Marijuana Business Magazine May-June 2019

Marijuana Business Magazine | May-June 2019 44 At more than 15 years old, the Dutch program is the closest thing Europe has to a “mature” MMJ market. After years of continuous growth, sales decreased for the first time in 2018. Patients bought 550 kilograms of MMJ in 2018 using 49,500 prescriptions. With a population of 17 million in the Netherlands, that’s roughly three prescriptions per 1,000 people per year—not a promising sign for those convinced Europe will soon become a multibillion-dollar market. In Switzerland, the number of patients grew exponentially from 2012 to 2017, reaching a peak of 3,335 before declining to 2,978 patients in 2018. That’s only three or four patients per 10,000 people at its maximum. In Michigan, by contrast, there are 300 patients for every 10,000 people. A Question of Coverage Of course, many in the industry expect a sales boost in countries where med- ical cannabis is covered by insurance. This was the key growth factor of the past two years, with Germany accept- ing about two-thirds of applications for reimbursement and 14 of Italy’s 20 regions covering cannabis. However, reimbursement isn’t the norm. In the Netherlands and the Czech Republic, cannabis isn’t cov- ered. Denmark covers it partially. Reimbursed or not, there’s one thing that most European countries have in common that is not prevalent in North America: Cannabis can be prescribed only as a last resort. In Europe, you don’t qualify for a “medical docu- ment,” as in Canada, or an “MMJ card,” as in many U.S. states. There are no dispensaries in Europe. Patients get a prescription to buy a specific narcotic drug in the pharmacy, and only after all other options are exhausted. It’s wishful thinking to predict that medical cannabis will be used by a certain percentage of European citizens just because they suffer from conditions for which there’s anecdo- tal evidence that cannabis could help. The German Medical Association (Bundesärztekammer) stated this March that there’s “not enough scientific evidence” to reimburse medical cannabis automatically without a case-by-case study of application. This was in response to a bill that would eliminate the need to apply for reimbursement and force health insurers to automatically cover cannabis like any other registered medicine. The Dutch National Health Care Institute stated at the end of 2017 that it sees “no reason” to include cannabis in health-care coverage with the current “low quality of the evidence” available. In Denmark, early opposition from the Danish College of General Practitioners (Dansk Selskab for Almen) has discouraged doctors from prescribing products that have not undergone clinical trials. In Jan- uary, the agency's chairman said he doesn’t believe it’s a good idea that any doctor can prescribe cannabis, as not all general practitioners have the right skills, and with so few patients, it’s hard to gain experience about the effects of cannabis treatments. The United Kingdom legalized cannabis last November, but the National Health Service website notes that “very few people in Eng- land are likely to get a prescription for medical cannabis.” In fact, almost a half-year after legalization, there are only a handful of patients. Growth Catalyst I constantly meet industry leaders from North America who are convinced that all they need to do is “educate” European regulators and doctors, showing them their North American experience and anecdotal evidence. It will be difficult for these trailblazers to reach European policymakers and health-care communities who aren’t eager to accept North Americans’ experience with medical cannabis. European regulators are more con- cerned about complying with inter- national drug control conventions, so countries that establish medical can- nabis programs usually do so as a special-access scheme that restricts use to exceptional cases. Policymakers and physicians generally prefer products that have undergone clinical trials to show efficacy. Parallel special-access programs for nonregistered products are typically allowed only with restrictions that can hinder growth. For Canadian cultivators and others pointing to Europe and its business opportunities, those hopes may prove overly optimistic. Time will tell. Growth seems inevitable, but its pace will be determined by how this nascent industry deals with the many hurdles ahead. Alfredo Pascual is an international analyst for Marijuana Business Magazine. You can reach him at alfredop@mjbizdaily.com . THE ENTHUSIASM CREATED BY THE EUROPEAN MARKET—AND GERMANY IN PARTICULAR—IS BASED ON LONG-TERM PREDICTIONS AND NOT ON AN IMMEDIATE, REALISTIC ESTIMATION OF THE MARKET. Trends & Hot Topics | Alfredo Pascual