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A Focus On German Patients: What Do They Still Face?

Written by Marguerite Arnold on . Posted in Medical.

At an undisclosed location, somewhere in Bavaria, a group of activists met on the first weekend of November. They were drawn there by their friendships and their long-time struggles to gain access to medical cannabis.

All of them were sick. But for all the disabilities, across a range and spectrum of chronic conditions, there was also a very serious commitment at the gathering too.
These were all German cannabis patients, frustrated with the many issues still in the room since the market began to reform and change in 2016.

Most have not been able to find regular doctors. All of them have struggled with insurers and finding regular supplies at their local pharmacies (including in big cities like Berlin), and a lot of them are starting to cultivate cannabis again if they ever stopped.

For all of the “reform” in the room, namely that cannabis is now available by prescription in German pharmacies, there is still a long way to go. What is on the market is too expensive not only for patients, but also insurers, to cover in increasingly large numbers. Changing the compensation that pharmacies must charge (as is now in the offing) is just one small piece of the conundrum.

In Germany currently, legal medical cannabis that patients can buy in pharmacies costs more than twice as much as what can be found on the unregulated market, and on the grey market prices can frequently go as low as 5 euros a gram, if not “free” for those who grow at home illicitly.

Some of the more business and cost-minded patients are estimating their costs too. Even the fairly novice growers understand that they are looking at the same costs per gram as growing say, tomatoes. Unless of course, they get caught.

Many patients now carry their cannabis in the pre-packaged containers that all the big companies provide flower in for the German market. The joke of course, if not the reality in every medical cannabis market in Europe right now, is that it is not what is actually in those plastic jars.

The patients at the deep end of both sick and tired are defending themselves in the only way that they can. As more than one of the meeting attendees said, “What are they going to do? Arrest me? They already have.”

Everyone knows at this point though, that at least a part of the battle has indeed been won. Germans at least know that really sick people can in fact legally obtain and use cannabis. The particulars, at least so far, however, have not moved the needle anywhere fast enough.

For those whose mobility and/or budgets are limited by their condition, the only way to respond in both protest (if not effective challenge) is very simple – grow their own, or be part of a cooperative that includes them for free or for a minimal charge in a circle of people who know this is the only drug that helps them manage their condition so effectively.

To leave them out of the circle of care, would be, at its core, a very un-German thing to do. It is not a message that the “industry” wants to hear, but it is in the room and as a steady drumbeat that will not go away.

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The IACM Pushes The Medical Conversation Globally

Written by Marguerite Arnold on . Posted in Medical.

Dr. Grotenhermen, the charismatic canna doc you might have seen or encountered in the world of ground-breaking medical cannabis science auf Deutschland, was on stage a lot in Berlin last week. He and a group of world-famous scientists, doctors, and medical researchers came together, as they do once every two years, for the bi-annual meeting of the International Association of Cannabinoid Medicines.

The audience was large, international and attentive.

What Is New?

There is clear evidence that cannabis is a wonder drug for a range of neurological conditions – from Parkinson’s’ to Alzheimer’s to epilepsy and traumatic brain damage. That was a big part of the conference discussion.

There are brave doctors who now say, in public, and professional conferences such as this one, that treating seriously ill children with cannabinoids, including small amounts of THC, is also effective.

The opioid-cannabinoid discussion was also in the room, with rather shocking data out of the US proving what activists and advocates have long known – cannabis is a gateway drug off of opioids, not on to it.

One of the coolest things about this conference is that it has stayed true to, since its inception, the inclusion of patients. Everyone in the room knows how hard it is to get trials going, and every serious canna doctor also knows that sometimes their best “research labs” are the unceasing din of patients now demanding the drug.

While the research and the data from both mouse and human trials is important, so are patient experiences and the IACM has never forgotten that.

The IACM is also making a concerted effort to bring diversity to speakers. There is now spoken understanding that women and cannabinoids are the next unexplored frontier.

