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Dutch cannabis experiment could see more patients turning to coffee shops

A four-year experiment aims to try and solve the Netherland’s ‘backdoor’ cannabis criminality problem.

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Recreational cannabis use has been tolerated within the walls of the Netherland's coffee shops since the 1970s

A four-year experiment to try and solve the Netherland’s ‘backdoor’ cannabis criminality problem could see patients turning to coffee shops for easier access.

The cultivation and sale of cannabis for recreational purposes are strictly prohibited in the Netherlands – unless you are visiting one of the country’s famous coffee shops.

These establishments are allowed to sell small amounts of cannabis but operate under strict rules, including a limited stock of 500 grams.

On a municipal level, authorities can decide how many coffeeshops it will allow if any, and as the country deals with a growing number of “drug tourists”, individual municipalities can choose to ban foreign visitors from entering the region’s coffee shops.

Although the sale of the drug is tolerated, coffee shops face a contradiction in Dutch law known as the ‘backdoor policy’. Shops can sell the drug to their customers, but their suppliers are forbidden from cultivating and selling cannabis to them. In other words, sales through the front door are allowed, while sales through the backdoor are not.

“As a result of the policy of tolerance, the sale of cannabis to users is permitted, but the cultivation, sale and purchase of that cannabis is prohibited, which easily leads to crime. After all, the coffee shop needs to be supplied,” said Ellen Gielen, head of the life sciences group at global law firm, CMS and co-author of the company’s ‘Expert Guide on Cannabis Legislation’.

“The discussion to legalise the supply of coffee shops with cannabis has been going on for several years.”

A 2008 “weed summit” brought together 33 Dutch mayors from various municipalities and different political parties to discuss drug tourism in border regions. A survey carried out by the evening newspaper NRC Handelsblad revealed that 80 percent of the mayors in attendance were in favour of ‘regulating the backdoor’.

Over a decade later, the Netherlands is now embarking on an experiment across ten municipalities to evaluate the effects of a closed supply chain for coffeeshops.

Ten commercial cultivators will be made exempt from current laws, allowing them to sell and deliver quality-controlled cannabis to a total of 79 coffee shops.

The experiment is known as the ‘controlled cannabis supply chain experiment’.

The legally produced cannabis will have to be lab-tested and meet the Dutch government’s quality, labelling and packaging requirements. But there will be no limit to the THC concentration and producers can set their own pricing.

Cultivators applied to be part of the study in July 2020 and are due to be selected this month before the Dutch government kick starts the four-year experiment.

“The aim is to see if and how cultivators can supply quality-controlled cannabis to coffee shops in a decriminalised way,” Gielen added.

“In addition, the government wants to examine the effects of the experiment on the problems that some municipalities experience – for instance, on crime and public health.

“The experiment means that more suppliers and cultivators are contracted by the government and there are more options for the sale of seeds and or cannabis.”

Gielen anticipates that recreational use through coffee shops will, in part, substitute medicinally prescribed cannabis.

“Doctors are holding back from prescribing cannabis and health insurance companies, in general, do not reimburse for medicinal cannabis,” Gielen said.

“Some patients therefore choose to get their cannabis at coffee shops.”

Although it has been legal for any physician to prescribe medical cannabis in the Netherlands since 2003, treatment guidelines do not encourage prescribing due to the lack of clinical evidence.

“Especially now that the government is planning to supervise the supply and quality through the experiment, expectations are that medicinal users will switch to the freely available recreational cannabis, as they have to pay for it anyway.”

A research consortium that includes Breuer & Intraval, Rand Europe and the Trimbos Institute was commissioned by the Dutch government and will carry out an evaluation over the four-year period.

The consortium will investigate the impact of the experiment on health, user experience, nuisance and displacement effects.

Stijn Hoorens cannabis experiment

Stijn Hoorens, senior research leader at RAND Europe

“We will conduct numerous interviews with coffeeshop owners, municipalities, police and other stakeholders,” said Stijn Hoorens, senior research leader at Rand Europe.

