A doctor on a hunger strike, patients in the dock for self-cultivation, 13 claims for health insurance reimbursement, courts making jurisprudence and companies suing the state for discrimination... Germany is in chaos, with the granting of cultivation permits postponed indefinitely.
Almost a year ago, Germany legalized cannabis for medicinal purposes, but many patients remain without safe access to the plant. The regulation of access in practice is causing chaos between the State, companies, patients and even doctors, who are demanding less bureaucratic access to the plant for medicinal purposes.
Last August, doctor Franjo Grotenhermen, a specialist in cannabinoid treatments, president of the German Association of Cannabis as Medicine and executive director of International Association for Cannabinoid Medicines (IACM)), launched a hunger strike against the bureaucracy in accessing medical cannabis and called for all patients who had medical cannabis in their possession to be decriminalized.
Franjo Grotenhermen, a doctor, has started a hunger strike on behalf of medical cannabis patients PHOTO: DR
In statements to Marijuana Politics, Grotenhermen stated that “the government has taken a step in the right direction, but many patients still rely on a treatment considered illegal. They face criminal sanctions and this is no longer acceptable, so a basic clarification in narcotics law should be established. The prosecution of patients to whom a doctor has certified the need for cannabis therapy must end.”
In addition to being criminalized for possessing cannabis, most patients cannot find a doctor with the necessary training to prescribe cannabis, because the doctors themselves, anticipating too confusing and bureaucratic processes, end up losing interest in this therapy.
Insurers obliged to contribute
Germany, which was known for a restrictive drug policy, innovated in 2017, becoming the first country to allow patients with severe pathologies to have their treatment covered by health insurance.
But before that regulation, and for six years, about 620 patients in special circumstances had already been authorized to access a total of 233 kg of medical cannabis. After the new law was passed in March 2017, the number of patients who turned to pharmacies to access medical cannabis increased exponentially, as did the number of patients who asked for reimbursement from health insurance, but responses continue to ebb. take more than five weeks and insurers can still request more information from the German health services before agreeing to reimburse cannabis-based treatments.
Earlier this year, a report revealed that the number of reimbursements for medical cannabis requested from insurers amounted to 13, compared to around 4 requests accounted for in July 2017.
Number of contributions in Germany
Increased demand, shortage of supply
A patient shows off his medical cannabis. Photo: DPA
In the middle of last year there were still reports that medical cannabis had run out of pharmacies, with the medical cannabis supplier, Cannamedical Pharma GmbH, recognized that the company that supplies it and which is its partner, the Dutch Bedrocan is also limited. However, the company's sales director, Niklas Kouparanis, explained that "in any case, we are one of the few vendors who are able to provide medical cannabis to our customers on a consistent monthly basis."
Self-cultivation for medicinal purposes is a political issue
Self-cultivation for medicinal purposes is in Germany, as in Portugal, a purely political issue, which prevents patients from being able to solve the lack of supply of medical cannabis in pharmacies.
The German Federal Government is thus admitting some problems in structuring its medical cannabis circuit and, until 2019, more patients may require self-cultivation. The German State risks losing to patients even more cases in court than those in which jurisprudence has already been made, since the tendency is that, once the precedent is set, the courts can no longer deny the right to cultivate to any more patient. .
At the end of 2017 around 70 thousand petitioners delivered one petition for the effective legalization of cannabis, considering that “the Legalization creates tax revenue, protects minors and creates legal jobs, while prohibition creates a black market with mafia structures. Any politician who continues to fight for the ban should be aware of this,” said George Wurth, one of the authors of the petition and president of the German Hemp Association.
Company sues German state for discrimination
In order to overcome these supply bottlenecks, Germany has started a production forecast of 6,6 tons of medical cannabis for the period between 2019 and 2022, but the process is already delayed. The tender for the award of cultivation licenses was heavily criticized due to the unattainable requirements for the vast majority of German companies.
Dr. Oskar Sarak, CEO of Lexamed GmbH
Oskar Sarak, CEO of Lexamed GmbH, a German startup, has started a court case against the Federal Institute for Drugs and Medicine (Bundesinstitut für Arzneimittel und Medizinprodukte – BfArM), due to the discriminatory requirements in the selection processes of public tenders for the production of medical cannabis.
One of the most contested prerequisites of the public tender is previous experience in cultivation, which, according to Oskar Sarak, “puts German companies at a disadvantage, because in this country legal cultivation has never been possible”
About 118 companies applied in June last year for a medical license to grow cannabis in Germany, but official assessments of the applications, which should have been decided in October, are on hold. Applicants for production and cultivation are required to meet numerous criteria that demonstrate their capabilities both in the cultivation and production of cannabis and in the processing and supply of the final product.
The public tender is based on a points system, which ranks candidates in order to ensure that the choice is based on experience and activity in the sector. Each producer must supply 200 kg of medical cannabis per year and for every 100 kg already grown, candidates earn 10 points, up to a maximum of 40 points. In this way, two-thirds of the minimum criteria will already be satisfied if a candidate can prove that they have grown 200 kg of medical cannabis in the last three years. A maximum of 20 additional points is awarded based on referrals for the other herbal medicines. Ten licenses will be awarded, distributed among all candidates who meet the required criteria. If fewer than ten companies meet these requirements, licenses will be awarded to applicants with the most points. For the period 2019 to 2022, the German government estimates a production need of around 6,6 tonnes of cannabis.
The German government is currently facing several court cases over the legalization of medical cannabis PHOTO: DR
German companies that do not associate themselves with foreign companies from Canada, Israel or the Netherlands, for example, which are countries that meet the requirements for previous cultivation experience, are only eligible for 20 of the 60 points available to candidates, thus creating an impediment to German industries interested in entering this market.
A Lexamed GmbH, que produz cadeiras de rodas e outro material médico quer investir no mercado da canábis e considera ter ficado indevidamente excluída do negócio, avançando assim com a queixa. “O concurso discrimina as empresas nacionais”, argumenta Oskar Sarak, CEO e advogado da Lexamed, porque a agência de canábis criou “um sistema de pontuação para o qual as empresas alemãs não são elegíveis por não terem experiência, obrigando a procurar parceiros estrangeiros”.
O Tribunal Regional Superior de Düsseldorf agendou uma audiência até Dezembro, que acabou por ser adiada indefinidamente, devido à sobrecarga laboral da instituição. Enquanto este procedimento não terminar, o concurso público não poderá ter seguimento.
Foto de destaque: Getty Images
Artigo: Pesquisa de João Costa