Perhaps the best panel from the nitty gritty end of the conversation was a frank “how to” for doctors considering treating their first cannabis patient. There are not enough of them. Anywhere. A fact that the IACM is also dedicated to changing.

What Is Not New?

As encouraging as advances are, if not the range of voices now uniting globally calling once and for all for medical change, there of course is much that is not new.

Doctors and researchers talked about frustrated funding efforts, including for trials. Patients as always have stories to share about stymied access and punishment.

There is a deep seated understanding, at least within the ranks of the pro-cannabis medical community, that the pace of change and acceptance is still too slow. As one questioner to the patient panel posited, perhaps the medical community should again take up the mantle of struggle that was first pioneered by gay activists in the struggle against AIDS and dropped during much of the modern legalization movement post 2010 in Canada and the U.S.

We are, as cannabis patients, everywhere. Get used to it.

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Which Conditions Are Receiving The Most Medical Cannabis Reimbursements In Germany?

Written by Johnny Green on . Posted in Medical.

The cannabis plant is one of the most versatile plants on earth. It has the power to feed, the power to clothe, and the power to heal. A growing number of suffering patients are turning to the cannabis plant to help treat their condition, including in Germany.

Since 2017, doctors in Germany have had to report medical cannabis information to the German government. It’s a requirement whenever German doctors prescribe medical cannabis that’s covered by statutory health insurance and thus is eligible for reimbursement.

The requirement to provide data makes it very easy for the German government to publish statistical data since the data is readily available. Germany recently disclosed the health conditions that have received the most reimbursements as of September, a summary of which can be found below along with what percentage the condition represents from the data set:

  • Pain (70.9%)
  • Spasticity (10.8%)
  • Anorexia (6.9%)
  • Epilepsy (1.6%)
  • ADHD (1.5%)
  • Tourette Syndrome (1.0%)

The remaining 7.3% is comprised of ‘other’ non-specified conditions. As you can see from the data, pain is the most likely condition to receive medical cannabis reimbursements in Germany by far, although that doesn’t mean that it’s necessarily the only condition that those patients suffer from.

It could be that using cannabis for pain management is really popular in Germany, but it could also be that pain is an easier condition to qualify for and that pain is a symptom of a number of other health conditions.

Many patients in Germany could very well suffer from multiple health conditions yet chose to only qualify for medical cannabis for pain management reasons. Rather than go into great detail with their doctors and be subjected to a number of tests, they can simply establish that they are suffering from pain and that cannabis helps.

This survey data that was released by BfArM involved 6,538 patients, although that’s not to say that there are only that many medical cannabis patients in Germany. German doctors are required to report the data only after the patient has received reimbursements for a full year or ‘as soon as treatment is interrupted.’

The number of patients involved in the study will increase over time. The requirement to participate in the data survey will continue until March 2022.

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France Authorizes A Cannabis Experiment

Written by Marguerite Arnold on . Posted in Medical.

On October 25, the French National Assembly finally gave the green light to a national experiment with medical cannabis. This has been in the offing for some time. As of now, the French government is finally willing to give the cannabis discussion a two-year trial. The Medicines Agency has already signed off.

Cannabis will be able to be prescribed for patients with treatment-resistant conditions including epilepsy, nerve pain, side effects of chemotherapy and for diseases of the central nervous system, including uncontrolled muscle contractions.

That said, the French are skipping the idea of “prescription joints” and will make oils and other ingestible basics (including drinkables) available via French doctors and through French pharmacies.

Prescribing doctors will have to complete an online training course, the details of which have not been released.

Will France Challenge Germany As Europe’s Most Lucrative Market?

Comparisons between France and other countries when it comes to cannabis are at this point premature. However, the French are certainly approaching the issue in a way that so far, even Germany has not.

