Deep-dive: Cannabis Pilot Programs Are Sprouting in Europe – Cannabis Wire

Unlike some states in the US, not one country in Europe has fully legalized cannabis. But lawmakers in several EU nations are tiptoeing towards legal cannabis, whether it is for therapeutic or adult use. 

Luxembourg, with just 500,000 people, has come close to becoming the first European country to make cannabis completely legal, but its proximity to—and open borders with—other nations appears to have slowed down the process. It shares a border with France, Belgium, and Germany, and is a close neighbor to the Netherlands and Switzerland. These countries, with the exception of the Netherlands, have a less liberal approach to cannabis policy, especially when it comes to adult use.

In the last four years, meanwhile, lawmakers across Europe have been working on pilot programs to experiment with safely introducing cannabis, still considered controversial in some countries, into the legal market. In Switzerland, researchers, supported by lawmakers, have been pushing for an experiment that would test the public health impact of allowing legal cannabis to be distributed by pharmacies for adult and therapeutic use. In Holland, where adult use of cannabis has been tolerated for forty years in coffee shops, an experiment to legalize the whole chain of production is on its way. And in France and Denmark, lawmakers are inching toward the legalization of medical cannabis, which is so far legal in half of the European countries, including Germany. 

Here’s a more detailed roundup:

Denmark

In Denmark, a four-year experiment with medical cannabis started in 2018. The aim was to offer sick patients who did not benefit from traditional medicines, “a lawful way of testing treatment with medicinal cannabis,” according to the Danish Medicines Agency. The government had planned to start an evaluation of the experiment as soon as January 2020, but leaders realized last December there were not enough patients registered in the study and thus not enough data to collect. As a result, the experiment was extended and the collection of data postponed.

Peder Hvelplund, a member of Parliament and the health spokesperson for the Green Party—who also sits on the House committee on health that wrote the bill—told Cannabis Wire that “many problems” were encountered with the experiment, and the biggest of them was the cost of the drugs. “The prices are too high and the reimbursement from the state too low,” he said. “So people simply don’t buy the products.” Hvelplund said he wished there was more funding from the government to help Danish patients buy more on the legal market. 

According to the guidelines of the experiment, the licensed sellers are free to change the products they want to sell, and free to fix their own prices, which can be readjusted every two weeks. The government is reimbursing fifty per cent of the cost of any product, up to about $1,400 US per year. But there are only a few products authorized and they all are imported, which means they are expensive. 

For example, according to the Danish Medicines Agency, the Danish company CannGros is the only one authorized to sell imported products from Holland. It sells herbal tea and oil products called “Bedica,” “Bediol,” and “Bedrocan,” at $125 US per package. At this cost, the reimbursement ceiling over a year  is quickly reached and the Danish patients who can’t afford the price have had to turn to the illicit market. Aurora is the only other competitor, with soft capsules called Sedamen sold at $237 US. 

In an attempt to lower the prices, in 2017, the government opened applications for authorization to cultivate to Danish farmers, too. But three years later, locally grown cannabis still hasn’t made it to the market. Torben Lippert, head of the Danish Horticultural Society and a board member at the group Cannabis Danmark, told Cannabis Wire that the process has been more difficult than he expected. He believes it took too long for the Danish growers to get approval from their government. “And when we were finally awarded a licence to grow, then our selling approval was denied.” Lippert said he is ready to file another request and hopes to have a licence to sell in no later than a few months.

According to Hvelplund, consumers have had to turn to the illicit market for another reason, too—because there was also a lot of resistance from the doctors. Doctors, he said, don’t want to use cannabis-based drugs because of the lack of enough evidence they have any effect. When the House of Representatives voted in favor of the experiment back in 2016, it was supported by the Health Minister, Ellen Trane Nørby, but the Danish Health Authority had advised against it and didn’t produce the guidelines the doctors needed to prescribe the drugs safely. A lot of them are still reluctant to do so.  

Switzerland

In Switzerland, cannabis with less than 1% of THC has been legal since 2017 but only for quantities below 10 grams. It can be found in tobacco stores and can even be grown at home. Doctors can also get special authorization from the Swiss Health Agency to prescribe cannabis with higher levels of THC to their patients. 

And researchers are pushing to find out what happens when the cannabis market is fully legalized for both adult and medical use. Last February, a bill authorizing the experiment related to adult use was successfully introduced in the House Committee on Social Security and Public Health. The bill was passed last week in the Upper House, the Conseil des Etats, with more than three quarters of the lawmakers voting in favor. In the small scale experiment, pharmacies will be the point of sale. All the major cities of the country, including Zurich, Bâle, Geneva, Bern, and possibly Lausanne and Winterthour, are eager to participate.

