Cannabis on prescription is booming - "Conditions like Ibu 600"
Since the legalization of cannabis, the business with medical cannabis has grown rapidly. The behavior of some providers raises doubts as to whether only the sick are being addressed - or if the high demand also returns to recreational consumers. The CDU expresses alarm, the SPD remains unclear.
Cannabis is delivered to the house via DHL. It's as if it were a sweater or a new coffee machine. The only difference: The signature of the recipient is not enough, the courier also wants to see their ID. Then the treatment can begin. The 20 grams packed in a vacuum flask are medical cannabis, grown in Canada. The patient had to fill out an online questionnaire beforehand on one of the numerous platforms that mediate video consultations with specialized general practitioners for a fee between 15 and 50 euros. The conversation with the doctor, who also wants to see an ID, lasts around five minutes. Medical history? Experience with cannabis? This is followed by a suggestion for cannabis strains and dosages. Subsequently, the prescription is issued, which can be submitted digitally to a mail-order pharmacy or personally to a specialized pharmacy.
So fast, so easy. The medical cannabis business in Germany is booming. Publicly, this aspect of cannabis legalization finds little attention. "Since April 1st, the medical cannabis market in Germany has nearly doubled," says David Henn, CEO of the medical cannabis wholesaler Cannamedical in conversation with ntv.de. The Bloomwell Group, which provides doctors and pharmacies with a digital platform for medical cannabis, reports on inquiry of a massive growth: The number of patients using the group's mediation service has increased by over 1000% in April compared to the average of the previous twelve months.
Suddenly no longer a narcotic
Behind this development is a little-known legislative change that occurred in the context of legalization: Cannabis has been removed from the list of drugs in the Narcotics Act (BtMG). As a result, cannabis has also fallen out of the Narcotics Prescription Ordinance. Doctors can now prescribe medical cannabis much easier than before. For pharmacies, the previously cumbersome documentation requirements and the specific storage regulations have fallen away.
David Henn says: "Cannabis is no longer the last-resort medicine for treating serious illnesses, but can indeed be used for a broad range of diseases." The regulatory requirements are now comparable to those for Ibuprofen - a non-plant-based painkiller that is prescribed, for example, after ambulatory surgeries or for acute back pain. Prescribing physicians for cannabis as a natural active ingredient are enthusiastic about this development for treating comparatively mild complaints such as sleep disorders and menstrual cramps. However, the practice raises questions: Is medical cannabis being targeted at recreational consumers? That is not immediately clear.
A central supervision or at least recording of the number of prescribed Cannabis recipes does not exist. Most recipes are privately paid for. Few seem willing to have the costs for recipes and medicines reimbursed by health insurance. This amounts to a significant three-digit sum per month for some, depending on individual consumption. The Spitzenverband Gesetzlicher Krankenkassen (GKV) is not aware of an increase in such health insurance prescriptions upon request. However, the number of recognized prescriptions for the current year is still not available to the GKV.
In online discussion forums like Reddit, numerous consumers discuss where and how much Cannabis they have been prescribed. Many users also report specific complaints such as menstrual cramps, headaches, and sleep disturbances, or severe chronic diseases they treated with Cannabis. Others apparently only have an interest in recreational use. Complaints about not receiving a prescription at all are rare. The prescription practice seems rather unregulated. Users are, however, frustrated with long waiting times for doctor appointments and longer delivery times of some mail-order pharmacies, which apparently cannot keep up with the high demand.
Cannabis Companies Anticipated More
Consultations for video appointments are provided by platforms like Bloomwell, Kanna Medics, and Canify. Bloomwell reportedly cooperates with over 65 doctors. The company, like its competitors, is also looking for more licensed general practitioners who want to offer Cannabis consultation hours. In B2C sales, apart from smaller pharmacies, mainly large, specialized providers are active: for example, Grünhorn Apotheke and Grüne Brise. Behind these are the big players in the business: Grüne Brise belongs to the Bloomwell Group, Grünhorn to the stock exchange-listed Cannabis company Tilray. In Canada and several US states, Tilray distributes and promotes Cannabis, and specifically for recreational use, as it is legal there.
In Germany, it's different: Pharmacies advertise on their websites and in Google previews with a view of their live inventory of different varieties and short delivery times. The Berlin Special Pharmacy Herbery even offers a "delivery service" within the city. Some providers sell not only accessories like Cannabis vaporizers but also merchandise: shirts and pullovers with "High Standard" or "No Sport without High" printed on them.
Expertise from the Manufacturer
Numerous companies and investors had prepared themselves for years for the fully commercial sale of Cannabis, as planned by the traffic light factions. However, this plan, which is also mentioned in the coalition agreement, has so far failed due to EU law. For Cannabis entrepreneurs, the medical Cannabis market remains the only option for now. They not only conquer it but also create it: with free further training for doctors, some of which are CME-certified. With the so-called CME points, doctors document that they have fulfilled their duty to continue their education. The same applies in the classical pharmaceutical industry, which also provides doctors with their expertise.
The providers of the corresponding continuing education courses are in some cases directly connected to the manufacturers of medical cannabis, such as Hormosan Pharma GmbH, a Frankfurt-based company specializing in pain therapies that has been in business with Tilray since 2021. Bloomwell states that it uses the data raised not only to better train cooperating doctors and physicians, but also to advance research on medical cannabis.
