Jax James said in a press release that was emailed to me.

The 2022 election marks the first time in U.S. history where less states approved legalization versus approving them when given the chance, which is a fact that cannabis opponents are touting to anyone that will listen. While technically the results in some states in the 2022 election were not as favorable as some had hoped, the election still had its cannabis victories and the emerging cannabis industry will continue to expand as a result. The states that failed to pass a legalization measure this time around will hopefully get on the right side of history they next time they have a chance to do so.

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Study Finds Cannabis Inversely Associated With Hypertension In HCV Patients

Written by Frank Schuler on . Posted in Science.

We previously reported that a peer reviewed study in France determined that medical cannabis use was associated with a lower BMI in patients diagnosed with hepatitis C (HCV). A separate study from France also found that cannabis is inversely associated with obesity among HCV patients.

It is estimated that as many as 58 million people suffer from hepatitis C worldwide. The World Health Organization estimates that roughly 1.1 million deaths occurred in 2019 due to hepatitis B and C, and their effects include ‘liver cancer, cirrhosis, and other conditions caused by chronic viral hepatitis.’

Hepatitis C is spread by contact with contaminated blood, such as from sharing needles or from people using unsterile tattoo equipment. Yet another study in France examined cannabis and HCV, and the results of this latest study indicate that cannabis use is inversely associated with hypertension in HCV patients. Below is more information about it via a news release from NORML:

Marseille, France: HCV (Hepatitis C virus)-infected patients who consume cannabis are less likely than non-users to suffer from either hypertension or other metabolic disorders, according to data published in the Journal of Clinical Medicine.

French researchers assessed the relationship between current and/or lifetime cannabis use and metabolic disorders in a cohort of 6,364 subjects infected with HCV.

Investigators reported, “Former and current cannabis use were both inversely associated with hypertension in both analyses (adjusted odds ratio [aOR]: 0.74 and 0.45).” They also possessed fewer metabolic disorders (e.g., obesity, diabetes, etc.) than did those with no history of cannabis consumption.

They concluded: “In a large cohort of people with chronic HCV infection living in France, current or former cannabis use was associated with a lower risk of hypertension and a lower number of metabolic disorders. … Future research should also explore the biological mechanisms underlying these potential benefits of cannabis use, and test whether they translate into reduced mortality in this population.”

Prior studies have identified an association between cannabis use and lower rates of diabetes and fatty liver disease in Hep-C infected subjects. Other studies have consistently identified a relationship between marijuana consumption and lower rates of obesity.

Full text of the study, “Cannabis use inversely associated with metabolic disorders in Hepatitis C-infected patients,” appears in the Journal of Clinical Medicine. Additional information on cannabis and Hepatitis C is available from NORML. Additional information on cannabis and hypertension is available.

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Cannabis Bust In Spain Highlights Need For Legalizing Cannabis, Not Continued Prohibition

Written by Johnny Green on . Posted in Policy.

If you are like me, then you read headlines over the weekend regarding a large cannabis operation bust in Spain. The bust was touted in mainstream media coverage all over the globe as being ‘the largest in Spain’s history.’ According to media coverage, the bust involved roughly 32 tons of cannabis (roughly 64,000 pounds). Or as the BBC put it, “equivalent to more than five adult African elephants.”

To be fair, the bust did involve substantial quantities of cannabis, however, there’s a lot of context that was left out of mainstream media coverage. I don’t know if it was intentional or not, but most of the mainstream media coverage that I read regarding the bust seemed to be straight out of a reefer madness communications guide, which is why I assume that cannabis prohibitionists around the world are pointing to coverage of the bust as some kind of ‘justification’ for continuing prohibition.

The fact of the matter is that this latest bust in Spain will do nothing to curtail the unregulated cannabis market in Spain or Europe in the grand scheme of things. Thirty two tons of cannabis may sound like a lot, but it is hardly enough to supply ‘all of Europe’ as some media coverage seems to imply. The total population of adults in Europe is measured in hundreds of millions, whereas the total reported amount of grams involved in this bust in Spain is measured in the tens of millions, meaning that if the cannabis involved in the bust was provided evenly to adults throughout Europe every adult would get a tiny fraction of one gram. From that perspective, the unregulated market share of this operation is being greatly overexaggerated.

Furthermore, the cannabis involved in this bust may not even all be usable cannabis. How much of the overall weight being reported involved cannabis stems and water leaves? All of the cannabis at the site of the bust may have been technically illegal, however, that is not the same as saying that all of the cannabis involved was truly going to make it to consumers. This bust was significant in size, however, when put into proper context, it’s likely not as big of a deal as some may think.

