Catalonia – essentially a Spanish “state” located on the upper North-Eastern Mediterranean coast of Spain, has long had an independent reputation.
In some ways, specific distinctions and differences notwithstanding, it is a “purple state” much like Colorado in the U.S. with a long history of conflict with its adjacent neighbours and the federal government.
For this very reason, the development of cannabis reform in Catalonia is intriguing – and not just from a recreational point of view. Essentially, the state, with its centre in Barcelona, has thrown down its own gauntlet to the Spanish federal government – and for a variety of reasons. The current grey zone of loopholes in which the cannabis club vertical has developed has caused more problems than they solved. Enshrining a situation where people can grow small amounts at home, in a private environment with others, makes sense. The cannabis clubs are non-profit, and so are the grows that supply them. This is also a stab in the heart of a growing black market trade with disturbing criminal elements that is also appearing to supply black markets, in particularly the UK.
It may not be perfect, but it is clearly the next formal step that is also taking place in a cash-strapped country, where insurers are not forced into the front lines. This is the case in any federal discussion. See Germany. And it creates, while not the ideal scenario for patients, at least a better one for an undefined interim period. It is possible, in this model, for patients to access medication for about the same amount of money every month as Israeli patients.
It does mean that the sickest patients are left out of the discussion. If you cannot afford membership, there is no formal way to make sure that happens. However, the focus on availability and access is more comprehensive by definition here. Why? The industry is still required to be non-profit and operate ostensibly for the good of local communities. That, by definition, means inclusion.
While it is not the “ideal” insurance model patients are pushing for elsewhere, is this in fact, a semi-reasonable compromise?
Patient Access Is Critical Right Now
As of 2017, patients are primarily concerned about one thing when it comes to cannabis, access. That means affordable products that are easy to find. It means doctors who are willing to prescribe. It means insurance companies who are willing to foot the tab and governments who are ready to enforce them. At present, the most widely available information shows that cannabis patients are still no more than 3.9% of any measurable population (Maine and California share this distinction). It says nothing about the many patients who still do not have access because of cost or transportation.
But just how many medical cannabis patients are there, on average, per country? The truth is nobody knows. In Canada, medical cannabis users now number between 130,000 people to as many as 170,000. This is up from 7,900 just 3 years ago. Even without insurance coverage. And that is expected to double again in a year.
Does this mean, from a global perspective, that perhaps the Catalonian model might make sense for a transitionary phase as cannabis is evaluated in global medical trials for jurisdictions who do not want to pay for underwritten, formal health insurance? There is an argument – to some extent born out by the path of change in the United States, that full legalization and “tax and regulate” is the way to go.
However, Catalonia has proven that in fact there is still a potentially viable third option to this discussion. And further, one where there are no taxes on the table, but neither is health insurance.
Still No Formal Medical Status
There are many negatives to the current situation in Spain. The first being that this is still not a federally regulated market. Experienced medical growers will be excluded from participation in any federal cannabis bid in other countries – starting in Europe. It also means that potentially, the Spanish government, when it makes its federal decision about medical use, could exclude the cannabis club vertical and skip straight to foreign or pharmaceutical firms – as the German government is doing now. That is not likely.
However what this also does, is create an island of small, relatively unfunded producers in-country who are facing the growth of a major international industry and multi-country players elsewhere. While at the same time not really allowing for capitalization of the same. This means that the government is on the hook also for medical trials that they alone must pay for. It also means investors from outside Spain who get into the market now must be motivated by something other than just short term profit.
It still also means that cannabis is not covered or recognized as a medical product – or at least of the prescription THC kind. And from the federal level. This is, in effect, really, no different than what is also now the operating procedure in Holland, where major insurers summarily dropped cannabis coverage as of Q1 this year. The major difference in the Dutch and Catalonian state experiment? The Dutch growers can operate for-profit coffeeshops with no membership required (although the Dutch government certainly tried with a doomed initiative called “Weedpass.”)
The answer, therefore, certainly from a policy and patient perspective, is that half-way measures are better than none. But being priced out of medicine, for any reason, is not much better than being sent to jail for a joint.
At present, none of these models or answers, are what patients really need everywhere reform is now being considered. But in a stop-gap, temporary, kind of way, the Catalonian clubs now offer an oasis if not beach hold of respite on a map that still has a lot of “green” areas missing.