German Medical Cannabis is as Easy as getting Ibuprofen 600 Editorial/Report (mixed) from a major German (conservative leaning) publication. Translated by, with the kind assistance of ChatGPT. Its the first report by a major german publication about the large Medical loophole.
Since the legalization of cannabis, the business with medical cannabis is booming. The behavior of some providers raises doubts about whether only patients are being targeted—or if the high demand is also coming from recreational users. The CDU (Christian Democratic Union, a major conservative political party in Germany) is alarmed, while the SPD (Social Democratic Party of Germany, another major political party) is undecided.
Cannabis arrives at the house via DHL (a major international courier service). As if it were a sweater or a new coffee machine. The only difference: a signature from the recipient is not enough; the delivery person also wants to see an ID card. Then the treatment can begin. The 20 grams, packaged in a vacuum-sealed bottle, is medical cannabis grown in Canada. Beforehand, the patient had to fill out an online questionnaire on one of the numerous platforms that, for fees ranging from 15 to 50 euros, offer a video consultation with specialized general practitioners. The conversation with the doctor, who also wants to see an ID card, lasts about five minutes. Medical condition? Previous experience with cannabis? This is followed by a recommendation for the type and dosage of cannabis. Then comes the prescription, which can be immediately submitted digitally to a mail-order pharmacy or taken in person to a specialized pharmacy.
So quick, so easy. The medical cannabis business in Germany is booming. This aspect of cannabis legalization receives little public attention. "Since April 1, the medical cannabis market has nearly doubled in Germany," says David Henn, CEO of the medical cannabis wholesaler Cannamedical, in an interview with ntv.de. The Bloomwell Group, which provides a digital platform for medical cannabis to both doctors and pharmacies, reports massive growth: The number of patients using the group's referral service increased by 1000 percent in April alone compared to the average of the previous twelve months.
Suddenly no longer a narcotic Behind this development is a little-known legal change that occurred as part of legalization: Cannabis has been removed from the list of drugs listed in the Narcotics Act (BtMG) (a German law regulating narcotics). As a result, cannabis also fell out of the Narcotic Prescription Ordinance. Since then, doctors have been able to prescribe medical cannabis much more easily than before. For pharmacies, the previously onerous documentation requirements and the mandates for particularly secure storage have been eliminated.
David Henn says, "Cannabis is no longer the medication of last resort for treating severe illnesses but can rightly be used for a wide range of conditions." The regulatory requirements are now comparable to those for Ibuprofen 600—a non-herbal pain medication prescribed after outpatient procedures or for acute back pain. Advocates of cannabis as a natural remedy for relatively mild issues like sleep disorders and menstrual cramps are enthusiastic about this development. However, the practice raises questions: Is medical cannabis also being deliberately marketed to recreational users? This is not easily determined.
Patients Pay Out of Pocket There is no central oversight or at least a record of the number of cannabis prescriptions issued. Most prescriptions are paid for privately. Few people seem to bother seeking reimbursement for prescriptions and medications from their health insurance. Depending on individual consumption, monthly costs can quickly reach triple digits. The National Association of Statutory Health Insurance Funds (GKV) is unaware of an increase in such reimbursed prescriptions. However, the GKV does not yet have figures for recognized prescriptions for the current year.
In online discussion forums like Reddit, many consumers share information about where and how much cannabis they have been prescribed. Many users mention specific ailments such as menstrual cramps, headaches, sleep disorders, or severe chronic illnesses they treat with cannabis. Others are clearly only interested in recreational use. Some are disappointed with the prescribed amount or the level of THC—the active ingredient responsible for the high. Complaints about not receiving a prescription at all are not found. The prescription practice seems to be minimally restrictive. Users are, however, frustrated by several weeks of waiting for a doctor's appointment and longer delivery times from some mail-order pharmacies that struggle to keep up with high demand.
Cannabis Companies expected more (relates to recreational not medical)
The video consultations are facilitated by platforms such as Bloomwell, Kanna Medics, and Canify. Bloomwell alone claims to collaborate with over 65 doctors. Like its competitors, the company is looking for more licensed general practitioners willing to offer cannabis consultations. In the end-customer distribution, alongside smaller pharmacies, large specialized providers are particularly active: for example, Grnhorn Apotheke and Grne Brise. These are backed by major players in the business: Grne Brise belongs to the Bloomwell Group, while Grnhorn is part of the publicly traded cannabis company Tilray. In Canada and several U.S. states, Tilray also markets and promotes cannabis for recreational use, as it is legal there.
In Germany, this is not the case: pharmacies advertise on their websites and in Google previews, highlighting their live inventory of various strains and short delivery times. The Berlin specialty pharmacy Herbery even offers a "delivery service" within the capital for those in a hurry. Some providers sell not only accessories such as cannabis vaporizers but also merchandise: shirts and sweaters with slogans like "High Standard" or "No High Without Sport."
Expertise from the Manufacturer Numerous companies and investors had prepared for years for the complete commercial distribution of cannabis planned by the traffic light coalition (government). However, this initiative, even though it was included in the coalition agreement, has so far been thwarted by EU law. For now, cannabis entrepreneurs are limited to the medical cannabis market. They are not just conquering it; they are also creating it: with free training for doctors, some of which are CME-certified. With these so-called CME points, doctors can prove they are fulfilling their continuing education requirements. This is similar to the classic pharmaceutical industry, which also provides its expertise to doctors.
