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Medicinal Cannabis on Prescription in The Netherlands: Statistics for 2003–2016

  • Hazekamp Herbal Consulting
Medicinal Cannabis on Prescription in The Netherlands:
Statistics for 2003–2016
Bas de Hoop,
Eibert R. Heerdink,
and Arno Hazekamp
In 2003, the Netherlands started one of the first National
medicinal cannabis programs in the world, where pa-
tients are provided with pharmaceutical-grade cannabis
of standardized cannabinoid composition. The pro-
gram is overseen by the Office of Medicinal Cannabis
(OMC), which is part of the Ministry of Health, while
cultivation, packaging, lab testing, and distribution are
performed by contracted specialized companies. Medic-
inal cannabis is available on prescription only and can
be dispensed by all Dutch pharmacies. Currently, five
different cannabis strains are offered, including THC
and CBD dominant varieties, as well as indica and sativa
Medicinal cannabis is recommended in the
Netherlands mainly for treatment of chronic neuro-
pathic pain, spasms and pain related to multiple scle-
rosis (MS), lack of appetite/nausea/vomiting related to
cancer or HIV/AIDS, therapy-resistant glaucoma, and
Tourette’s syndrome.
Previously, we analyzed the prescribed cannabis use
among Dutch patients for the first time.
data were obtained from the Dutch Foundation for
Pharmaceutical Statistics (in Dutch: SFK), an indepen-
dent organization collecting detailed information from
community pharmacies, covering over 90% of all pre-
scriptions dispensed in the Netherlands, including can-
nabis. The existence of a continuous medicinal cannabis
program combined with the comprehensive data col-
lected by SFK provides a unique opportunity to learn
more about medicinal cannabis use within a long-
term stable national program. The main goal of our
analysis was to provide physicians and prescribers in
other countries, where medicinal cannabis is available,
with objective reference data regarding average daily
use, duration of use, or age distribution of patients
using prescribed cannabis.
In our current study, we compare the previously pub-
lished data covering the period 2003–2010 (period 1;
n=34,023 dispensed prescriptions identified) with new
data collected for 2011–2016 (period 2; n=95,022
dispensed prescriptions). Results are summarized in
Table 1. As shown, the age distribution of patients was
very comparable between the two study periods, with
patients in the age of 41–60 years making up the largest
group. In addition, the average daily use did not change
much over the years; in period 1, the study population
used 0.64g of cannabis per day, whereas patients in pe-
riod 2 consumed an average daily dose of 0.73 g, with re-
markably small differences across sexes or age groups.
A small shift was witnessed in gender ratio: the percent-
age of female patients decreased from 57.1% (period 1)
to 51.4% (period 2). Meanwhile, the average duration of
use (time passed between the first and last dispensed
prescription recorded for each individual) showed al-
most no change between study periods.
In period 1 (covering 8 years), we identified a total
of 5601 individuals who received at least one prescrip-
tion for cannabis. In period 2 (covering only 6 years),
10,826 individuals were identified. The prevalence rate
of patients using cannabis on prescription at least once
per year was fairly stable from 6.4 (patients per 100,000
inhabitants) in 2003 to 6.9 in 2010, but then it rapidly
increased to 24.6 in 2016. Since 2003, cannabis has been
Bedrocan International, Veendam, The Netherlands.
Department of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht,
The Netherlands.
Division of Laboratory Medicine & Pharmacy, Department of Clinical Pharmacy, University Medical Center, Utrecht, The Netherlands.
Hazekamp Herbal Consulting BV, Leiden, The Netherlands.
*Address correspondence to: Arno Hazekamp, PhD, Hazekamp Herbal Consulting BV, Utrechtse Veer 12b, Leiden 2311nc, The Netherlands, E-mail: hazekamp.hc@
ªBas de Hoop et al.2018;PublishedbyMaryAnnLiebert,Inc. This Open Access article is distributed under the terms of the Creative Commons
License (, which permits unrestricted use, distribution, and reproduction in any medium, providedthe
original work is properly cited.
Cannabis and Cannabinoid Research
Volume 3.1, 2018
DOI: 10.1089/can.2017.0059
Cannabis and
Cannabinoid Research
prescribed a total of about 170,000 times to over 15,000
patients in the Netherlands (population 17 million).
Until recently, Dutch medicinal cannabis was only
available in herbal form (dried cannabis flowers). How-
ever, in late 2015, the available cannabis varieties were
also made available in the form of concentrated extracts,
known as cannabis oils. This led to an enormous in-
crease in dispensed cannabis prescriptions; in the year
2016 alone, the number of patients using oil on prescrip-
tion (n=6421) already far surpassed those using herbal
cannabis (n=4196). Our data (summarized in Table 1)
show that patients using oil, on average, were somewhat
older and more often female, compared with patients
using herbal cannabis. Unfortunately, the prescribed use
of cannabis oil was introduced too recently to reliably de-
termine its average daily use or other interesting data.
