Medical cannabis prescriptions: three years of cannabis law in Germany

Medical cannabis prescriptions: three years of cannabis law in Germany
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Since the introduction of the cannabis law in Germany in 2017, healthcare provider, the BARMER, will have  received 14,986 applications for medical cannabis products by the end of January this year.

BARMER’s analysis shows that of the number of medical cannabis product applications they have received since the inroduction of the cannabis law in Germany, a total of 10,255 (68.4%) were approved and 4,731 rejected.

Dr Ursula Marschall, chief medical officer at BARMER, said: “Cannabis is a highly complex drug that requires specialist medical knowledge. Used correctly, it can be a valuable therapy option for seriously ill patients, but not a panacea.

“Medicinal products containing cannabis should therefore only be prescribed by doctors who are familiar with the full therapeutic range of the medication and its various ingredients.”.

This means that cannabis can be used as a medicine in a more targeted way than before for patients who actually benefit from it. In this way, the rejection rates are likely to decrease further.

Number of applications increased over the years

According to the BARMER analysis, the number of applications for reimbursement of medicinal products containing cannabis has increased in recent years. While there were 3,090 applications from March to December 2017 inclusive, there were 5,238 applications the following year and 6,094 applications last year.

While the approval rate was 65% in the 2017 period, it rose to 72% in 2018 and decreased to 67% last year.

“Cannabis applications are rejected, for example, if they are to be used for clinical pictures for which other alternative therapies have not yet been examined,” says Marschall. In contrast, cannabis helps particularly well with special nerve pain, which is often stronger than cancer pain.

Significant regional differences in the permits

The analysis shows that in the past three years most of the applications for reimbursement of cannabis-containing preparations in Bavaria were 3,029, followed by North Rhine-Westphalia (2,871) and Baden-Württemberg (1,310).

Marschall said: “There are so many cannabis regulations in Bavaria because there was a research focus at the University of Munich in the mid-1990s. The doctors are accordingly experienced in formulating the applications.

This is not the case to the same extent everywhere, which may result in lower approval rates in some regions. These ranged from 77.8% in Saxony-Anhalt to 56.4% in Hesse.

Marschall added: “If in some regions far fewer cannabis applications can be approved than in others, this can also be due to information deficits and incorrect applications. Additional information is required here.”

Cannabis flowers most often prescribed

According to the analysis, since March 2017, BARMER insureds have been prescribed almost 83,000 packs of cannabis-containing preparations worth around €35.3m ($38.49m). Among them were almost 20,000 packs of unprocessed cannabis flowers.

“The demand for cannabis flowers is so high that delivery bottlenecks can sometimes occur. Their use is not without problems. Unlike formulations and finished medicinal products, they have very different amounts of active ingredients and are difficult to dose,” says Marschall.

Above all, special medical knowledge regarding the proper prescription is required so that the flowers are incorporated into an overall therapeutic concept. In addition, cannabis flowers are also more expensive than cannabis-containing capsules and sprays.

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