The providers of the relevant training courses are partly directly connected to the manufacturers of medical cannabis. For example, a course offered by the Frankfurt-based company Hormosan Pharma GmbH, specializing in pain therapies and partnered with Tilray since 2021, can be found with a quick Google search. According to Bloomwell, they use the collected data "not only to better train the cooperating doctors but also to promote research on medical cannabis."
Potential consumers are also being targeted: Bloomwell, for instance, collaborates with the rapper Xatar. In a TikTok video clip featuring the highly successful musician in Germany, he learns that the THC limits for cannabis patients while driving do not apply. Bloomwell offers patients an expert opinion for the driver's license authority for around 150 euros. In response to an inquiry from ntv.de, the Federal Ministry of Health explains that advertising for prescription medications is prohibited. However, advertising for telemedicine is allowed "if a personal doctor-patient contact is not required according to generally accepted professional standards."
Millions of new potential patients
But who sets these standards? On what scientific basis are prescriptions even made? "There are no clinical trials for medical cannabis, but that doesn't mean there's no scientific evidence," says Cannamedical CEO Henn. Expensive clinical approval studies are uninteresting for the industry because the various active ingredients in cannabis plants, known as terpenes, cannot be patented. Thus, the cannabis industry produces much of the existing expertise itself by cooperating with universities and institutes. This doesn't have to be unscientific or improper, but it does highlight a potential conflict of interest.
"Medical cannabis patients continue to be stigmatized, even though the numbers speak for themselves: about 13 million people in Germany suffer from chronic pain and 6 million from sleep disorders," Bloomwell shares upon inquiry. This also indicates the scale of potential future patients the company is targeting. At the same time, Bloomwell defends against the suspicion that the company is targeting customers other than those who are ill. "The new regulations aim to meet the real needs of patients and not to promote recreational use," writes a spokesperson.
Cannamedical CEO Henn, for his part, claims not to see any abusive use of the new opportunities. "There must be a doctor who stands by this therapy. I am not aware of any treatment—whether through a teleclinic or an in-person doctor—that is simply waved through and where, to put it bluntly, someone readily stamps the treatment requests," he says. Henn also points out that the misuse of non-herbal, prescription medications is hardly publicly discussed, whereas cannabis still faces stigma.
The Federal Ministry of Health, led by Social Democrat Karl Lauterbach, states upon inquiry that "doctors must not facilitate the abusive use of their prescriptions." It also notes that "pharmacies are legally obliged to counteract recognizable drug abuse appropriately." The ministry does not have "the ability or the authority to monitor or review individual medical practitioners' offers." Uncovering violations of medical professional duties is the responsibility of the state supervisory authorities.
Concerns and Criticism in the Bundestag
Even if the parties involved are not violating laws and duties, the Bundestag (German Federal Parliament) views this development with concern. Carmen Wegge, who co-negotiated cannabis legalization for the SPD, says, "We observe that online platforms have suddenly emerged where, if you indicate enough issues like sleep disorders and depression, you immediately get a prescription without ever having seen a doctor in person. This was not the legislator's intention, to put it very clearly."
Wegge is also concerned about the high THC content of medical cannabis. While the legislature has allowed the distribution of cannabis with up to 10 percent THC in cultivation associations to individuals up to 21 years old, most products offered in online specialty pharmacies have a THC content of 20 to 25 percent, sometimes even up to 30 percent. "For recreational use, we cannot support this," says Wegge. "20 percent THC content is very strong and potentially harmful, especially for the developing brains of young people."
Tino Sorge, the health policy spokesperson for the CDU/CSU parliamentary group, is even more critical of this development. "It would be an admission of failure by the traffic light coalition if they allowed commercial distribution of cannabis through the backdoor in this way," Sorge says in an interview with ntv.de. "It cannot be that stoners are supplying themselves with medical cannabis via self-payer prescriptions. This amounts to a deliberate deception of the public if the coalition has created and tolerates a gray market where cannabis needs are met through medical cannabis for alleged illnesses."
The CDU/CSU faction helped enable easier access to medical cannabis for people with severe illnesses in 2017 and has since supported further easing, Sorge notes. However, he fears that the high sales are due to a flaw in Germany's cannabis legalization: "The governing parties have legalized possession without clarifying the source. Those who smoke today cannot yet have the stuff from legal cultivation, whether private or in cultivation associations," Sorge says. This has promoted the black market and the potential abuse of medical cannabis.
Need for Clean, Legal Weed Sorge demands, "Federal Health Minister Karl Lauterbach must take action and cannot just let it slide when laws are not being followed." If the federal government wants this, it must enable manufacturers of medical cannabis to legally distribute it to recreational consumers.
The high demand for medical cannabis shows that the government's plans for the trial introduction of licensed distribution points must be implemented quickly, says SPD politician Wegge. She sees a positive side to the high demand for medical cannabis: "At least this way, people get clean, unadulterated cannabis. They neither give their money to criminal organizations nor have to come into contact with them," Wegge says. "It is important that we see here: People want to move from organized crime to a legal market."
https://www.n-tv.de/politik/Fragwuerdiges-Geschaeft-mit-Cannabis-auf-Rezept-boomt-article25056962.html