Based on the data collected, it can be concluded that
an increasing number of Dutch patients are using me-
dicinal cannabis on prescription, while the average
daily consumption has remained remarkably stable
over many years. This suggests the absence of tolerance
or overconsumption in this population. In a future
study, we hope to include more details about the pre-
scribed use of cannabis oils, such as the preference of
patients for THC versus CBD dominant oils for differ-
ent medical conditions. We believe that our results pre-
sented here will contribute to a better understanding of
medicinal cannabis use in the Netherlands and abroad
and will help physicians and prescribers around the
world to make better informed decisions about their
own prescribing of medicinal cannabis products to pa-
tients in need.
Author Disclosure Statement
No competing financial interests exist.
1. Hazekamp A, Tejkalova K, Papadimitriou S. Cannabis: from cultivar to
chemovar II—a metabolomics approach to cannabis classification.
Cannabis Cannabinoid Res. 2016;1:202–215.
2. OMC: Office of Medicinal Cannabis, Department of Health. (accessed January 2018).
3. Hazekamp A, Heerdink ER. The prevalence and incidence of medicinal
cannabis on prescription in the Netherlands. Eur J Clin Pharmacol. 2013;69:
Cite this article as: de Hoop B, Heerdink ER, Hazekamp A (2018)
Medicinal cannabis on prescription in the Netherlands: statistics for
2003–2016, Cannabis and Cannabinoid Research 3:1, 54–55, DOI:
Abbreviations Used
CBD ¼cannabidiol
THC ¼tetrahydrocannabinol
Table 1. Characteristics of Dutch Patients Using Herbal Cannabis (2003–2010 vs. 2011–2016)
and Cannabis Oil (2015–2016) on Prescription
Herbal cannabis: 2003–2010 Herbal cannabis: 2011–2016 Oil: 2015–2016
daily use (g)
duration (days) n%
daily use (g)
duration (days) n%
Study population 5601 100.0 0.64 251 10,826 100.0 0.73 254 6720 100.0
Male 2401 42.9 0.66 237 5257 48.6 0.77 275 2667 39.7
Female 3200 57.1 0.62 262 5569 51.4 0.68 235 4053 60.3
, years
£20 110 2.0 0.70 178 189 1.7 0.79 151 170 2.5
21–40 852 15.2 0.66 296 2006 18.5 0.82 323 580 8.6
41–60 2567 45.8 0.63 300 4640 42.9 0.72 306 2533 37.7
61–80 1755 31.3 0.64 188 3348 30.9 0.69 175 2976 44.3
>80 317 5.7 0.69 118 643 5.9 0.68 113 461 6.9
Recorded age at date of first dispensation.
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... In the U.K., 2 y after the legalization of cannabis for medical purposes, only 60 prescriptions in total were issued, whereas the target population was estimated at 1.5 mln (2% of the total population) [59,61]. In The Netherlands, only 16,000 patients benefited from the Medical Cannabis Programme from its beginning until 2016 [62]. At the same time, other reports demonstrated that numerous users of recreational cannabis take it for medical reasons [61]. ...
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Introduction: Different countries have employed a variety of methods for their populace to access medical cannabis. Objectives: The purpose of this literature review was to assess the international literature on pharmacists' beliefs and attitudes towards medical cannabis. Methodology: This literature review summarized the various countries that utilize pharmacies and pharmacists to dispense medical cannabis. The countries included in this review were: Australia, Canada, Denmark, Finland, Germany, Israel, Italy, Netherlands, Poland, Serbia, Switzerland, USA, and Uruguay. Discussion: The pharmacist perspective has been of key importance within the medical landscape, as they are the ones who not only dispense medication but also counsel and monitor patients and it is this perspective that is lacking. Conclusion: Overall, this review found that even though pharmacists are generally comfortable with dispensing medical cannabis; they still require further education to do so as safely and effectively as possible.
