Germany is the largest medicinal cannabis market in Europe and can be divided into two main submarkets:
The pharmaceutical cannabis market, which represents cannabis-based pharmaceutical drugs. Germany allows the sale of most of these cannabis medications, including Sativex, Dronabinol and Nabilone.
The medical market. Medical cannabis includes plant-based and plant-derived cannabis products. Germany has permitted the use of cannabis flower for medical purposes since 2017. The country’s medical cannabis programmes are still being developed; however, they will be among the most robust in Europe.
Since March 2017, medical cannabis has been legal in Germany. Plants belonging to the genus Cannabis were transferred from Appendix I to Appendix III of the BtMG. This made cannabis flower and extracts marketable and prescribable. Before that time, this was the case for pharmaceutical products only.
Pharmaceutical products include:
- Sativex: Sativex is used to treat spasticity for people who have multiple sclerosis.
- Dronabinol: Dronabinol is used to relieve nausea for patients undergoing chemotherapy. It is also used to restore appetite for people with HIV.
- Nabilone: Nabilone is used to treat nausea among cancer patients undergoing chemotherapy.
Medical products include
- Cannabis flower: the flower can be inhaled by using a vaporiser. Smoking is not prescribed as it is considered toxic.
- Cannabis extracts: these liquids are applied under the tongue and enter the bloodstream
At the moment, the cost of treatment with cannabis flower is significantly more expensive than an opioid-based treatment.
These high prices mainly stem from:
- a shortage of supply
- a lack of domestic cultivation, which adds import costs
- preparation fees charged by pharmacies to cover the costs of packaging, labelling and dosing
Medical cannabis supply chain Prior to 26 March 2019, 993,30 kilograms of medicinal cannabis flower were imported to Germany:
In 2017, Germany imported 1,200 kilograms of medicinal cannabis flower. This more than tripled in 2018 and stood at approximately 4,400 kilograms (just over 3,000 kilograms of which was provided for pharmacy dispensing). Prior to April 2019, the Netherlands and Canada were the only two countries that could export medicinal cannabis to German pharmacies for distribution to patients, and in 2018, half of it came from Canada. As of April 2019, Cansativa GmbH, a German cannabis distributor and wholesaler, was the first European company to claim to be authorised to import cannabis for scientific purposes from Latin America, in partnership with Colombian company Clever Leaves and Fotmer Life Sciences from Uruguay. Moreover, in September 2019, Cansativa received medical cannabis from Portugal and medical cannabis oil from Australian company Little Green Pharma for testing purposes. Import volumes to Germany currently double every year, but domestic supplies are likely to come online as of 2021. In 2019, the Dutch Minister of Health informed the country’s parliament that exports of medicinal cannabis flower to Germany will increase this year. The Netherlands’ parliament reported that in 2019 the country would increase its medicinal cannabis exports to Germany by 1,000 kilograms per year. For the years 2019 and 2020, the Netherlands is planning to export a total of 2,500 kilograms to Germany. It had planned to deliver 1,500 kilograms by August and the remaining 1,000 kilograms by the end of December 2019. Canadian company Tilray announced that it signed a €3 million deal with Cannamedical Pharma GmbH to supply medical cannabis to the German market from its newly opened facility in Coimbra, Portugal. Medical cannabis (on presentation of a medical prescription) can be sold only in pharmacies, of which there are about 20,000 in Germany.