Cannabis programs in different countries
Cannabis programs in different countries
In recent years, the medicinal use of cannabis has rapidly gained acceptance worldwide. Several countries already have government-supervised programs, in which quality-controlled herbal cannabis, as well as derived products such as cannabis oil, are supplied by specialized and licensed companies. Other countries are in the process of setting up their own programs, or import products from such as the Dutch program. The large regulatory shifts in these countries signal that the Single Convention and the punishment-based prohibition that goes with it, may have reached its expiry date. Below is an overview of some of the most relevant countries and their regulations (in alphabetical order).
In 2016, Australia amended its Narcotics Drug Act at the State level to permit the cultivation of cannabis and its manufacture to pharmaceutical finished dose forms intended for medicinal purposes. These legislative changes are currently being interpreted by individual States and Territories, which may result in different regulatory approaches adopted across the country. Patient access is generally approached through a Special Access Scheme, typically requiring evidence that other, conventional, treatments have failed. The permitted indications vary by individual States and Territories, meaning there is inequitable access regarding the types of diseases that can be treated. The recreational use of cannabis is illegal in Australia, with formal criminal charges from illegal cannabis use varying across the country.
In Canada, cannabis is regulated under the Canadian Controlled Drugs and Substances Act (CDSA) as a Schedule II controlled substance. As such, all activities associated with it are illegal except those under authorized federal regulations. The conditions for possessing, consuming or growing cannabis for medicinal purposes have been outlined in the ‘Marihuana for Medical Purposes Regulations’ (MMPR) issued by Health Canada that was first created in 2011 and came into force in 2013. About three dozen medicinal cannabis producers have been licensed so far (Health Canada 2016), and they are allowed to deliver cannabis products directly to authorized medical patients. In 2017, cannabis may be legalized for recreational use (Government of Canada 2016).
Germany intends to start a medicinal cannabis program in 2017. This program will be run in the fashion of a registry study; all patients receiving cannabis products on prescription will be registered in a national database to monitor consumption of the drugs, as well as the health benefits and risks. The database will be analyzed after a trial period of multiple years, in order to inform policymakers on if, and how, to continue the program. All participating patients should receive reimbursement by health insurance of the products used, as part of the registry study.
Already in 1992 the Ministry of Health in Israel approved marijuana for medical use but it took until 2007 before the Ministry established a formal medical marijuana program that has been updated several times since then (Ministry of Health, Medical Cannabis Unit). The program is regulated by the Israel Medical Cannabis Agency (IMCA) and registered patients receive either cannabis oil or cannabis flowers through a dispensary or directly from the medicinal cannabis growers.
Whereas most countries have followed an approach of punishment-based prohibition on cannabis and other drugs, the Netherlands have traditionally focused on harm-reduction. Cannabis has not been legalized, but small scale sales through outlets known as coffeeshop and personal use are tolerated. In 2001 this approach became the basis of creating the Dutch Medicinal Cannabis program, under supervision of the Ministry of Health (OMC 2016). Various cannabis varieties are available on prescription from pharmacies around the country. Cannabis is typically prescribed when other, conventional medicines, have proven ineffective, or too many adverse effects occurred. In some cases, health insurance companies reimburse the expense to the patient. Currently, The Netherlands legally export pharmaceutical grade cannabis to a range of countries.
New Zealand adopted clinical guidelines for the use of medicinal cannabis in 2007, but initially very few patients were able to access cannabis based medicines. Non-registered, pharmaceutical grade cannabis-based medicines are now permitted for use in named patients only, under the oversight of a specialist, when all other traditional treatment options have failed. The recreational use of cannabis is illegal in New Zealand, however, a police cannabis diversion scheme exists which removes first time offenders from formal criminal charges resulting from illegal cannabis use.
In the United States, the use, sale, and possession of all forms of cannabis is illegal at a Federal level. Cannabis is a Schedule I drug under the federal Controlled Substances Act, (FDA, Controlled substances act, Title 21, Chapter 13). Despite this fact, California was the first US state to allow medical marijuana, by referendum in 1996 (California Department of Public Health, Proposition 215). As of early 2017, more than half the States in the US have introduced laws that allow the medicinal use of cannabis, and some have fully legalized all use including recreational or ‘adult use’. Also, each state where cannabis is allowed has their own regulatory landscape. In 2011 (updated in 2013) the US Department of Justice announced a memorandum to its federal marijuana enforcement policy (Cole memorandum) that says that based on assurances that states will impose an appropriately strict regulatory system, the US Department of Justice defers its right to challenge their legalization laws at this time (United States Department of Justice, Office of Public Affairs).