Despite a global increase in support for the use of medical marijuana, patients across Europe have been left frustrated by the reluctance of governments to make cannabis products available to those who stand to benefit from them. France, for example, is still in the early stages of exploring medicinal cannabis, while official guidelines in the UK have made it extremely difficult for clinicians to prescribe cannabis products, and patients to access them.
Fortunately, however, Denmark looks set to break the mould, having launched a unique medical cannabis pilot programme in 2018. Due to run for a period of four years, the programme has recently passed its halfway point, and the results of the initiative are expected to inform future legislation on the use of medicinal cannabis in the country.
What Does The Programme Entail?
A limited number of medical cannabis products, such as Sativex and Nabilone, have been available on prescription in Denmark for specific conditions since 2011. However, given that these medications are only approved to treat neuropathic pain, doctors have not had the liberty to offer cannabis products to patients suffering from other conditions.
For this reason, the government decided to launch a bold new pilot programme that allows doctors to prescribe untested cannabis products for any condition. This means that since January 1st 2018, doctors have effectively been unshackled and given the freedom to use their discretion when deciding which patients should be allowed to try cannabis-based medications.
According to the Danish government, “the purpose of the pilot programme is to offer patients a lawful way of testing treatment with medicinal cannabis if they have not benefitted from authorised medicines.”[i]
Doctors have been equipped with a set of guidelines to help them make decisions regarding the prescription of cannabis products, but they are not bound to follow any specific regulations. These guidelines include access to all of the scientific literature on medical cannabis, which means clinicians can consult the evidence when deciding whether or not to prescribe marijuana for depression, anxiety, cancer-related pain and a wide range of other ailments.
The guidelines recommend that doctors specifically consider prescribing cannabis for the treatment of painful spasms caused by multiple sclerosis or spinal cord damage, nausea resulting from chemotherapy, and neuropathic pain. However, the government has insisted that “neither the law nor the pilot programme’s guidelines prevent doctors from prescribing medicinal cannabis to patients with other illnesses than those mentioned in the guidelines.”
Which Cannabis Products Are Included?
When announcing the scheme, the government stated that clinicians would be allowed to prescribe cannabis products that are “not authorised medicines” and which have not been subject to clinical trials. This approach represents a significant departure from the position of the UK, where clinicians are prevented from prescribing most medical marijuana products precisely because they have not been extensively tested.
Eight different products were initially included in the scheme, all of which were imported from either Canada or the Netherlands, with a longer-term plan to start producing home-grown medical cannabis in Denmark. Unfortunately, however, four of the Canadian products have since been removed from the market, and the establishment of a Danish cannabis market has been hit with delays, which means that only four medications are currently available through the programme.
These include three different types of cannabis flower produced by Bedrocan in the Netherlands, and a soft capsule called Sedamen, which is produced by Canadian firm Aurora.
This narrow range of products has proved to be the programme’s main stumbling block, and critics have been calling for the inclusion of more medications, particularly oils.
Has The Programme Been A Success?
The pilot programme massively exceeded all expectations in its first year and saw an exponential increase in the amount of patients receiving medical cannabis. A total of 411 prescriptions were written in the first quarter of the 2018, with this figure more than tripling to 1,329 during the final quarter of the year.
This upward trend continued through the first half of 2019, but suddenly hit a snag when half of the products covered by the programme became unavailable. As a consequence, only 696 prescriptions were handed out during the fourth quarter of the year, although this rose to 825 for the first three months of 2020.
Around two-thirds of these prescriptions have been for pain-related conditions, while a fifth have been given to patients suffering from various forms of epilepsy. The government has also helped patients pay for their prescriptions by subsidising 50 percent of the costs, up to a maximum of 10,000 krone (£1,235) per person per year.
Clearly, the programme is not without its faults, and some details still need to be ironed out. Whichever way you cut it, though, there’s no getting away from the fact that the scheme has made medical cannabis more readily available to those who need it.
The outcomes of the programme will be evaluated once the four-year period ends in 2022, although hopes are already high that the success of the scheme will result in permanent legislation supporting the widespread use of medical cannabis.
As for the rest of Europe, most governments will be keeping a keen eye on developments in Denmark in order to gain a better understanding of how to introduce medical cannabis in their own countries. Hopefully, the success of this pilot programme will convince the British authorities to loosen the shackles and launch something similar in the UK. Until that happens, medical cannabis users unable to access or afford medical cannabis prescriptions should consider signing up to Cancard, which will decriminalise the use of cannabis for people with certain medical conditions from November 1st.
A fundraiser is currently running to help finance the card, and you can find out more details about that here.