Iceland: proposed pilot project could permit use of medical cannabis

A four-year pilot project, which would permit the use of cannabis for medicinal purposes in Iceland, has been proposed by policymakers.

Following a debate in Alþingi [Icelandic parliament] last week, officials have proposed a four-year pilot project to permit the use of medical cannabis, as well as the cultivation, production and distribution of cannabis-based products for medicinal use. 

If approved, the Ministry of Health will work with the Minister of Culture and Trade to establish a working group to prepare a bill allowing companies to apply for licences to produce and distribute cannabis medicines. 

The bill would need to be presented by the ministry by 31st December with the four-year pilot programme expected to begin on 1 January, 2024.

Currently the only cannabis-based medicine which can be legally prescribed in Iceland is Sativex, which contains isolated forms of CBD and THC and is used as a treatment for spasticity associated with multiple sclerosis (MS) and muscle dystrophy. However, access to Sativex is strictly regulated and can only be prescribed by licensed neurologists.  

CBD products are legal in Iceland, providing they are THC-free. 

Pilot could follow Denmark’s medical cannabis model

According to documents published by Alþingi, the project will take a similar form to the model which was established in Denmark in 2018 with the aims of improving knowledge on the effects of cannabinoids, while preventing patients from having to access cannabis products illegally. 

The Danish project was divided into two parts, including a plan to allow for the cultivation of Cannabis sativa in order to extract and produce medicines, alongside an experiment to look at the use of substances from the plant for medicinal purposes. 

The Danish Medicines Agency guidelines allow for the prescription of cannabis medicines to be considered for four conditions. These include multiple sclerosis, spinal cord injury, patients undergoing chemotherapy and patients with chronic pain.

Following a report which was published in 2020, the project was deemed to have provided a ‘good and safe framework’ for the use of cannabis as a medicine.

A document issued on behalf of the Alþingi, states: “The authors believe that the pilot program that the Danes have been working on must be looked at seriously, based on their experience and that of other nations, and create a basis for the consideration of allowing cannabis for medicinal purposes on a trial basis. 

“It is clear that the experimental project in Denmark has not been carried out without criticism, and it is therefore important that the shortcomings that may have existed in the project be considered and lessons learned from them.

“Denying patients’ access to cannabis products to protect potential abusers is not justified. It is clear that chronic pain is a major social problem and a great cost to society in the form of lost work capacity and strain on the health care system. 

“Although the evidence for the positive effects of cannabis as a medicine for medical purposes is still limited, the benefits of medical cannabis products are considered to outweigh the negative effects.”

The remit of the working group

Once the proposal is approved, the Icelandic working group will be tasked with examining, discussing and drafting a bill on the following:

• Definition of licences for the cultivation, production and distribution of cannabis for medicinal purposes.
•  Issuing permits.
• A development plan that will be valid for four years and will be in accordance with the rules on drug test plans. 
• A list of the cannabis products that will be allowed to be produced and distributed and that can be legally prescribed by doctors and dispensed in pharmacies.
• Application form and the application process
• Conditions for issuing licences and that growers ensure traceability in both directions and can specify the parties from whom they have received inputs, such as seed and seeds.

The approval of the proposal has been postponed to a later date.

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