Doctor training and certification, for example, are not centrally managed, administered, or even made available (no matter how many people are trying to set this up). However, Germany will be a producer within the next two years, unlike current plans in France. Unless and until French cultivation happens, French patients will be caught in the same conundrum as everyone else in Europe.

The idea of getting a prescription is very nice, but actually obtaining one, plus the approvals of health insurance to remove the burden of payment, is much, much harder than many people think.

In the short term look for more foreign-based businesses to get established in France, and further to see products entering the country from all points of the globe, starting with Portugal, Spain, Greece, and Poland.

There is a silver lining of course. Now that the two most powerful, economically intact economies in Europe are in the cannabis basket, it will drive other kinds of reform.

The idea of getting patients into an established program and out of the unregulated market is the ultimate goal, of course, however, it is a goal that is so far unreachable in an environment where medical cannabis is still expensive and far too hard to obtain.

So yes, vive la cannabis! But this is hardly the great green wave revolution most in France, if not in other places, have hoped and fought for. This is not the vision of the “industry” that most have sacrificed and worked for.

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Do Medical Cannabis Patients Ever Really “Come First?”

Written by Marguerite Arnold on . Posted in Medical.

Putting patients first is a mantra that you hear a lot in the cannabis industry, and certainly in Europe. The problem is, no matter how much the “industry” says it, is this really ever true? In multiple places, patients, advocates, and their ilk are up against a for-profit industry that takes no prisoners.

In fact, in Canada, the industry has repeatedly tried to challenge the constitutional right of Canadian patients to access the plant unsuccessfully. Until that goes away, at least in Canada, patients are actually the industry’s biggest, albeit grey market, competition.

In Europe, the conversation is slightly different. However, the discussion is, by definition,  “pro-patient” starting with the fact that most of the bigger companies are public and focused on profits. This means that the industry, certainly within Europe, is looking for ways to preserve its mandate – namely the right to produce, manufacture and distribute (if not export) a product that in its raw form can be grown in a backyard garden, greenhouse, or even indoor grow room without too much difficulty.

As it has elsewhere (see Canada and the United States), this also automatically pits those with capital against those without. There are many, many patient groups who see the future, and it does not include them in it. Being a passive consumer who has to fight paperwork to get a product they might not necessarily want or choose is not the mandate of most activists in this part of the world.

Why should patients organize and fight to normalize an industry that has rarely included them?

That was the question on the table in Poland last week as the first Central European Cannabis Forum kicked off in central Warsaw. Yes, the room was full (of a mostly Polish crowd, but also an international audience). Yes, the big guys showed up, but so did the patient groups and the organizers of the network in Poland. 

Because the industry in Poland is still “illegal” no one is really doing any selling. The patient groups have designed, like elsewhere, efficient non-profit distribution channels that have nothing to do with going public or posting profits, but rather making sure sick people get help.

It is that clash that the industry (everywhere) has yet to address, even though the industry for the most part in Europe is focussed on medical, not recreational. 

Why is that? Because there are still so many patients who have yet to be accepted into the growing medical system. Even when they are, they have to deal with hassles that simply do not exist in the cheaper unregulated market.

Patients, even in a still medical-only market that promises at least to help with the high costs of treatments, are still left in the cold.

Finding ways to incorporate advocate patients into the legitimate industry is in effect, the only answer to help address this important issue. So far, at least, it is a conundrum that neither the business interests trying to solve the problem or patients themselves have adequately answered. But it is the biggest question in the room, no matter the location of the conference.

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France Approves Funding For Two Years Of Medicinal Cannabis Research

Written by Johnny Green on . Posted in Medical.

France is one of the least progressive countries in Europe when it comes to cannabis policy. France is one of the few remaining countries in Europe that completely prohibits medical cannabis. However, that could be changing.

On Friday lawmakers in France voted to approve funding for a two-year medical cannabis research project. Per The Local:

Olivier Veran, a lawmaker from President Emmanuel Macron’s centrist party who proposed the budget inclusion, said the experiments could target some 3,000 sick people in France.

