The following is meant as a short overview of current state of affairs with regards to Cannabis and / or Drug Policies in three European countries. It is intended as a short supplement to Part A. and Part B.
Portugal, since 2001, has ambitiously decriminalised all drug usage and possession, based on the assumption that it is a Public Health issue rather than a Criminal one. This approach does not make an explicit distinction, in the case of cannabis, with regards to medical or recreational use and is centred on a usage and harms reduction approach. In the words of Dr. João Goulão, Director-General of The General-Directorate for Intervention on Addictive Behaviours and Dependencies (SICAD) in Lisbon:
“It’s difficult to measure the impact of decriminalization as an independent variable; the evolution of the indicators has to be seen as a result of the development of all those responses. Considering different indicators of changing drug use patterns and demographics, some effects of decriminalization have included:
- Levels of drug use are below the European average;
- Drug use has declined among those aged 15–24, the population most at risk of initiating drug use;
- Lifetime drug use among the general population has increased slightly, in line with trends in nearby countries (however, lifetime use is widely considered to be the least accurate measure of a country’s current drug use situation);
- Rates of past-year and past-month drug use among the general population have decreased;
- Rates of continuation of drug use (i.e., the proportion of the population that has ever used an illicit drug and continues to do so) have decreased;
- Rates of problematic drug use and injecting drug use have decreased;
- HIV infections among injecting drug users have decreased.”
Portugal’s case is generally accepted, including by the French report discussed, as a relative success with promising aspects to implement more generally. Given that it is not cannabis specific, it is difficult to assess its impact, particularly in terms of Harms Reduction. Although a bold and commendable policy decision, it fails to address distribution side of things, particularly in the case of large-scale organised crime. The existence of such organisations can divert significant police resources and have spill-over effects into unrelated criminal activities, with drug distribution often being a major source of income. This also makes a case for the notion that no matter the amount of prevention, drug usage as whole is not an issue that can be tackled in isolation. It is extremely unlikely that demand for cannabis will evaporate instantaneously. It is therefore necessary to address the issue and distribution resulting from that demand.
For a detailed overview of all European countries’ drug policies and harm-reduction initiatives visit EMCDDA.
German Health Minister Hermann Gröhe has recently announced the country’s plans to make Medical Cannabis available to seriously ill patients by 2017. The law is rather an amendment on previously existing Medical Cannabis policies, relaxing conditions giving patients access to the plant. Due to Germany’s federal makeup, there are various degrees of tolerance of cannabis not explicitly destined to medical use, with notable examples like Bremen and Berlin which are spearheading progressive policies.
With regards to medical cannabis and the 2017 amendment, there have been several critical voices, particularly when it comes to reimbursement and social security. Incorporated within the proposal is the clause that makes reimbursement available only to those patients that agree to participate in research programs. What those ‘research programs’ entail is not yet defined, however that requirement creates issues of social justice even in principle. Adding the mobility restriction of many patients this stands to be a very controversial issue.
Another issue of concern is production. With distribution ensured through the existing network of traditional pharmacies, Germany also intends meet its internal demand with domestic production. However initial estimates are skeptical of the country’s ability to develop appropriate facilities in time. In that case, Germany will be depended on imports. One can speculate as to the possible source of the product but it is hard to overlook Bedrocan form the Netherlands. Concerns from the Dutch experience pertaining to an over-centralisation of production are an interesting case-study for German politicians and decision-makers.
With an estimated 800.000 potential patients making use of the coming law, it is not an inconsequential change. It is very interesting to see how the implementation will be carried out, what measures are taken towards training the medical professionals to prescribe, monitor and get the better out of the plant, as well as the production and quality measures.
Combined with some relatively tolerant cannabis policies, this amendment to medical cannabis improves significantly the aggregated effect of the legislations, giving access to the plant to those that need it most while resisting the outright criminalisation of non-medical users. According to recent polls, the vast majority of Germans support the legalisation of medical cannabis, with a significant chunk of them favouring outright legalisation. It is therefore not unwarranted to expect further changes, whether regional or national, on cannabis legislation in Germany.
The Netherlands are known worldwide for very a tolerant cannabis policy. With regards to medical cannabis, patients with prescriptions can buy purpose-grown cannabis from pharmacies since the spring of 2000. The product originates from Bedrocan, the grower designated by the Dutch Office of Medicinal Cannabis (part of the Ministry of Health) in order to ensure the necessary quality of the final product. Further Quality Control procedures and check-ups are performed along its production and distribution life-cycle.
However the Dutch notoriety for tolerant policies obfuscates various grey zones of the Dutch system. In particular, personal growing and cannabis growing in general is illegal (and attacked) in the Netherlands, which means that effectively coffee shops are breaking the law on a daily basis. This has created a monopoly – a monopoly which is significant on commercial terms, but even more so on ideological terms. The latter refers to the resulting conception of the plant as determined exclusively within the constraints of the coffee shop system (quality, use, method of delivery, personal and societal consequences etc.). This confusion, sustained by commercial interests, has created a chasm between perceived and actual cannabis and has fostered short-termism in plant manipulation and potency increase as opposed to sustainable scientific research & development.
Focusing on the explicitly medical side of things, a number of criticisms have been voiced by patients and patient organisations as well as NGO’s such as ENCOD (For a 2015 ENCOD-sponsored report click here). Criticisms tend to converge on the following points:
- Lack of strains and medical cannabis derivatives (edibles, oils, pills etc.)
- Overall quality of final product
- Lack of dedicated training for health professionals resulting in a reluctance towards prescribing cannabis
A highly centralised system, modeled on some aspects of the existing pharmaceutical industry, has created a very monolithic environment for medical cannabis users. With limits placed on the strains and products that can be labelled ‘medicinal’, the patient’s ability to find the right care for themselves is severely restricted. Furthermore, stringent decontamination methodology with gamma-ray irradiation over the final product, has a created a quality-compromised product. The main reason being, according to literature, the fact that gamma-rays destroy the terpenes of the plant, responsible for cannabis’ distinctive taste and smell. It is also believed, although scientific confirmation is still lacking, that terpenes can have a modulatory effect on the main cannabinoids – the entourage effect (Gamma-ray irradiation is an FDA approved technique for decontamination of food products, particularly ones destined for import / export).
With a relatively restrictive list of ‘recognised conditions’, one could easily argue this as a negative of the system on both medical and social justice / human rights grounds. Coupled with a reported reluctant health establishment to prescribe cannabis, serious concerns have been voiced over the ability to access the medicine. The latter is further aggravated by a repressive policy on personal growth. A February 2016 court ruling, in a highly publicised case, gave permission to a patient to grow his own cannabis for treating his HIV. This is however an individual result that applies only to that person which further points out the need for access to medicine.
Overall the Dutch system has the merits of not criminalising a whole section of its population who choose to use cannabis for whatever reason. However, reluctance to update and evolve the system, namely by integrating production into mainstream economic activity, the underground market hasn’t evaporated. This can partly be explained away by what is known as the ‘neighbour effect’ – meaning that neighbouring countries with repressive cannabis legislations drive that demand. However, there are important reasons to doubt that argument when the origins of coffee shop cannabis is considered. Furthermore, the Netherlands has a relatively sophisticated, albeit extremely rigid, medical cannabis infrastructure. However the aggregate of both policies stands to greatly benefit from a progressive amendment.
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