The health hazard presented by opioids is not a new public health concern. Largely in response to the widespread use of heroin and the synthetic opioids developed in the 1930’s, the United Nations established its Single Convention on Narcotic Drugs in which it called for a unified ban of those substances in addition to coca, and, you guessed it, cannabis. Despite those bans, a steady creep of legislative changes in favor of cannabis regulation are slowly but surely transforming the treaty from an international standard to an obsolete document of yesteryear.
Portugal was the first country to decriminalize all drugs in 2001. In 2014, Uruguay became the first country to legalize cannabis at the national level. Canada is on track to have federally regulated cannabis by July 2018. Though illegal at the federal level, cannabis has been legalized for either medical or recreational use in 29 states and the District of Columbia in the United States. Though it remains illegal in the Netherlands (possession and sale are treated as civil infractions and cultivation remains criminalized), cannabis use is so accepted that Amsterdam is internationally recognized as a mecca for pot lovers. Mexico might be infamous for its brutal war on drugs, but it legalized weed for medicinal purposes in June 2017. Both Italy and the Czech Republic have authorized medicinal cannabis as well. There is a growing movement of anti-prohibitionism, and Germany is the newest country to join the fold—at least when it comes to the use of cannabis for medicinal purposes. One of the most concerning aspects of cannabis prohibition is the plant’s superior therapeutic efficacy to many synthetic drugs and the withholding of such beneficial medicine from patients in places where cannabis is banned.
The chemical compounds housed in the plant, including the psychoactive tetrahydrocannabinol (THC), cannabidiol (CBD), and various terpenes, may work symbiotically to produce what is known as the entourage effect. In a 2011 study conducted by Ethan Russo, the synergy between cannabinoids and terpenes was found to have the potential to alleviate the symptoms of cancer, bacterial infections, fungal infections, pain, inflammation, epilepsy, addiction, anxiety—all without the risk of overdose.
Germany Gets on Board
That’s why Hermann Gröhe, Germany’s Minister of Health under Chancellor Angela Merkel, presented draft legislation to the cabinet in May 2016 for the legalization of cannabis for medical use. “Our goal is that seriously ill patients are treated in the best possible ways,” Gröhe said. In January 2017, Germany’s lower house of parliament passed that legislation. The law makes cannabis an option for patients suffering from illnesses including attention deficit disorder, chronic pain, nausea, multiple sclerosis, and 26 others. Before this law, only about 1,000 patients used cannabis through special authorization from the government. Though the personal cultivation of cannabis remains illegal, this law is still far more progressive than others in one important regard: insurance coverage.
“Those who are severely ill need to get the best possible treatment and that includes health insurance funds paying for cannabis as a medicine for those who are chronically ill if they can’t be effectively treated any other way,” Gröhe said. While cannabis will only be offered as a medicine if other treatments fail, the ability to receive the medicine with a prescription rather than through a cumbersome special application process and be reimbursed for it through insurance makes this legislation one of the most accessible for medical patients. However, Germany’s medical cannabis regulation isn’t perfect. Though insurance coverage is an option, it’s only offered for the most severe conditions even though doctors have the freedom to prescribe it for an array of ailments varying in their severity.
Another limitation with mixed reviews is the influence doctors have over the type of cannabis consumed. Patients receive scripts instead of medical cards, and vaporizers and capsules are much easier to dose than edibles or flower.
The Cannabis Industry
Business-wise, cannabis in Germany will be very different than what we have seen in, say, California. Since cannabis will be obtained through pharmacies, there will be no dispensaries. This is good for those looking for discretion—the product a patient is interested in is much less obvious when purchased from a pharmacy than from a dispensary dealing exclusively with cannabis. On the other hand, this means less room for entrepreneurial innovation. The German industry will be made up mostly of cultivation, packaging, and ancillary businesses. Despite some limitations, it will still be a boon to the job market.
No Recreational Cannabis...Yet
Part of the reasoning for the law’s regimented nature is the cabinet’s desire to prevent recreational cannabis use. As in countries all over the world, cannabis consumption is a polemic topic. While some laud the plant’s medicinal value and appreciate its function as a relatively safe way to have a good time, others fear widespread, government sanctioned intoxication and addiction. And even those interested in weed as medicine would like more conclusive research on the plant’s effects. That’s why Germany’s law has also mandated a simultaneous study of cannabis’ medical efficacy. As of now, the Health Ministry is wary of recreational cannabis consumption. “International studies from the last 10 years show that the use and abuse of cannabis can be associated with a number of serious short-term and long-term risks, particularly among young people,” the Health Ministry said. “Psychological and psychosocial disorders (such as schizophrenic psychoses), organ-medical effects (such as cardiovascular diseases) and neuro-cognitive impairments (such as the impairment of learning attention and memory functions) are mentioned.”
Both opponents and proponents of Germany’s new law see it as a step toward blanket legalization. Georg Wurth, CEO of the German Hemp Association, is optimistic about cannabis’ future in Germany. “I believe that medical marijuana will relax the attitudes of Germans towards cannabis, especially by the older, more conservative generation. The decision to legalize it for medical purposes was more or less unanimous, whereas the majority of Germans still don’t think it should be legal for recreational use” Wurth said. Germany will authorize specific plantations as cultivation sites by 2019, but until those are up and running, it will import cannabis from the Netherlands and Canada.
The cultivation program will be overseen by a still-forming cannabis agency run by companies from throughout the European Union.