The medical cannabis industry expressly shares the goal of preventing misuse in the prescription practice of medical cannabis. Accordingly, we support the Federal Ministry of Health’s concern to regulate dubious providers.
However, this requires a clear differentiation between dubious platforms that use anonymous questionnaires to avoid the necessary medical consultation and medically responsible telemedicine platforms on which licensed doctors prescribe based on a medical history via video or structured teleconsultation. The current draft law to amend the MedCanG does not differentiate here and therefore oversteps the mark: In its current form, it affects the entire care structure – with collateral damage for patients, doctors, pharmacies and the responsible part of the medical cannabis industry.
An effective change to the MedCanG must consistently but accurately and legally prevent misuse while maintaining patient care. Blanket bans, on the other hand, weaken trust in evidence-based, digital as well as contemporary health policies, endanger security of supply and, moreover, are unlikely to be (constitutional and EU) legally compliant:
- Telemedicine is established practice:Telemedical video consultations are a recognized standard. Just recently, the evaluation committee (BA) adjusted the limit on video consultations, which now allows doctors to treat up to 50% of all patients exclusively via video consultations (1). Federal Health Minister Nina Warken herself emphasized that initial assessments are particularly useful in telemedical form to relieve the burden on practices (2). This shows: Telemedicine is politically desired, secures care and is legally and medically equivalent to on-site discussions. Physicians should retain the decision as to which form of treatment is appropriate, as with other prescriptions, within the scope of their therapeutic jurisdiction. Telemedical prescriptions from other EU countries in which medical cannabis is not approvedis also already prohibited (3).
- Blanket shipping ban weakens patient care: In Germany, around 800,000 patients receive cannabinoid-based therapy. A blanket shipping ban makes access to medical cannabis massively more difficult, especially for seriously ill people and people with mobility restrictions (both statutory health insurance and self-pay patients) who rely on continuous, barrier-free care close to home. Especially in rural regions, care is already under pressure due to the decreasing density of doctors and pharmacies – there is often a lack of knowledge about the cannabinoid-based therapy option. The planned shipping ban for medical cannabis flowers also represents an objectively unjustified unequal treatment compared to other prescription drugs with a comparable risk that can still be delivered by courier service or mail order.In addition, a shipping ban applies to German pharmacies, as the shipping of medical cannabis flowers is already carried out exclusively by local pharmacies with a lot of advice and not, as is often incorrectly claimed, by pharmacies from other EU countries. Several hundred small and medium-sized pharmacies with mail order permits are threatened by the planned changes to their existence. With a blanket shipping ban, the tax would be even more restrictive than the previous BtMG regulation, when shipping was not fundamentally prohibited.Several hundred small and medium-sized pharmacies with mail order permits are threatened by the planned changes to their existence. With a blanket shipping ban, the tax would be even more restrictive than the previous BtMG regulation, when shipping was not fundamentally prohibited.Several hundred small and medium-sized pharmacies with mail order permits are threatened by the planned changes to their existence. With a blanket shipping ban, the tax would be even more restrictive than the previous BtMG regulation, when shipping was not fundamentally prohibited.
- Damage to business and innovation: A complete ban on telemedicine and shipping of cannabis flowers is slowing down a nascent domestic industry. This still young industry of producers, specialized pharmacies and service providers would be abruptly set back, with negative consequences for jobs and tax revenues in Germany. 15,000 jobs are currently dependent on the growing medical cannabis industry; In 2025, it will generate sales of at least EUR 1 billion including added value for local pharmacies. This results in almost EUR 200 million in taxes from VAT/VAT alone. Furthermore, several pharmaceutical cannabinoid companies are currently investing tens of millions in production facilities in Germany.
Suggested solutions
Blanket bans weaken confidence in a digital, contemporary as well as evidence-based health policy, endanger security of supply and, moreover, are unlikely to be (constitutional and EU) legally compliant. The desired containment of misuse in prescription practice can also be achieved with more targeted, legally compliant and at the same time milder means.
Regarding the current draft law amending the MedCanG, we demand:
- Personal contact, yes, but maintaining freedom of therapy: Initial telemedical contact is also personal if it takes place via video consultation hours. The choice of the form of treatment, whether telemedical or on-site, as the basis for the prescription must still be the responsibility of the doctor.
- Qualified shipping instead of blanket ban: A blanket ban on postal delivery is disproportionate. It should remain possible through pharmacies that have a mail order license (only possible from Germany anyway) with documented advice, identification/age check, patient information leaflet/proof of queries and/or pharmacovigilance information.
- Enforce existing remedies: Stringent enforcement of professional, medicinal product advertising, pharmaceuticals and pharmacy legislation (including rules of supervision and advertising) with risk-based prioritisation; appropriate authorities should be strengthened where enforcement gaps are demonstrated.
- Prescription location & pharmacy checkpath: Standardised indication of the country of residence of the doctor/licence status on the prescription(s); mandatory testing and documentation steps in pharmacies to exclude EU prescriptions from countries without medical cannabis clearance.