They will seek to determine whether cannabis derivatives can alleviate the symptoms of certain illnesses, and in which doses, he said.

Seventeen other European Union members have already authorised cannabis-based therapies, he added.

The list of health conditions that will reportedly be a part of the study will include epilepsy, chronic pain, cancer, and multiple sclerosis. The study will not involve inhaled-forms of cannabis. Rather, participants will consume cannabis-derived medical products via capsules and other oral dosing methods.

The medical cannabis experiments in France are certainly better than nothing, however, the study is limited in size compared to others that will be conducted on the European continent in the near future.

Earlier this month a medical cannabis study was announced in the UK which will involve 145,000 patients and will be narrowly focused on whether CBD is an effective treatment for Parkinson’s disease.

Still, the approval for medical cannabis research funding in France is significant and will hopefully lead to an increase in future research and help build momentum for medical cannabis reform in France.

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Canada’s Arthritis Society: Sell Medical Cannabis In Pharmacies

Written by Johnny Green on . Posted in Medical.

Cannabis is medicine. That may seem like a simple statement, yet despite an ever-growing mountain of evidence to support the claim, cannabis is often not treated as actual medicine. Many states in the U.S. and countries around the world continue to view cannabis as possessing no medical value.

Most professional sports leagues do not recognize the medical benefits of cannabis. Even in places where cannabis is legal for medical use and/or adult-use, cannabis is often not treated the same way as other medicines. Why is that?

Canada’s Arthritis Society came out recently calling for cannabis to be treated like other medicines, including a call for Canadian pharmacies to sell medical cannabis. Per CBC:

Canada’s Arthritis Society is taking advantage of the federal election to lobby the federal parties to change some of the ways medical marijuana is handled.

They’re asking the parties to commit to lift the $1 a gram federal excise tax, and have medical cannabis dispensed only at pharmacies.

“Just like other prescription medications,” said Jone Mitchell, the society’s executive director for Atlantic Canada.

“That will ensure that patients receive reliable education from trained health care professionals on the safe and effective use. And they also have an understanding of the other medications their patients may be taking.”

It would be convenient for patients to be able to purchase cannabis through pharmacies. Germany’s medical cannabis model is built on sales at pharmacies. For many patients, making their purchases at pharmacies would be ideal.

However, pharmacies should not be given the monopoly when it comes to medical cannabis sales. Not every patient can get to a pharmacy, which is why pharmacies should be one of the safe access options for patients, but not the only one. For some patients, other options are better for their particular situation.

One out of every five people over the age of 15 in Canada suffers from arthritis. Studies have found that cannabis can be an effective treatment for arthritis.

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Australia Launches Multi-Million Dollar Medical Cannabis Research Effort

Written by Johnny Green on . Posted in Medical.

The cannabis plant is one of the most useful plants on earth. It has the ability to feed, clothe, and in many cases, the power to heal.

Cannabis possesses a tremendous amount of wellness properties that can be used to treat a number of conditions, from chronic pain to insomnia.

Demand for medical cannabis research has existed for decades. Unfortunately, harmful prohibition policies in the United States and other areas has hindered research from filling that demand.

That’s not to say that there’s no cannabis research being conducted. As of this article, a search for ‘marijuana’ on PubMed.gov (US National Library of Medicine National Institutes of Health) returns over 31,000 results for peer-reviewed cannabis studies.

The current body of research is significant, however, it’s not enough. Researchers need to be able to study the cannabis plant without political hindrances and hurdles.

Australia’s Health Minister recently announced that a fund will be launched that will be dedicated to medical cannabis research. Per Reuters:

Australia will provide A$3 million ($2.03 million) for research on the use of cannabis to help cancer patients, its health minister said on Sunday, as the demand for medicinal cannabis products grows rapidly.

