A History of Danish Cannabis
A lot has happened around Danish medicinal cannabis in the past 5 years, and despite the progress made, the ups and downs, nobody knows how the Danish cannabis adventure will end.
Dr Julie Moltke | Medical cannabis educator and doctor at the pain and medical cannabis Clinic Horsted in Copenhagen. Consultant psychiatrist at Ryhov hospital, owner of Margreteholm Mindfulness Manor.
More details of the work from Dr Moltke can be found here - www.drjuliemoltke.com
A lot has happened around Danish medicinal cannabis in the past 5 years, and despite the progress made, the ups and downs, nobody knows how the Danish cannabis adventure will end. But let’s start from the beginning.
The first licensed cannabis-based medicine to reach the pharmacy shelves in Denmark was GW pharmaceutical’s Sativex. The 1:1 ratio THC to CBD sublingual spray was approved by the danish medicines agency in 2011, after a change in the law about narcotic drugs. This allowed neurologists to prescribe medicinal cannabis for a small group of patients suffering from multiple sclerosis (MS). From the change in the law in 2011, four more years passed before one pharmacy in Denmark saw an opportunity and a demand. They started producing the first pharma-grade cannabis oils with cannabinoid extracts from medical cannabis flower. Glostrup pharmacy is one out of two in Denmark where magistral medicines are produced, this means that products are produced specially for the patients on demand from doctors. These are unlicensed products but any doctor has the right to prescribe these to their patients if they estimate it is the most appropriate choice. In 2015, the first visionary danish doctors could prescribe these THC and CBD containing oils to their patients, for whichever indication they saw fit.
In 2015 only one doctor prescribed medicinal cannabis to five patients. In the fall of 2016, 200 patients had been prescribed magistral produced cannabis-based medicines from 20-30 danish doctors. These oils and capsules are expensive non-subsidised medicines and as an example, a 30 ml bottle with THC/CBD 10 mg/25 mg/ml costs 1600 DKK (approximately 190 GBP). At this time doctors were not allowed to prescribe the dried cannabis flower.
Around the same time in 2016, politicians in the Danish government were meeting to lay out a proposition for a 4-year medicinal cannabis pilot project, where danish companies would be allowed to produce medicinal cannabis flowers and doctors would be allowed to prescribe it for certain indications with patients getting subsidised up to 10.000 DKK a year (approximately 1150 GBP). A majority of the government agreed on the proposal in December 2017 and this was the foundation for the beginning of the danish cannabis adventure. Behind the scenes, visionary people like the former tomato and vegetable producer Mads Pedersen and the former advertisement magnet Lars Thomassen saw opportunities. This resulted in two new danish cannabis companies with growth licenses forming joint ventures with two major Canadian companies; Aurora and Canopy Growth. By 2018, the forerunners in the Danish cannabis production were Aurora Nordic, with CEO Mads Pedersen behind the steering wheel, and Spectrum Cannabis, where Lars Thomassen as the first CEO.
With the initiation of the 4-year Danish Medicinal Cannabis pilot project all licensed danish doctors were allowed to prescribe the products that were approved for the trial by the danish medicines agency.
In the beginning these only included the Dutch produced cannabis flowers for vaporization and tea, named Bedrocan, Bediol and Bedica. Between September 2018 to November 2019 three oils were also available for doctors to prescribe through the pilot project. The magistral products from Glostrup pharmcy did not become part of the pilot project with the exception for a high THC-oil. At the time of writing only flower and Indica based 5 mg capsules are approved through for the trial.
Doctors are currently allowed to prescribe for the following indication through the 4-year pilot programme:
Chronic neuropathic pain
Painful spasms after spinal cord injury
Nausea and vomiting after chemotherapy
Painful spams because of multiple sclerosis
The patients have to have tried all kinds of approved licensed drugs before they can get a subsidised prescription for medicinal cannabis.
If they have not tried all alternatives, they need to try them first, or the doctor has the choice of prescribing the magistral products from Glostrup pharmacy, with the patient paying themselves. This means that only patients with one of the above indications can access medicinal cannabis flower in Denmark.
One visionary pain physician and anaesthesiologist quickly saw the potential of cannabis medicine. Dr Tina Horsted has specialised in medicinal cannabis for chronic pain and is the owner of Clinic Horsted, a range of clinics in Denmark. Dr Horsted has prescribed medicinal cannabis for more than 5000 patients from her clinic in Copenhagen. She has trained many of the danish prescribers and is a founding member of the Clinical Cannabis Forum, a danish organisation for researchers and clinicians in the field of medicinal cannabis and cannabis-based medicines.
During 2018, the first year of the pilot, 1,211 patients were prescribed medicinal cannabis through the pilot scheme. If you include the magistral cannabis-based products from Glostrup pharmacy and licensed cannabis-based medicines this figure rises to 2,923 patients. A big proportion of these prescriptions were made by doctors in Clinic Horsted, though doctors across all of Denmark prescribed. By the last quarter of 2020, 6,451 patients had been prescribed cannabis-based medicines in Denmark since 2018 and about 44% of these received a subsidised prescription through the trial. For more figures look here.
There have been many bumps in the road, ranging from lacking support from the Danish royal college of doctors to extremely long processing time of applications from danish licensed producers. This sadly means that almost 4 years after the trial started and the first licensed producers started their cultivation of medical cannabis, we still do not have danish cannabis products on the market. Furthermore, Canopy Growth sadly had to close Spectrum Therapeutics near the Danish town Odense, which lead to more than 100 jobs being lost together with an investment of more than 350 million kroner.
With the pilot program running on its last year the negotiation for a continuation is pending. The hopes are that the period will be extended so we can continue working on getting the statistical and scientific data we need to make medicinal cannabis permanent in Denmark. In Clinic Horsted, we continue to support our patients and fight for better research data, access and education about medicinal cannabis.