Online prescribers | Medical cannabis could be more strictly regulated

Is the brief rise of legal cannabis in Germany soon over? This impression might arise when reviewing statements and intentions, particularly from CDU politicians, in recent months. The coalition had agreed to conduct an "open-ended evaluation of the law on the legalization of cannabis" in the fall of 2025. Specifically, the initial focus will be on medical cannabis.

Health Minister Nina Warken (CDU) wants to introduce stricter regulations for its prescriptions because the number of private prescriptions and online purchases have recently increased significantly. Overall, import volumes more than quadrupled in 2024, the year cannabis was partially legalized for so-called recreational use. In the second half of 2024, the number of prescriptions at the expense of health insurance companies increased by only nine percent, but trade in medical cannabis grew by 170 percent.

Legalization effectively overtook the regulations for medical cannabis, which also eliminated the need for a narcotic prescription. Online prescriptions also became possible. However, the increase in this area is also due to the fact that the regulations for legal recreational cannabis make it rather difficult for consumers. So far, authorities have approved 293 cannabis clubs nationwide. North Rhine-Westphalia and Lower Saxony are leading the way, followed by Rhineland-Palatinate and Baden-Württemberg. Saarland does not yet have a single approved club, and Berlin only has seven. Applications for 328 of these establishments are still being processed. Only 27 have been rejected, and 53 have been withdrawn by the applicants.

Because procurement through clubs is cumbersome and potential suppliers are often held back by their design, the demand for clean cannabis is apparently growing in parallel – and many interested parties believe that the safest way to obtain it is through medical cannabis. In addition, given the generally relaxed regulations on the trade and possession of the drug, a few clever individuals may have come up with the idea of swindling prescriptions and then circulating the prescriptions for their own profit.

The regulation planned by Warken obviously doesn't fit the plans of those companies that specialize in telemedical cannabis prescriptions, including mail-order sales. One of these platforms is Doktor ABC, whose operators are particularly critical of the foreseeable disadvantages for patients in rural areas that the new regulation will cause. One of the problems, they say, is that pharmacies don't stock the entire spectrum of cannabis flowers, which doctors will only be able to prescribe after direct contact in the future. Very few physicians are likely to want to deal with the qualities of more than 1,000 flower varieties in addition to their daily patients and their concerns.

The industry now fears that supply shortages are foreseeable. Patients would then either have to forgo treatment or resort to the black market, where medical oversight is lacking. Doctor ABC, for example, works with 300 certified partner pharmacies and can thus ensure fast, nationwide delivery, they say.

Generally, a maximum of 100 grams of cannabis flowers can be prescribed per month per person. For those with statutory insurance, the co-payment ranges from five to a maximum of ten euros, depending on the price. With a private prescription, patients would pay six to 15 euros per gram of dried flowers, depending on the provider and variety.

However, according to the draft legislation from the Ministry of Health, the drug can only be prescribed in the future after a prior personal consultation with a doctor. A follow-up prescription requires doctor loyalty: This practice must have been consulted for four quarters beforehand. This would put a stop to the prescription for otherwise healthy individuals. Even well-controlled chronically ill patients often only visit their family doctor twice a year.

Mail-order sales of medical cannabis via online pharmacies would be completely banned. Current users would be left with the option of using a local doctor's office and pharmacy or obtaining supplies on the illegal market. Others could consider home cultivation. The latter two options are fraught with uncertainty, especially if precise dosage and good quality are desired.