“There have only been a limited number of well-designed clinical studies on medicinal cannabis, and we need to increase the evidence base to support medical professionals,” a ministry statement cited him as saying.

Australia is home to a growing medical cannabis program that is experiencing strong growth with more and more patients being permitted to cultivate, acquire, and/or use medical cannabis.

The launch of the fund demonstrates that Australia is taking the issue of medical cannabis research seriously, provided that the studies involved are objective and free from bias.

Cannabis opponents in Australia and everywhere else around the world often cling to the false talking point that ‘there needs to be more cannabis research’ before laws can be reformed.

Those same opponents simultaneously do everything that they can to prevent research, which makes it clear that their motives are not based on compassion, but rather they are based on politics.

A sensible approach to cannabis policy involves scientific research and figuring out ways to get all of the best benefits that the cannabis plant can provide while also figuring out ways to mitigate any undesirable properties that may exist for certain patients and required treatment regimens.

Hopefully other countries follow Australia’s lead and embrace cannabis research instead of prohibiting or limiting it. Public health policies should be guided by science, and not the harmful political views of a handful of lawmakers.

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Brazilian Regulators To Vote On Medical Cannabis Proposals Tomorrow

Written by Johnny Green on . Posted in Medical.

Brazil is the largest nation in South America, as measured by population size, and the next closest country on the continent isn’t close. Brazil’s population of over 200 million people dwarfs the next closest country on the list, Colombia, which has a population of fewer than 50 million people.

A new, compassionate, and exciting industry being created out of thin air in Brazil would be a really big deal on a global scale because of how large the country is. Brazil is the fifth most populated country on earth.

That is what is happening right now, albeit slowly, right before our very eyes. The medical cannabis industry is coming to Brazil beyond imports of pharmaceutical-based cannabis medicines. 

Multiple proposals of regulatory models are currently being considered by Brazilian regulators, with a vote expected tomorrow. The vote was originally expected last week until a delay was announced leading up to the vote. Per Brazil’s National Health Surveillance Agency (Anvisa):

Some suggestions from the Agency’s directors on the texts of the Resolutions to be deliberated on Tuesday (8/10) on cultivation and registration of cannabis-based medicines need to be evaluated. Tema returns to the agenda of the Anvisa Collegiate Board at the next meeting, scheduled for October 15.

Initially, topics discussing criteria for cultivation and registration of plant-based drugs would be deliberated at the Board meeting on Tuesday (10/08).

However, some suggestions from the Agency’s directors were presented to the text. Prior to consideration by the Board of the Agency, the new considerations will be evaluated by the technical areas related to the topic, as well as by the Anvisa Attorney.

Brazil is currently a leading importer of pharmaceutical-based cannabis medicine. It’s far from being an optimal situation. Those types of products are extremely expensive compared to cannabis flower and other cannabis product options that are available in many legal cannabis markets.

Pharmaceutical-based cannabis products are not effective for a large number of suffering patients in Brazil. Those patients need legal access to other forms of cannabis that can be consumed via a wide array of consumption methods.

Domestically cultivated cannabis is what Brazilian lawmakers tasked the government with building a regulatory framework for, and once that becomes a reality, Brazil will likely become home to some of the cheapest medical cannabis options in the world.

It is no secret that cannabis grows better and easier in many parts of South America compared to the rest of the world, similar to other agricultural products. Brazil is no exception. The climate in many parts of Brazil is ideal for sungrown cannabis cultivation.

Not only could Brazil produce its own medical cannabis cheaper than current options for legal cannabis imports, it very well could end up cultivating so much cannabis that it creates the opportunity for Brazil to become a top cannabis exporter to countries around the globe.

Suffering patients in Brazil deserve better medical cannabis options, and individuals and entities that can do honest work and provide quality medicine to those patients should be allowed to legally do so. Hopefully this week’s vote is favorable and Brazil moves closer to implementing a legal, regulated medical cannabis industry.