GQC Editorial Board
GQC Editorial Board
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Legislative Panorama: Focus On Denmark

Denmark has a relatively small cannabis market compared to other European countries, primarily due to strict regulations and high prices in its medical cannabis program. These factors have limited the program’s success thus far. 

Medical cannabis is legal in Denmark, and patients have several options to access it. Authorized medicines like Sativex and Epidiolex, which contain cannabinoids and cannabidiol, are available for specific conditions. Sativex is prescribed by neurologists for individuals with multiple sclerosis, while Epidiolex is used as an oral solution for rare forms of epilepsy. For medications not authorized in Denmark, physicians can apply for compassionate use permits, allowing patients access to medicines like Marinol and Nabilone, which contain synthetic cannabinoids. 

Danish doctors have been able to prescribe cannabis through magistral orders since 2011. Doctors accept personal responsibility for providing medications they believe would help their patients under this approach. The prescription contains exact instructions on the drug’s composition and dose, which is then created by one of Denmark’s two pharmacies that handle magistral orders, with Glostrup Pharmacy serving as the major source of cannabis-based pharmaceuticals. 

Denmark’s membership in the European Union enables patients to receive prescriptions from countries such as Germany or the Netherlands and obtain their cannabis in another EU country. Prior to the implementation of the trial program, some individuals resorted to this method either because there were no prescribing doctors available in Denmark or due to personal preference. However, it is important to note that carrying medicinal cannabis across borders requires a medical pass or pill pass, and typically, the drug is allowed for a maximum supply of 30 days. 

Denmark established a four-year medicinal cannabis pilot program on January 1, 2018, which has been extended until December 31, 2025. Any doctor can prescribe herbal cannabis to patients with any sickness or condition under this scheme. The availability of products in the pilot program is determined by cannabis product makers who request admission to make their offerings available for prescription. It should be noted that the cannabis products featured in the pilot program are not approved as medicines in Denmark or any other country. As a result, doctors are solely responsible for prescribing such medications, including calculating the right dose for individual patients. 

The Danish Medicines Agency has provided guidelines to doctors considering prescribing medicinal cannabis. These guidelines suggest that medicinal cannabis should be considered for indications such as painful spasms caused by multiple sclerosis or spinal cord damage, nausea following chemotherapy, and neuropathic pain. However, the law and the pilot program’s guidelines do not prohibit doctors from prescribing medicinal cannabis for other conditions. Reimbursement under a special scheme is available, with terminally ill patients receiving full reimbursement and other patients receiving a 50% subsidy of up to DKK 10,000 per year. Currently, eight products are registered for use in the pilot program, including Sedemen Aurora Nordic Cannabis, Bedrocan CannGros, Billiono Little Green Pharma, and Stenocare THC Oil. 

Despite the implementation of the pilot program, the overall success of the medical cannabis initiative has been limited, as the majority of patients continue to rely on the illegal market. In 2019, there were nearly 2,000 patients per quarter who used regulated medical cannabis products. However, by the end of 2021, this number had decreased to just over 1,400. Several factors contribute to this lack of success, including high prices and doctors’ reluctance to prescribe medical cannabis. As a result, the variety of available products in the trial program has diminished. Currently, only Stenocare offers a THC product, which is priced at EUR 331.27 for a 30ml bottle of THC oil, equivalent to EUR 11.04 per ml. Bedrocan CannGros provides the most affordable flower product, priced at EUR 93.21 for a 5-gram package, or EUR 18.64 per gram. In comparison, the illegal market offers flower prices ranging from EUR 5 to 12 per gram. 

Since 1998, industrial hemp cultivation has been legal in Denmark, with strict regulations limiting THC content to 0.2% or below to comply with both EU and Danish laws. The Danish Agricultural Agency is responsible for overseeing the regulation and approval process for the commercial cultivation of industrial hemp, which typically takes approximately six weeks. Licensed growers have the authority to cultivate, process, and sell industrial hemp for a wide range of commercial purposes, including the production of hemp seeds, hemp seed oil, hemp flour, grains, and hemp protein powder. 

It is worth emphasizing that the cultivation of hemp for medicinal cannabis purposes is not permitted under the industrial hemp license. Exclusive authority lies with the Danish Medicines Agency, which is responsible for issuing permits related to medicinal cannabis cultivation, manufacturing, distribution, and importation. In January 2019, new legislation was enacted, allowing for the export of cannabis bulk and cannabis products, subject to the necessary authorizations granted by the Danish Medicines Agency. Danish companies such as Little Green Pharma, Aurora, and Stenocare currently operate cultivation facilities within Denmark, producing medical cannabis products without encountering any legal restrictions on their production capacity. 

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