The German Health System Will Cover Therapeutic Cannabis for the Seriously Ill with Prescriptions

Everything suggested that Germany would approve the bill, which ensures patients greater access to the plant. And so it was: on 19 January the Bundestag, the lower house of the German parliament, unanimously ratified the new law, by which patients will be able to obtain their cannabis-based medications with a prescription, and with the help of subsidisation by health insurance, both public and private.

In Germany the use of cannabis for medical purposes was already permitted. However, there were numerous bureaucratic obstacles to actually acquiring it. Patients had to request special authorisation from the Federal Institute for Drugs and Medical Devices (known by its German acronym, BfArM). The process entailed a series of exhaustive analyses and controls that, in many cases, culminated in refusals. In April of 2016 only 647 patients had the federal permit entitling them to buy cannabis as medicine at pharmacies. Under the new law, which enters into force in March, these procedures are suspended, and it will only be necessary to present a prescription for the drug.

Still, doctors will restrict access to these prescriptions. The law indicates that they may prescribe cannabis to patients suffering from serious diseases, such as cancer, epilepsy or Multiple Sclerosis, and who really need cannabis because they do not stand to benefit from other, alternative therapies. The association of physicians and other health professionals specialising in pain and palliative medicine in Germany (BVSD, for its acronym in German) stressed that the new law is "significant", as it boasts the potential to provide a large number of patients with relief. 

In addition, under the new rules, cannabis costs will be lowered. Thus far patients were required to cover these drug costs, which in some cases came to 1,800 euros per month. Now both the public and private health systems will be responsible for shouldering at least part of the cost.

Those who are seriously ill need the best possible treatment, which entails payment by medical insurance for cannabis-based medicine for the chronically ill if they can not be effectively treated any other way.

In this regard Health Minister Hermann Grohe was very satisfied with the unanimous outcome of the vote. "Those who are seriously ill need the best possible treatment, which entails payment by medical insurance for cannabis-based medicine for the chronically ill if they can not be effectively treated any other way," he said.

Representative Rainer Hayek, meanwhile, with the conservative CDU party, also indicated that "today is a great day". However, he was quick to point out that the law "will not allow people to smoke pot using prescriptions", and that it certainly does not mean the legalisation of recreational cannabis.

The creation of a state agency and drugs imported from Holland

For supply and production Germany will create a State Cannabis Agency. However, until it is launched, drugs (cannabis flowers, dry leaves and extracts) will be imported, under supervision by health authorities, from countries such as Holland, a pioneer in the sale of therapeutic cannabis, already poised to increase production in order to supply its neighbours. The same will apply to the active ingredients dronabinol and nabilone, which will only be provided in exceptional cases.

In this way the new legislation meets growing demand from patients. Chronic pain, epileptic seizures and nausea and vomiting caused by chemotherapy in cancer patients may be allayed by cannabis, which means better quality of life for them. Weary of all the bureaucratic obstacles to legally obtaining cannabis, many patients had turned to the black market. Thus, the online version of the German newspaper Die Zeit stated that "cannabis will finally become a medicine for all those who need it, and not just for the rich". 

Homegrowing in Germany: more to be done

Despite the achievement the new law constitutes for patients, there is still work to be done. Homegrowing, for example, remains prohibited. Even for therapeutic purposes. The law alleges that this is due to the need to prevent low-quality products that escape health authorities' oversight. 

Still, all is not lost. One German recently received permission from the Federal Institute for Drugs and Medical Products to cultivate his own plants for medical use, after 16 years in court. This victory accelerated the approval of the new law, which, paradoxically, continues to penalise homegrowing. But the door is open to each patient fighting, on his own, in court, for permission to plant medical cannabis for his own consumption.

The new law will serve as a scientific study

The German Health Ministry also made sure that the new legislation will make it possible to track all the cases of patients who are treated with cannabis, to assess its benefits. In this way a major scientific study will be launched to gauge the effectiveness of marijuana in relieving the suffering of the terminally ill. Because of its many benefits, this could lead to another legislative step forward in the future permitting, for example, homegrowing for patients who need it. 

In this regard, several have spoken out in support of more liberal access to the plant. In the German Parliament the party The Left called for extending cannabis therapies to all kinds of patients, and not just the chronically and terminally ill. The Greens, meanwhile, repeated their endorsement of legalising cannabis under state control. 

A step further: the demand to regulate recreational cannabis in Germany

Recently the federal state of Berlin and the region of Dusseldorf submitted to the central Government two bills to regulate the sale and distribution of cannabis by adults for recreational purposes. 

And Berlin drew up a proposal with support from the Social Democrats, The Greens and The Left to allow adults to buy and distribute cannabis in a controlled manner. It is not the first time that an initiative of this type has been advanced by the capital and the areas surrounding it. The Berlin district of Friedrichshain-Kreuzberg made a similar request, in which it asked to legalise cannabis trafficking. However, the Federal Institute for Drugs and Medical Devices rejected the initiative on the grounds that it violated the current narcotics law, according to which cannabis is a narcotic.

Meanwhile, in the region of Düsseldorf (part of the state of The Rheinland, in North Westphalia) it was decided to set up a group of expert groups to assess the advisability of an initiative for the regulated sale of cannabis to adults for recreational purposes. Physicians, psychologists, police and economists joined forces to yield a joint vision in this regard. Representatives from other municipalities, such as Cologne and Münster, also attended meetings in order to implement similar discussions in their action areas. 

Despite interest in several states and regions, the complete legalisation of cannabis is still far away in Germany, as it is in the rest of Europe. Calls by citizens do not translate into interest amongst politicians in passing laws facilitating access to cannabis, especially when it comes to homegrowing. In any case, the financing of these drugs by the German health care system is a big step; although too little in the view of many, it is a sign of the plant's therapeutic and medical effectiveness.