Evidence, Access and the Future of Cannabinoid Medicine: Key Takeaways from Cannabis Health Symposium Frankfurt – Part 1

A recurring message throughout the day was that progress requires more than generating evidence. It also depends on policies that reflect those findings, pharmaceutical standards that keep products consistent, and training for the clinicians and pharmacists working with cannabis-based medicines.

The day’s afternoon sessions will be covered in Part 2, focusing on German reimbursement reform, pharmaceutical standards, pharmacy responsibilities and cross-market patient access.

If you couldn’t make our Frankfurt edition, the second annual London event will be taking place at Conway Hall on 26 November, and tickets are available here. 

Evidence or Ideology? Germany’s data dilemma 

This panel brought together Professor Bernd Werse, Dr Artur Schrörs, and Copeia co-founder Garvin Hirt, moderated by MJ Universe CEO Lisa Katharina Haag, to discuss the enduring gaps in clinical evidence in regard to cannabis medicine and the barriers researchers face in generating this data. 

Speakers broadly challenged the perception that Germany lacks sufficient evidence to inform cannabis policy, arguing that existing research is often overlooked or interpreted out of context.

Professor Werse, who has studied drug consumption trends for more than two decades, pointed to findings suggesting that fears of increased youth cannabis use following Germany’s 2024 reforms have “not materialised”. 

“Since the Cannabis Act was introduced, the trends that existed before haven’t really changed at all. There has been a relatively significant increase among adults since 2012… and that trend has continued, though the curve has actually flattened out a bit.”

He added that this increase could be attributed to more people “simply being honest about using cannabis”, with 2024’s partial legalisation helping reduce stigma more broadly. 

Challenging assertions that it was essential to differentiate between medical and recreational use, Prof Werse argued that people may use cannabis for therapeutic and recreational reasons simultaneously, complicating the categories used in research and policy.

“There are many, many people who fall into a grey area,” he added.

Turning to the barriers holding back the research many in the medical mainstream have long called for, the panel highlighted the specific issues within Germany’s current framework. 

Dr Artur Schrörs, former head of Frankfurt’s drugs department, told the conference he had discussed proposals to establish a scientific pilot project in the city, which were rejected by officials, following the recent change in government.

This could have answered “so many questions”, Dr Schrörs noted, providing valuable insights into consumption patterns, public health outcomes and the impact of legal supply on the illicit market. 

Garvin Hirt discussed the existing evidence base for medical cannabis and the limitations of current clinical research. He insisted it is “fundamentally the industry’s responsibility” to collect data through patient registries, real-world evidence and post-marketing research, while also noting the potential issues around bias in industry-sponsored research. 

“The companies are responsible for collecting data,” he told the panel. “And that doesn’t happen to the extent it should.” 

Cannabinoids vs opioids: a new class of treatment for chronic pain?

Prof Michael Ueberall, Medical Director, Center of Excellence in Health Care Research / Institute of Neurological Sciences, questioned whether cannabinoids should continue to be positioned as a last-resort treatment for chronic pain in his presentation, Cannabinoids vs Opioids: A New Effective Class of Treatment for Chronic Pain?

He explored how Germany’s regulatory framework has historically required patients to exhaust conventional treatment options before accessing medical cannabis through statutory health insurance, arguing that this positioning reflects legal and reimbursement considerations rather than necessarily the most appropriate clinical approach.

Drawing on recent clinical trials published on the cannabinoid-based drug Exilby, which has now been approved in Germany for use in chronic lower back pain with a neuropathic component, he presented evidence suggesting that certain cannabinoid medicines could have a role earlier in treatment pathways.

He also explored the role of the endocannabinoid system in chronic pain, emphasising that effective treatment should address not only pain intensity but also how patients experience, tolerate and respond to persistent pain.

“It’s no longer just about reducing pain but about truly and adequately treating the progression of pain, its chronicity, and all the problems associated with it,” he said.

While stressing that treatment decisions must remain medically appropriate and evidence-based, he added: “Can I really, in good conscience, still prescribe opioids for chronic lower back pain in today’s climate? No. Honestly, no.”

Endometriosis and beyond 

The final session of the morning, Endometriosis and Beyond: Medical Cannabis in Women’s Health, highlighted the longstanding underrecognition of women’s pain and the need for more targeted research in this area. 

Dr Sylvia Mechsner, a gynaecologist at Charité University Hospital, outlined the complexities of endometriosis, highlighting the long delays women face in obtaining a diagnosis and the tendency for menstrual pain to be dismissed or normalised.

Mechsner explained how endometriosis-related pain can become increasingly complex, involving inflammation, nerve sensitisation and changes in the body’s pain-processing pathways.

Presenting findings from a survey of 912 women, including 114 who reported cannabis use, Mechsner described perceived improvements in symptoms including menstrual pain, sleep and nausea.

She also discussed a small clinical study involving 30 patients with treatment-resistant endometriosis-related pain who received a balanced oil.

The study identified improvements in several patient-reported outcomes, including pain and quality of life, although Mechsner acknowledged its limitations, such as the fact it was not placebo-controlled.

Highlighting the need for larger, controlled clinical trials capable of informing future treatment guidelines, she emphasised that cannabis-based medicines should be considered, where appropriate, as part of a broader treatment approach rather than a replacement for established hormonal therapies.

“There remains a small portion who have treatment-resistant pain… and medical cannabis could certainly play a role here.”