“We will count coffeeshop visitors and conduct a survey amongst customers and ask them about their purchasing and consumption behaviour.”

The Trimbos Institute, meanwhile, will take cannabis samples from coffeeshops in both experimental and control cities and have them lab-tested and compared.

“At RAND, we will also aim to measure some of the developments outside the coffeeshops and whether we could observe any displaced effects on the illegal market,” Hoorens continued.

“This is very difficult, because we don’t have a reliable picture of what’s happening in the illegal market in the first place, let alone as a consequence of the experiment, but we’ll try.”

The results from the ten multiplicities involved with the experiment will be compared with a control group of ten other regions where the current laws are maintained.

The conclusions of the study will later be used by the government to decide on its next steps for designing the future of cannabis policy, however Hoorens said the main objective was not to reduce illegal production or curb organised crime.

“The primary objective is to test whether it is at all possible, or feasible to design, operate and enforce a closed supply chain for decriminalised cannabis,” Hoorens said.

“If the main actors in the supply chain, producers, distributors, coffee shops, consumers, local authorities and law enforcement are happy, the experiment has succeeded. However, we are also asked to attempt to measure the effects on public health, public safety, nuisance, crime, and displacements effects.”

At such an early stage, it is difficult to predict the outcome of the experiment, but Hoorens believes it is unlikely that the “backdoor” policy will still exist in the Netherlands after the four-year experiment.

“We have a number of hypotheses that we will test, but anything could happen,” Hoorens added.

“If customers don’t like the legally produced cannabis, the illegal market might thrive. If the legal products turn out to be a success, there might be a displacement from the illegal market, and perhaps even from other cities towards the coffee shops in intervention cities.

“I think it’s fair to say, that it is unlikely that the situation with a decriminalised front door and a criminalised back door will still be present in the Netherlands.”

Industry

New fully digital cannabis dispensary launches in UK

It aims to streamline the process through which  cannabis patients can access their medicine.

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New fully digital cannabis dispensary launches in UK

A new fully digital medical cannabis pharmacy aims to improve the dispensing experience for UK patients.

A new digital dispensing solution has launched in the UK, with the aim of streamlining the process through which cannabis patients can access their medicine.

Through the new system, patients are able to schedule delivery to their home or office, with a 120-minute delivery service in London and Birmingham and next-day delivery across the UK.

Akanda subsidiary, CanMart, has partnered with digital pharmacy infrastructure Phlo Connect and Cellen Life Sciences to bring the project to life.

The process will be increasingly seamless for patients in the near future as Phlo Connect, Cellen and CanMart build additional digital interconnections, Akanda said.

Osteoarthritis: A banner advert for the medical cannabis clinics

Tej Virk, CEO of Akanda, said: “Akanda is committed to expanding access to high-quality products for anyone in need, and that is qualified in the United Kingdom, a growing market for medical cannabis.

“Phlo Connect and Cellen are the ideal partners to make this happen, combining the UK’s first fully digital pharmacy with a digital dispensing model that is easy to use, secure, and real-time.

“In the nascent UK medical cannabis market, patients currently suffer from excess friction as the prescription process, and last-mile delivery is disjointed.

“We firmly believe that our solution is the best way to satisfy patients and get our 1P and 3P-supplied medical cannabis in their hands quickly and conveniently, which will greatly improve the patient experience.”

New fully digital cannabis dispensary launches in UK

The partnership with Phlo Connect builds on CanMart’s existing partnership with Cellen, a health tech company that provides treatment to chronic pain patients through Leva Clinic, as well as through partners including the NHS, and Boots UK.

The Leva Clinic, which is licensed and regulated by the Care Quality Commission, is one of the first fully digital pain clinics in the UK.

Cellen is also a medical cannabis supplier to Project Twenty21, the large-scale medical cannabis observational study monitored by Drug Science that aims to improve access to medical cannabis.