Potential consumers are also addressed: For instance, Bloomwell cooperates with rapper Xatar. In a TikTok video spread by the successful German musician, he informs his followers that the then applicable THC limits at the wheel do not apply to cannabis patients. Bloomwell offers patients a certificate for around 150 euros for the driver's license authority. In response to an inquiry from ntv.de, the Federal Health Ministry states that advertising for prescription medications is prohibited. However, advertising for telemedical treatments is allowed if a personal medical contact with the person to be treated is not required according to generally recognized professional standards.
Millions of potential patients
Who sets these standards? On what scientific basis are prescriptions issued? "There are no clinical studies for medical cannabis, but that doesn't mean there's no scientific evidence," says Cannamedical-CEO Henn. Expensive clinical approval studies are of no interest to the industry because it cannot patent the various active ingredients in cannabis plants, known as terpenes. So the cannabis industry produces a large part of the existing expertise itself by cooperating with universities and institutions. This is neither unscientific nor unethical, but it does indicate a potential conflict of interest.
"Medical cannabis patients continue to be stigmatized, even though the numbers speak clearly: In Germany, approximately 13 million people suffer from chronic pain and 6 million from sleep disorders," Bloomwell reveals upon request. The company thus makes it clear on what scale future patients the business aims for. At the same time, Bloomwell defends itself against the suspicion that the company has other customers in mind than the sick. "The new regulations aim to address the authentic needs of patients and not to promote recreational use," a spokesperson writes.
No signs of misuse?
Cannamedical-CEO Henn can also confirm, according to his own statements, that there is no misuse of the new possibilities. "There must be a doctor who also supports this therapy. I am not aware that a treatment - be it via a teleclinic or a stationary doctor - is simply granted and that someone, roughly spoken, readily approves the treatment requests." Henn also points out that the misuse of non-plant, prescription-only medications is hardly publicly discussed, but with cannabis, because the plant is still stigmatized.
The German Social Democratic-led Federal Ministry of Health, headed by Karl Lauterbach, has stated in response to an inquiry that "doctors and physicians should not make advances for inappropriate use of their prescriptions" and that "pharmacies are legally obliged to take appropriate measures against recognizable drug misuse." The Federal Ministry of Health does not have the ability or authorization to monitor or examine offers from medical personnel in individual cases. Discovering violations of professional duties is the responsibility of the regulatory authorities of the federal states.
Concern and Criticism in the Bundestag
Even though those involved are not breaking laws or duties, there is concern in the Bundestag about this development. For instance, Carmen Wegge, who negotiated the Cannabis legalization for the SPD, stated to ntv.de: "We are observing that there are suddenly online platforms where one can get a prescription issued immediately if one reports enough sleep disorders, depressions, without ever having seen a doctor in person." Wegge continued, "That was not the intention of the legislator, as clearly stated."
Wegge is also concerned about the high THC content of medicinal cannabis. While the legislator only allowed the distribution of cannabis to people up to 21 years old in a maximum THC content of 10%, most of the products offered in online pharmacies have a THC content of 20-25%, and sometimes even up to 30%. "We cannot welcome this for recreational use," Wegge said. "A 20% THC content is already quite strong and potentially harmful for developing brains."
Tino Sorge, the health policy spokesperson for the CDU/CSU Bundestag faction, assessed this development even more critically. "This would be an oath-breaking act by the traffic light parties if they enabled commercial distribution of cannabis through the back door in this way," Sorge told ntv.de. "It cannot be that potheads are supplied with self-pay prescriptions for medicinal cannabis." Sorge continued, "This corresponds to a deliberate deception of the public if the traffic light coalition has created a gray market and tolerates it, in which the cannabis demand is covered through medicinal cannabis for the treatment of alleged illnesses."
The Union faction enabled easier access to medicinal cannabis for people with serious illnesses in 2017 and has since supported further simplifications, Sorge emphasized. However, he expressed concern that the high sales could be due to a construction flaw in the German cannabis legalization: "The government parties have granted possession but failed to clarify the origin. Anyone who smokes weed today cannot obtain the substance legally, whether privately or in cooperatives," Sorge explained. By doing so, the coalition has provided a boost to the black market and encouraged potential misuse of medicinal cannabis.
Call for a Clean, Legal Supply
Sorge demands: "Federal Health Minister Karl Lauterbach must take action and cannot just let it run its course if laws are not being followed." If the federal government wants to do this, it must allow legal sales to recreational cannabis consumers from medicinal cannabis producers.
SPD politician Wegge states that the high demand for medical cannabis shows that the federal government's plans for the provisional introduction of licensed sales outlets need to be implemented urgently. Wegge, a domestic policy expert, can therefore also derive positive aspects from the high demand for medical cannabis. "At least people come into contact with clean, unadulterated cannabis this way. They do not give their money to criminal organizations, nor do they have to come into contact with them," Wegge says. "It's important to see that people want to switch from organized crime to a legal market."
- The CDU, led by Tino Sorge, criticizes the current situation, expressing concerns that medical cannabis prescriptions are being misused for recreational use.
- In a bold move, Bloomwell cooperates with rapper Xatar to inform his followers about the exemptions for cannabis patients from traffic law THC limits, raising questions about advertising prescription medications and recreational use.
- Pharmacies and specialized providers like Grünhorn Apotheke and Grüne Brise, often backed by large cannabis companies, advertise their cannabis products directly on their websites and Google previews, blurring the lines between medical and recreational use.
