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The last four years since the law on cannabis as medicine came into force have brought both praise and criticism. And now? Now it’s time to improve what can be improved. We asked experts from industry, politics, medicine, but also lawyers and patients: What do they see as future opportunities and risks and what are their wishes for the future of medical cannabis in Germany? After the Bundestag elections, the prospects are good that the new government will readjust the law on cannabis as medicine.

The approval proviso must go and de-bureaucratization

The greatest consensus is regarding the authorization proviso: “Too many patients are unfortunately still denied access to this additional therapy option. It is time to make medical cannabis available to patients like a normal medicine,” says Dr. Adrian Fischer, co-founder and CEO of Demecan. He gets agreement from Lana Korneva. The CEO of Drapalin Pharmaceuticals would like to see “the abolition of the authorization requirement for reimbursement by SHIs for cannabis medicines – at least for the common indications.” One of the leading cannabis physicians, Dr. Franjo Grotenhermen, also welcomes on behalf of the Arbeitsgemeinschaft Cannabis als Medizin (ACM) the current demand of the FDP and the Greens to “abolish the approval proviso in the reimbursement of cannabis-based medicines by statutory health insurers.” Hemp association executive director Georg Wurth says, “Doctors and patients should decide together about the therapy.” Sebastian Schütze, member of the management and director policy at the German Pharmaceutical Industry Association and head of the industry working group on cannabis, agrees: “In general, there should be more reliance on physicians’ responsibility for therapy. But they must also have the opportunity to gain medical therapy experience.” This, in turn, is only possible with a corresponding cost commitment, without which the physician may not issue a prescription for cannabis at the expense of the statutory health insurance.”

Less effort for chronically ill patients and easier access to low THC preparations

Julian Wichmann, MD, criticizes the fact that regular on-site doctor visits are required for chronically ill patients to obtain a prescription. This is “an additional burden and in some cases unreasonable.” The question is therefore “how to keep the effort for follow-up prescriptions low in the interest of the patients while at the same time preserving the regulations,” says Wichmann. In addition, the specialist, who cares for well over a thousand patients with Algea Care, demands: “In perspective, it should be explored to make preparations with a low THC content prescribable by normal prescriptions instead of narcotic prescriptions. This would significantly increase acceptance within the medical profession.”

Home cultivation should be legalized on a small scale

Alex Rogers, director of ICBC, would like to see “all citizens* be able to grow on a small scale at home.” He says it’s “important for everyone to be as independent and proactive as possible when it comes to taking care of their own health.” Wurth also calls for home cultivation to be approved for all patients “who can and want to do it.” That works smoothly in the U.S., he said. Regardless of home cultivation, Blienert calls for an expansion of cultivation in Germany “to enable real trade and exchange.”

More money for research and development

Alexander Rieg, a consultant at AR Pharma Consulting and founder and former managing director at Geca Pharma, criticizes the contradiction of calling for medical evidence on the one hand, “but hardly funding scientific studies” on the other. “Otherwise, we run the risk of not fully exploiting the therapeutic potential of medical cannabis,” Rieg fears. He is not alone in this concern. Jens Iwer of the Association of German Cannabis Patients (BDCan), Blienert and Schütze would also like to see a better study situation. – “In order to be able to make the diverse possibilities of cannabis medicine accessible to more patients,” says Iwer.

Better trained physicians and pharmacists

Max Plenert, one of the first cannabis patients in Germany, calls for more knowledge transfer and networking for various stakeholders. As an example, he cites “knowledge kits for doctors and patients for consultation hours.” Alexander Rieg wants to improve the “education of physicians, pharmacists and all professional groups involved in care regarding medical cannabis quickly.” “At Drapalin, we have found that there is still a great need for continuing education from physicians and pharmacists – especially for daily practice. Therefore, we have taken the issue of CME continuing education into our own hands and set up a digital offering for the time being,” says CEO Lana Korneva about the current offering of education and training for professionals.

New dosage forms and whole extracts are gaining in importance

Jürgen Neumeyer, managing director of BvCW, expects that “more standardized medicines with cannabinoids will come onto the market in the future.” Expects, however, that “several more decades” will pass before these can cover “the spectrum of effects of flowers.” Axel Gille, president of Aurora Europe, observes that alternative dosage forms such as full cannabis extracts are becoming increasingly important. Dennis Stracke of Medios Apotheke agrees. He sees an opportunity for “cannabinoid-containing prescription drugs to develop further, new dosage forms to establish themselves and thus the portfolio of application options” to expand. “Despite the existing supply difficulties, we will see more supply – both for flowers and extracts – in the future. The stability and deliverability of the products is still a big challenge for the companies, but we also expect new countries from where cannabis for the German market will come,” Lana Korneva from Drapalin estimates the future supply situation.

Direct forwarding of the goods

Georg Wurth of the Hemp Association advocates a simpler trade chain: “The nonsense of opening the cans with the hemp flowers, checking them and then adding a hefty price surcharge must be stopped. There’s nothing wrong with directly passing on what’s already been checked by cannabis agencies and bringing the price down to a normal level.”

More transparency and uniform regulation

Neumeyer wants to achieve with his BvCW, more transparency and nationwide equal regulations. Peter Homberg, an attorney at Dentons, also calls the inconsistent legal handling of medical cannabis nationwide “in every respect” in need of “improvement.” It represents a complex hurdle for intra-German trade, he said.

Beware of charlatans

Meanwhile, Stephen Murphy, founder of Prohibition Partners, warns that interest in cannabis is also being exploited by publicly traded companies. He fears a crash in Europe analogous to the North American market experience: “Investor education and transparency in the industry will continue to be key.”

More competition must not affect quality

Competition has intensified recently. Cansativa’s Jakob Sons warns, “`Prevent’, therefore, that competition goes hand in hand with a quality deficit. `Improve’ we can as an industry our efficiency to realize lower costs and competitive product and service offerings at the same quality.”

Incidentally, the chances of things happening in the next year are not bad at all: SPD politician Burkhard Blienert expects the law to be reformed “quickly” in any case after the Bundestag elections.

Based on the materials

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Seit dem Inkrafttreten des „Cannabis als Medizin” Gesetzes am 10. März 2017 ist die Verschreibung von Cannabis in Deutschland zu therapeutischen Zwecken legal. Unter ärztlicher Anleitung können Patienten ein Rezept für medizinisches Cannabis erhalten und damit medizinisches Cannabis in verschiedenen Formen erhalten und anwenden.