Germany is likely to legalise the adult-use of recreational cannabis in 2024, but what does this mean for the country’s medical cannabis community?
Cannabis is not a dirty secret in Germany. Tens of thousands of patients—potentially more than 1% of the population—benefit from medical access, with the country’s medical cannabis market one of the largest and most developed in Europe.
Additionally, according to German Federal Minister of Health Karl Lauterbach, an estimated four million people already access cannabis through the country’s illegal legacy market.
Now that Germany’s government has announced plans to legalise the recreational use of cannabis for adults, questions remain around how this could affect access to medical cannabis treatments for current and future patients and how the medical and recreational markets can co-exist.
Germany’s medical cannabis landscape
In March 2017 an amendment to Germany’s Narcotic Drugs Act enshrined access to medical cannabis into law. While some cannabinoid-based medicine had previously been allowed via a special permit in very rare cases, medical cannabis was not widely available and could not be covered by a patient’s health insurance.
Germany’s Medical Cannabis Act of 2017 provided unprecedented access to cannabis-based treatments in the country and, for the first time, allowed medical cannabis products to be covered by Germany’s statutory health insurance.
“In this respect, access for patients to therapies with cannabinoid-based medicine is theoretically easier, compared to the UK,” writes Franziska Katterbach, president of Khiron Europe, in correspondence with Cannabis Health.
“But de facto access is often hindered by bureaucratic and other hurdles.”
One hurdle is insurance. Not all patients in Germany are getting their insurance claims covered, with up to 40% of applications for insurance reimbursement rejected by firms. Based on research carried out by Cansativa, a leading local platform for medical cannabis in Germany, about half of medical cannabis patients in Germany access it through private prescriptions.
Legalisation in Germany: potential impacts on medical cannabis community
Minister of Health Karl Lauterbach published draft proposals for the legalisation of adult-use cannabis in October.
Under the proposals, cannabis will no longer be classed as a narcotic and citizens over the age of 18 will be free to carry up to 30g of cannabis for personal use, with consumption in public spaces permitted after 8pm. Consumers will also be permitted to grow up to three plants per person at home.
As one of the most prolific medical cannabis companies in the world, Khiron is keeping a keen eye on how the recreational market may develop in Germany and what this might mean for the medical cannabis community.
“We are already feeling positive effects, as the discussion around the topic of cannabis in Germany is now being conducted more actively, with the focus being on the topic of health and not on a political opinion,” writes Katterbach.
“This is a big step forward for everybody and our patients, as the topic of cannabis still carries a stigma that needs to be removed.”
Legal adult-use recreational cannabis doesn’t necessarily mean easier access for people seeking cannabis for specific medical conditions. Take, for example, Canada’s legalisation of recreational cannabis in 2018. The overly-complicated system undermined a thriving medical cannabis industry and sparked the closure of numerous production facilities resulting in the loss of hundreds of jobs.
One 2019 study on how recreational legalisation affected access for medical cannabis patients in Canada indicated that almost a quarter of all patients found it harder to access cannabis post-legalisation.
“It is our biggest mandate to make sure that [patient access is not disrupted],” writes Katterbach.
“After all, the market for medical cannabis in Germany is steadily growing and reimbursed. This is a huge difference in comparison to the US and Canada.”
She continues: “If recreational cannabis is legalised in Germany, the categories of demand, availability, and production capacity must be carefully considered in order to protect patients’ access to cannabinoid-based medicine therapies.”
Enough high-grade quality products to meet demand?
Katterbach believes there needs to be a distinction between high quality, pharmaceutical-grade medical cannabis that is GMP certified (the minimum standard that a medicines manufacturer must meet in their production processes) and ‘so-called street cannabis’ that is used for recreation purposes.
“Even if it is basically the same plant, different standards apply to regulation, production, ingredients, and use,” she says.
“What has been shown with the legalisation of recreational cannabis in Canada since 2018 is that quality [cannabis] brands prevail that have the trust of consumers. We [can] build this trust in the medical market, which gives us an opportunity to transfer this to a recreational market later on.”
Availability of supply could also hinder patient access. Annual demand for illegal cannabis is, according to Katterbach, estimated to be 400 tonnes by some experts, yet demand for medical cannabis is also steadily increasing and currently sits around 20 tonnes per year.
Most cannabis in Germany is imported.
Katterbach explains: “All three [medical cannabis] producers in Germany provided only 250 kilograms of medical cannabis in the first half of the year. Not even the demand for medical cannabis will be able to come from domestic production and many sides are very critical about a lack of production capacity in Germany regarding a medical and a recreational market for cannabis.”
Legalisation in Germany is not a done deal
While all eyes are on Germany, Katterbach highlights that there is still some way to go before an adult-use market becomes a reality.
“One thing needs to be clarified on the topic of the planned legalisation of recreational cannabis in Germany,” she writes.
“Some act as if the key points from this cornerstone paper by Minister Lauterbach on legalisation are already a finished law.”
All legislative processes take time, and there are still many rounds of country- and EU-level reviews and decisions to be made before legalisation can happen.
“The proposals on production/cultivation, distribution, possession, THC-limits, and prevention are very immature and getting criticism from all sides,” emphasises Katterbach.
“The upcoming positioning of the European Union on the ideas from the key points paper will have a decisive influence on the entire legislative process and thus on the planned legalisation of recreational cannabis in Germany.”
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