Sven Trelle, a professor at the university of Bern and head of the Clinical Trial Unit where the experiment was designed, told Cannabis Wire his goal is not to test any hypothesis on whether cannabis should or shouldn’t be legalized. Rather, he and his fellow researchers are interested in seeing how the consumer is impacted when access to cannabis is legal and when the drug is quality-controlled. “We want to compare it with the current illicit market and see whether patterns change. For instance, we want to see if legal access increases consumption, and the consequences on the consumers’ health,” he said. He added that pharmacies are supportive of the experiment. 

Each city will recruit about 1,000 volunteers, all at least eighteen years old, to test the new system. New cannabis consumers won’t be accepted in the experiment and the volunteers will have to prove they were consumers before. Their behavior will be monitored for five years, and doctors will record any changes in mental and physical health. They will also observe the changes in the market and check if consumers withdraw from the illicit market to turn to pharmacies. Data will be collected across the country and centralized in Bern where Sven Trelle’s team will be in charge of analyzing it. 

“We’ll be looking for changes in the quantities consumed, but also in the psychiatric disorders, and maybe we’ll see an increase in lung disease,” he said. 

Swiss lawmakers added a provision in the bill requiring that the production be reserved to Swiss farmers. The idea is not just to produce local organic cannabis but to ensure that the Swiss farming sector “benefits from these experiments.” 

Holland

For four decades, in the famous coffee shops of the Netherlands, cannabis has been sold openly but illegally over the counters—a practice only “tolerated” until last fall, when lawmakers voted in favor of a bill that framed a new experiment in which the supply chain would be legalized and regulated in specific cities. 

In this new experiment, called “Wietexperiment,” or “The Closed Coffee shop Chain Experiment,” the Dutch government wants to “ascertain whether or not it is possible to regulate a quality-controlled supply of cannabis to coffee shops and to study the effects of a regulated supply chain on crime, safety, public nuisance, and public health,” according to the website of the Dutch government. By creating a legal supply of cannabis grown in Holland, the hope is that official legal growers will push out the imported illicit products coming from Afghanistan, Thailand, or Morocco, and that street dealers will be left without supply

The experiment was initiated by mayors across the country, who have been seeking restrictions on the consumption of cannabis inside the coffee shops since 2008. That year there was an attempt to implement a membership system. It was put in place in several cities but quickly withdrawn after consumers, who were afraid to provide their identity, turned from the coffee shops to street dealers. 

The calls for applications to become a licensed grower ended in July. The government will now select ten growers among the applicants, which would be the only providers for all the coffee shops in ten designated cities, starting in January 2021. (Amsterdam will not take part in the experiment. With more than 160 coffee shops in the city, the government decided it would have been difficult for the new sellers to keep up with the demand.) 

In each of these cities, coffee shops will not be allowed to buy cannabis from any other sources, putting all the current illegal providers off-limits. The experiment will last four years, and will be monitored by a team of researchers who will gather data on crime and noise annoyances in the coffee shops’ neighborhoods. 

Iggi De Backer, owner of a coffee shop called Rag-a-Muffin in the city of Groningen, two hours north of Amsterdam, told Cannabis Wire that he is eager to see it implemented. “I have had a semi-legal job for the last twenty years, so I would like that to change.” But in Groningen, there might be obstacles. The former mayor of Groningen, Peter den Oudsten, was in favor of the bill but he retired in the fall. His successor, Koen Schuiling, a conservative from the People’s Party for Freedom and Democracy, said publicly he would not allow his city to pay for the experiment, and warned the Parliament in a letter in January that he needed funding in order to go ahead with it. In the meantime, the supply at the Rag-a-Muffin coffee shop is still unregulated. While De Backer can’t reveal who his sellers are, he says they are Dutch, just not licenced.

France 

France, the country with the most cannabis users in Europe, also has a long history of strict enforcement of the ban against adult and medical use. 

But a medical experiment, pushed in the lower house by a doctor and MP turned-Health Minister, Olivier Véran, was approved in the fall of 2019. It was set to start in January but was delayed to September 2021 because of COVID-19-19. The experiment plans to recruit patients with epilepsy, neuropathic pain, or multiple sclerosis. Cannabis will be prescribed only  in the forms of oil and dry flower to be vaporized. The experts of the National Agency for the Safety of Medicines and Health Products advised against smoking the drug, foreseeing negative effects on the combustion process on the health of the patients and of those around them. 

The prescription will be issued by a neurologist or a doctor specialized in pain management. There will be a follow-up of the patients for at least six months in the hospitals where the experiment will be carried out. The first dose of cannabis will be provided by pharmacies affiliated with hospitals, and then by local pharmacies. 

Last May, the committee of experts that approved the experiment also looked at options for producers. The experts said they didn’t think French producers would be ready in time to start providing for the trial and that they were already looking at foreign producers. 

 

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