Adam Hunter, CCO of Phlo Connect commented: “We believe partnering with CanMart and Cellen will be a game-changer for medicinal cannabis patients here in the UK.

“By integrating with both CanMart and Cellen via our API-driven pharmacy platform, we believe that this partnership is the first truly end-to-end digital experience for medicinal cannabis patients in the UK.”

He added: “Our patients require access to new high-quality products without the friction and hassle of traditional dispensing services. This partnership is another example of our continuing efforts to build on our national, established relationships with the wider pharmaceutical community in innovative ways.

“We believe that CanMart’s access to high quality products as well as Phlo Connect’s extensive capabilities in dispensing will go a long way to helping our service to our patients.”

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CiiTECH celebrates five years with five days of CBD offers

CiiTECH’s five-year birthday is a pivotal moment, the company said.

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Cannabis healthcare company CiiTECH celebrates its fifth birthday and reflects on a turbulent half-decade for the CBD industry.

CiiTECH’s five-year birthday is a pivotal moment, the company said. After what has been one of the most turbulent times for the industry, the firm has achieved six months of stability. With new crypto projects on the horizon and new markets on the cards, the company is gearing up for a period of growth.

CBD is a tough industry to be in right now but that has never stopped CiiTECH CEO and founder, Clifton Flack, from driving the business through regulatory issues and the challenges of an increasingly saturated market.

“When we started the business in 2017 the market was approaching the peak of interest and excitement. Since then, alongside the hundreds of brands that have been born to compete with us, we’ve also faced monumental regulatory pressures and flip-flopping,” Flack said.

“We’re still here though, independent and with a bright future ahead as the coming year ahead brings settled regulations.”

After a stormy start to the year, the FSA delivered on their promise to roll out a framework by which products can be set on a supervised pathway to novel food authorisation. The market is now more difficult than ever to penetrate for new and emerging brands, however it gives established UK CBD companies like CiiTECH an advantage over international companies attempting to penetrate the UK market.

“In parallel, the industry and our peers have had a two year pandemic, Brexit supply chain disruptions and now a cost of living crisis set to put all previous volatilities to shame,” Flack added.

“Now more than ever, cannabis healthcare companies need to take our time, avoid the panic and focus on delivering quality products behind trusted brands that are built for the long term.”

Recently, CiiTECH investigated a stock market listing on the London Stock Exchange but the IPO did not come to fruition.

“As the CEO, I had to make an impossible decision,” Flack said.

“Amongst other things, the timing was just not right. Consumer sentiment and demands are volatile and we found the essence of our company getting lost in bureaucracy at a time when it should have been front of mind.

Yesterday, CiiTECH launched five promotions over five days to celebrate the anniversary of the company.

“As a revenue-driven business, CiiTECH would not be in the position it is today without its army of loyal Provacan customers, so we’re giving back to them the best way we know-how.

“With five days’ worth of promos and freebies to mark five years of success. Our Friday promo emails have become somewhat legendary among our customers but we have never done anything like this before.”

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GPs should prescribe medical cannabis, says industry review

A new review has recommended the roll out of a national trial, permitting GPs to prescribe medical cannabis.

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GPs should prescribe medical cannabis, says industry review
Polling showed strong support for allowing all doctors to prescribe cannabis as a treatment. 

A new UK report has recommended the roll out of a national trial permitting GPs to prescribe medical cannabis.

GPs should be allowed to prescribe medical cannabis in the UK, according to a new review published on Monday 27 June.

Industry experts have recommended the roll-out of a national trial, which would see GPs permitted to prescribe cannabis-based medicinal products, alongside specialist consultants. 

The recommendation was published as part of the Hodges Review, commissioned by The Centre for Medicinal Cannabis (CMC) and the Association for the Cannabinoid Industry (ACI).

The report, which aims to set out how the UK can be a world-leader in cannabinoid innovation, is set to be launched today (27 June) with a speech by MP George Freeman, the minister for science, research and innovation.

