2017 has been a big year for cannabis legalization in Germany. On January 19, 2017, the German Bundesrat (the lower federal houses of Parliament) unanimously voted in favour of medical use.
“Critically ill people must be cared for in the best possible way,” Federal Health Minister Hermann Gröhe said at the time, adding that the costs would be met by health insurance. That is highly significant here as 90% of Germans hold public health insurance.
In March, the law went into effect. A month later, the government issued its first tender bid for domestic cultivation in Germany. The next round of semi-finalists is now waiting to hear from the government about who has made the cut.
In the meantime, many patients have been forced into a difficult situation. And while most of these difficulties are clearly on a path to resolution eventually, that does not solve the immediate problems many face.
The Situation On The Ground
Taking a bird’s-eye point of view, the German government is moving in steps first established by Israel in establishing a medical program. It is just moving much slower (although that may now begin to change). To put this into perspective, by 2008, only 7 German patients had won the right to buy cannabis legally, from pharmacies. In the subsequent 8 years, the issue moved forward, primarily through the courts as the government did not act. As of today, there are only 1,000 recognized cannabis patients in the country, although potentially hundreds of thousands more will qualify under new government rules.
Several years ago, in 2014, as the legalization discussion got another shot in the arm thanks to events in the U.S. and Israel, five German patients took the government to court over the issue of affordability. They argued that since cannabis was not covered by health insurance, buying it in pharmacies was cost prohibitive and they should be allowed to grow it at home.
At the time, three of these patients won that right. In the meantime, existing patients who had to apply via a tedious application process, were still stuck with as much as 1,600 euros a month in medication costs.
This year’s developments were supposed to ease that burden. Since March, however, despite moving quickly to establish a national cannabis agency, the devil has certainly been in the details.
Many existing patients report significant problems finding a doctor to prescribe medical cannabis. And most are finding that their health insurance companies are still refusing to reimburse them. Those who were allowed to grow their own have been summarily told that they must stop home cultivation and seek official approval like everyone else.
Kinks In The Machine
There are now several large issues facing patients and their advocates in Germany. These are also unlikely to resolve themselves until crop and pharma cultivation begins here in earnest. At present, the government is still importing. Up until last year, just like Israel used to do, the German government relied on Dutch exporters. However, these companies are bound by Dutch law in terms of the volume they are allowed to export. As a result, last year, the German government signed the first of what will be several agreements it is expected, with Canadian licensed producers to supply the country on an interim basis.
Even last summer this could already be seen at pharmacies, where even legal, unrecompensed sales jumped dramatically. However retail prices have also almost doubled. In part this is due to supply and demand issues (already) – and partly due to additional costs tacked on by pharmacies just before issuing cannabis flower to legal patients.
In turn, prescribing doctors – the few that actually do work with cannabis on a regular basis – have been put on notice by insurance companies. For the next two years, prescribing doctors will be held liable for the entire cost of the drug for each of their patients.
The government expects to be able to begin to supply domestic crops by 2019. It is also turning to the problem of educating doctors.
In the meantime, however, German patients are suing their insurance companies for coverage. And as a result, the organizers behind a much broader legalization drive, still have a rallying issue. Medical use has broad support here – and if recreational reform is the only way that happens, advocates will continue to make noise.
“Current studies and reports from experience clearly show that cannabinoids on the one hand in many cases are only weak pain-relievers, but on the other hand for certain select patients can definitely be helpful,” as Dr. Michael Schäfer wrote for the German Pain Society last year.
Germans, as a society, are also very well aware of that. Look for ongoing change here for the next several years.