Cannabis prohibition does not work, which is why the void created by this bust will be quickly filled by other people. The only way to properly mitigate the unregulated market in Spain, Europe, and the rest of the world is to end cannabis prohibition and work to transition cannabis sales into a regulated market. Thankfully, we now know that the concept works being that it’s successfully occurring in more and more jurisdictions around the world, and on a much larger scale compared to what was involved in this latest bust in Spain.

Using the State of Oregon as an example (it is where I live), in just the month of October 2021 alone over 5.5 million pounds (or roughly 2,750 tons) of regulated cannabis was harvested according to the agency that regulates the industry here. That is one state, in one month, and for those that are unaware Oregon is one of the less-populated legal markets in the United States. All of that cannabis is in a regulated system that prevents diversion to the unregulated market, and speaking as a consumer here, I have had no need to search out unregulated sources for several years now because going the regulated route is so much better from a convenience and selection standpoint.

Make no mistake – the cannabis industry is going to exist in Spain and other countries in Europe whether cannabis is legal or not, it’s merely a matter of if that industry will be run by organized crime or government regulators. Lawmakers in Spain are currently making a conscience decision to let cannabis consumer and patient dollars go to organized crime instead of to regulated businesses and the funding of things that everyone in society benefits from, such as public works. Lawmakers in Spain are currently making a conscience decision to let organized crime decide the working conditions of cannabis industry employees instead of workplace safety regulators.

And just as that is true in Spain, it is also true wherever else cannabis prohibition still exists both within the European continent and everywhere else around the world. The bust in Spain is a reminder that cannabis prohibition does not work, and that there is a better way to handle cannabis policy. Spain’s cannabis is world-class, and it’s beyond overdue that the nation adopt a public policy and regulatory framework that embraces the nation’s favorite plant instead of criminalizing it.

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Canadian Study Arrives At Obvious Conclusion Regarding Cannabis Purchasing Decisions

Written by Johnny Green on . Posted in Business, Policy.

I am one of those lucky people that lives in a legal cannabis jurisdiction, and in my opinion, I live in the best legal market for cannabis consumers on earth. The State of Oregon in the U.S., where I reside, passed an adult-use legalization measure in 2014, with regulated sales beginning in 2015. Since the start of regulated sales, Oregon’s unregulated market as it pertains to domestic consumers has progressively shrunk, so much so that it’s virtually non-existent these days. That has resulted in me often being asked by cannabis observers around the world how Oregon did it?

Oregon is obviously not the only place to allow regulated sales, and yet, most other legal markets struggle with competing with the unregulated market. To be sure, unregulated cannabis is still cultivated in Oregon, however, none of it stays within the state’s borders from what I can tell, which is not a coincidence in my opinion given that Oregon has the lowest prices for legal cannabis products in the nation. Presumably, unregulated Oregon cannabis goes to other jurisdictions that have yet to legalize sales, and in some cases, some of it likely even goes to other legal markets where the price of legal cannabis is exponentially greater.

Price Matters

I have read my fair share of theories and expert analysis pertaining to ‘what needs to be done to combat the unregulated cannabis market’ and while much of it provides some level of insight, at the end of the day it’s an extremely straightforward ‘riddle’ to solve. As with anything, price matters, which is what yet another recent study determined, this time out of Canada.

“Higher prices and inconvenience of legal sources were common barriers to purchasing legal cannabis,” researchers concluded. “Future research should examine how perceived barriers to legal purchasing change as legal markets mature.”

A previous study from 2018 determined that cannabis consumers are willing to pay a bit more for regulated cannabis from licensed outlets compared to the regulated market, however, there’s a limit to how much more they are willing to pay. Every dollar that gets added to the price of legal cannabis results in some percentage of customers choosing to go the unregulated route, and thus, lawmakers and industry regulators should strive to do what they can to keep prices low.

Reasonable Taxes And Regulations

When people think of the government’s involvement in the cannabis industry, they often seem to oversimply it. After all, there’s more to operating in the industry than just initial licenses and taxes. Every regulation that is added to the cannabis industry contributes to a higher final price at the point of purchase. Evolving packaging requirements, security requirements, and many other regulatory components make operating a cannabis business expensive.

Current tax provisions for cannabis businesses are such that those business have to pay considerably higher taxes compared to other legal businesses, and for those that have banking access issues, additional security expenses may also be involved, such as armored transport services. Then there’s also, of course, the taxes on purchases themselves, which also adds to the final price for legal cannabis. Collectively, all of the costs and taxes can add up.

Meanwhile, nearly all of those aspects of the legal cannabis industry that drive up prices for legal products do not exist in the unregulated market, and as such, prices for regulated products will never be equal to prices for unregulated products. The goal is to get legal prices as low as reasonably possible so that the other benefits of regulated cannabis (testing, convenience, wider selection, etc.) are worth the extra cost. If lawmakers tax legal cannabis to death and regulators fearfully implement regulations that are obviously overkill, the unregulated market will always thrive, and it doesn’t have to be that way.