Despite what you hear about Colorado, California, Canada or even Holland, FYI, getting medical cannabis legally in Germany is not as easy as buying candy from a store.
The great cannabis debate has landed here, auf Deutschland, and it is a conversation that is just starting. So that means there are also a lot of questions.
What Kind of Cannabis Is Available In Germany Now?
Broadly, there are two kinds of cannabis and cannabinoid-based products available legally in the German market.
The first is based, for now, on CBD flower and CBD products – in other words made from low THC hemp or cannabis plants, or the plants themselves. No matter if it is sold in a grocery store, head shop or pharmacy, these are all over the counter (OTC) products that do not require a prescription. This market also has absolutely nothing to do with the prescription medical market. It is regulated broadly under food products and via cosmetic regulations.
Cannabis, by prescription, can include flower, oil, extracts or pills includes both CBD and THC and sometimes both. Medical CBD has a concentration of at least 1% CBD and trace amounts of THC. Medical THC comes in several strengths and combinations in Germany, but the highest concentration on the market is now 25% THC..
Prescription cannabis, even CBD, is treated as a narcotic under German law, along with opiods and other restricted, new use and orphan drugs that fall into this category.
Last year in 2017, the Bundestag, or German parliament voted to mandate that public health insurers reimburse medical cannabis when it was prescribed for patients with intransigent, drug resistant treatment. Before that time, patients who wanted to get medical marijuana in Germany had to apply and receive an exemption from the Federal Institute for Drugs and Medical Devices (BfArM). The law was changed after patient lawsuits successfully forced the government to accept the medical efficacy of the drug and that patients had the right to obtain coverage for the same (in lieu of patient home grow which was also subsequently stopped).
Steps To Obtain A Legal Prescription:
- You need to find a physician who is licensed to prescribe narcotics. Generally, patients who have obtained coverage so far (according to the Techniker Krankenkasse, University of Bremen Cannabis report have conditions like cancer, movement disorders and chronic pain caused by a variety of factors. Generally the doctors who are also qualified and certified to dispense cannabis will specialize in things like neurology, oncology and paediatrics (as CBD, low THC cannabis is now being prescribed for child epileptics).
A. Set up an appointment. Usually the first best step to find such a specialist is to ask your GP for a referral. If you have public health insurance, this step is also usually required. When you go, also go with research. Research your condition thoroughly (if you have a diagnosis) and look for scientific studies about the same and how cannabis has been proven to treat it. It will be a hunt, but there is a great deal of scientific evidence now available online. Do your homework.
B. Prepare the documents such as medical history and current prescriptions, if you have them. Be prepared to have them on hand frequently, especially if you are sent to several different kinds of doctors.
What the author recommends: Look for uni-klinik-sponsored trials and doctors. While there are some specialists now beginning to discuss their cannabinoid practice, few solo practioner, GPs are yet willing to take the plunge. Be willing to engage with your physician on an ongoing basis, and look for doctors who are willing to work with you. This is a drug and you must show that despite your condition or disability, you are willing to work with the medical system.
- Submit your medical history and discuss it with the doctor who will conduct your physical examination and review existing health conditions and what drugs you take now. You might not yet have a diagnosis. That of course is the first step. Most of the early successfully approved patients in Europe, however, have an established medical history and a diagnosis of a chronic condition. Here is also the next wrinkle: The only on label use of cannabis in Germany is Multiple Sclerosis or MS. In this instance, approvals are fairly straight forward. Everyone else has to prove that their condition has so far been unsuccessfully treated with another kind of drug. This is a highly difficult process, but it is also why your research beforehand and during this process is so important. The next battle is to prove that you need flos or whole plant options vs. the synthetic dronabinol, which is still the most widely prescribed cannabinoid in the German market.
What the author recommends: Find a sympathetic doctor. That is the first step. Work with that healthcare professional. Keep a diary of your current drug regimen, and how it makes you feel. This can be hard to do, but it is one helpful way to go about this process. Your doctor is probably also confronted by all of this for the first time too. It will help if you show you want to work as a team.
Your prescription should be complete with the dosage and type of medication you can use. Some patients prefer inhalation of either plant based “flos” or flower. Some prefer to vape. In many instances (see children and the elderly or those who do not smoke by choice), edible options including oils, pills and distallates, are an option in the German market. Remember that cannabis that enters your bloodstream via the liver is doing so via a different route, and one that also is less efficient that inhaled cannabinoids. That said, there are several companies working on such issues with new technology to aid that process. Regardless, for now, these are the major options. Think about what each might mean for you, including lifestyle management. Even vaped cannabis carries a smell. If you microdose, can you do this at work, for example?
- If you are on public health insurance, it will be either you or your doctor that then submits the prescription to your health insurer for approval. This is theoretically a five week wait. Most cannabis patients report much, much longer waits than this. Your doctor may also not be willing to be your advocate (although that is why you should search for one who is). They also inevitably involved in the approvals process, which involves arguing on your behalf, submitting medical records and a special form. This form actually is passed through all insurers in Germany to the MDK, a regional approver, because of the current status of the drug. This is why, unless you are terminally ill in Germany, you can expect to wait a long time. Privately insured patients have an equally difficult time, especially because they have to pay upfront for the drug until it is reimbursed. At current prices, that is not a cheap proposition.
- Take your prescription to a pharmacy that carries medical marijuana. Not all of them do. However a quick internet search should, at this point, begin to show pharmacies across the country who are specializing in the same. Most major cities and regions have at least one and usually more at this point. The pharmacist will have to check usually with both your insurer and your doctor to see if the prescription has been approved and if indeed if the prescription is not fake.
What the author thinks: Talk to your local pharmacy specialist. Ask for their advice. In general, however, it will be easier if you have obtained all the preapprovals beforehand.
What is coming: What we have described here is the way that chronically ill patients and their caregivers obtain cannabis and other specialty, orphan or new to the market drugs and medical equipment in Germany and across Europe today.
We here at MedPayRx are proposing to change this process while increasing patients’ ability to control their medical records and saving the rest of the ecosystem (from doctors to insurers, distributors, manufacturers and pharmacies) a great deal of time and money. MedPayRx is a blockchain-based DApp (distributed application) that works between them all, and further is designed to work for all prescription drugs and medical devices legally available in Germany and other jurisdictions we plan to operate in.
MedPayRx is a digital prescription platform, among other things, that is designed to preserve the legal, compliance and regulatory environment that exists to protect patients, while cutting through the red tape, time, cost and other inconveniences caused by more conventional processing systems available today.
See our pilot, coming to Cologne Germany in January, 2019.