US research programme studies cannabinoids in ovarian cancer

GP prescribing 

In the UK, GPs may prescribe as part of a ‘Shared Care’ agreement, under the direction of a doctor on the specialist register, but they are not permitted to initiate treatment themselves.

According to polling data, collected for the review from 1,500 individuals across the UK, between the 9-13th June, 2022, there was strong support for allowing all doctors, not just specialists, to prescribe cannabis as a treatment. 

Two-thirds of respondents (65 per cent) believe GPs should be allowed to prescribe medicinal cannabis and more than a third said they would trust their GP to prescribe it to them.

Among 20 recommendations made by the report, the authors suggest an “opt-in model” which would give GPs the option to consent to prescribing cannabis-based medicines and participating in data collection to help inform future guidelines.

In more than 50 countries worldwide where medical cannabis has been made legal GPs make up the majority of prescribers. 

A survey of over 1,000 GPs, published last year by the Primary Care Cannabis Network, found that there was a willingness from UK doctors to prescribe too. 

Almost a quarter (24 percent) said they would be willing to take on the role of prescribing and overseeing medical cannabis treatments and just under three quarters (73 per cent) were open-minded about having a more active role in the field.

Read more: How GPs could open up access to medical cannabis

Quoted in the Hodges Review, Hazel Neavyn-Neita, medical information lead, Althea Life UK and Ireland said: “The cost of supplying product to the UK is roughly 3.2 times higher than supplying product to Australia.

“Allowing GPs to prescribe and widening patient access may increase sales. It would also reduce the costs of consultations for private patients since they could see a GP rather than a specialist consultant. If volumes increase, companies will be able to reduce the cost of manufacture and shipping which will reduce the cost to the patient.” 

Deepak Anand, principal of ASDA Consultancy Services, added: “By not allowing all GPs to prescribe, we’re effectively putting people into the black market, because people are going to try to access this whichever way they can… That is a serious and abject policy failure from a public health perspective by the government. Once we start to see GPs prescribing, you will see a real opening up of the industry in the UK.”

The report also highlighted the need to “take forward commitments” for coordinated data collection, suggesting that GP prescriptions could involve patient enrolment in a national registry to help gather real-world evidence.

Further recommendations include consulting with patient groups and police forces to introduce Home Office guidance for frontline officers to verify patients who have a valid prescription, and creating a single formulary of all available products in the UK to support doctors in prescribing with up-to-date information.

Attitudes towards medical cannabis 

Among those polled, there was broad support for cannabis as a medical treatment.

One in five respondents said they personally know someone whose health has benefited from medicinal cannabis and 63 per cent would be supportive if a family member was taking it to address a health condition.

Only eight per cent said they would be “somewhat” or “very” opposed to it and almost one in seven people admitted that they have used cannabis for “health reasons” themselves. 

Of those who had used cannabis for medicinal reasons (whether prescribed by a doctor or not), 90 per cent experienced positive benefits, including a fifth whose symptoms were “completely resolved”. 

There was also recognition of a need to make cannabis medicines more accessible for patients in the UK, with 59 per cent of those polled believing that the government should help lower the cost of cannabis supplied by private clinics so more people can afford it.

A large majority (64 per cent) of respondents believe the government should do more to support scientific research into cannabis in the UK.

CBD vs Medical cannabis

Although public awareness of medicinal cannabis was lower than of CBD, the report found evidence to suggest that public levels of trust are generally higher. 

When asked about CBD products, the most concerning thing for 43 per cent of respondents was if the product was synthetic and not from natural ingredients, or if the product was not tested for purity. 

Those hesitant to try CBD said they would be most likely to try a product if there was more public information about CBD and how to take it and if the government made it clear that CBD was legal.

The report also claims that where young people are more open to the use of CBD, older people are more likely to report positive views towards medicinal cannabis.

By contrast, young people were more likely to think that medicinal cannabis is “not a serious clinical treatment”.

A total of 59 per cent of respondents believe that in 10 years time the medical benefits of cannabis would be more widespread and accepted.

You can download the full report here

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