Neurodegenerative diseases (NDs) represent one of the most important public health problems, and worldwide, hundreds of millions of people are affected by NDs, displaying strong evidence to these diseases is one of the most significant challenges to public health. Neurological disorders include several common diseases of the central and peripheral nervous system such as Alzheimer's disease and other dementia, epilepsy, headache disorders, multiple sclerosis, Parkinson's disease, and others. The discovery of substances capable of preventing or treating neurological disorders has been the goal of researchers for several years. New therapies and new molecules should be explored. In this context, natural compounds represent an important source for the development of new drugs. For example, between 1981 and 2014, from a total of 12 new approved molecules for the treatment of Parkinson's disease, only one was a synthetic drug, being the others biological, derived or inspired in a natural product. In the same line, > 50% of all new antidepressant molecules were synthetic/mimetic of a natural product. Anticholinesterases like physostigmine and neostigmine, opioids alkaloids, galantamine, are some examples of drugs utilized from derived plants for the treatment of neurological disorders, highlighting the relevance of studying and searching for new natural products for the treatment of neurological disorders. This chapter aimed to summarize the most important compounds originated from natural sources that were targets of clinical studies, associated with neurological and psychiatric disorders, obtaining a total of 13 articles, in the last 10 years. Also, we characterized these compounds structurally. Considering the vast diversity of plants, few herbal medicines or botanical drugs were approved for human use, in the last centuries, only few innovative therapeutic products have been developed, especially in the field of neurological diseases.
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Background In Denmark the boundaries between cannabis as an illicit drug and licit medicine have shifted rapidly in recent years, affecting also policy. However, the vast majority of Danes, who use cannabis as medicine (CaM) continue to rely on the unregulated market for supply. This study explores patterns of use and motives for use of CaM in Denmark. Methods An anonymous online survey was made available to a convenience sample of users of CaM from July 14, 2018 to November 1, 2018. Participants were recruited through patient organisations, social and public media, and the illegal open cannabis market. Results Of the final sample ( n = 3,021), a majority were women (62.6%) and the mean age was 49 years. Most had no prescription for CaM (90.9%), a majority had no or limited previous experience with recreational cannabis use (63.9%), and had used CaM for two years or less (65.0%). The most common form of intake was oil (56.8%) followed by smoke (24.0%). CBD oil (65.0%) was used more than hash, pot or skunk (36.2%). Most frequent conditions treated were chronic pain (32.0%), sleep disturbances (27.5%), stress (23.7%), osteoarthritis (22.7%), anxiety (19.6%), and depression (19.6%). Overall, users experienced CaM to be effective in managing somatic and mental health conditions and reported relatively few side-effects. CBD oil only users were more likely to be women, older, have limited recreational experience and have initiated use recently. Conclusions A new user group has emerged in Denmark that, for the most part, use illegally sourced CaM to treat a broad range of somatic and mental health conditions, often with experienced effect and relatively low level of side-effects. The prevalent use of low-potency CBD oil indicates an interest in effects beyond the high normally associated with cannabis use. More clinical research into the effects and side-effects of CaM is needed to draw the boundaries of the medical utility of cannabis.
Background Since the introduction of the National Medical Cannabis Programme in The Netherlands, many other countries in Europe have made medical cannabis (MC) and cannabis-based medicines (CBMs) available. However, each of them has implemented a unique legal framework and reimbursement strategy for these products. Therefore, it is vital to study healthcare professionals’ knowledge level (HCP) and HCPs in-training regarding both medical uses and indications and understand their safety concerns and potential barriers for MC use in clinical practice. Methods A comprehensive, systematic literature review was performed using PubMed/MEDLINE, EMBASE, and Google Scholar databases, as well as PsychINFO. Grey literature was also included. Due to the high diversity in the questionnaires used in the studies, a narrative synthesis was performed. Results From 6,995 studies retrieved, ten studies, all of them being quantitative survey-based studies, were included in the review. In most studies, the majority of participants were in favor of MC and CBMs use for medical reasons. Other common findings were: the necessity to provide additional training regarding medical applications of cannabinoids, lack of awareness about the legal status of and regulations regarding MC among both certified physicians, as well as prospective doctors and students of other medicals sciences (e.g., nursing, pharmacy). Conclusions For most European countries, we could not identify any studies evaluating HCPs’ knowledge and attitudes towards medicinal cannabis. Therefore, similar investigations are highly encouraged. Available evidence demonstrates a need to provide medical training to the HCPs in Europe regarding medical applications of cannabinoids.
Cannabis can synthetize more than 400 compounds, including terpenes, flavonoids, and more than 100 phytocannabinoids. The main phytocannabinoids are Δ-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Cannabis-based products are used as medicines in several countries. In this text, we present an overview of the main neurochemical mechanisms of action of the phytocannabinoids, especially THC and CBD. We also reviewed the indications and adverse effects of the main cannabis-based medicinal products. THC acts as a partial agonist at cannabinoid 1/2 receptors (CB 1/2). It is responsible for the characteristic effects of cannabis, such as euphoria, relaxation, and changes in perceptions. THC can also produce dysphoria, anxiety, and psychotic symptoms. THC is used therapeutically in nausea and vomiting due to chemotherapy, as an appetite stimulant, and in chronic pain. CBD acts as a noncompetitive negative allosteric modulator of the CB 1 receptor, as an inverse agonist of the CB 2 receptor, and as an inhibitor of the reuptake of the endocannabinoid anandamide. Moreover, CBD also activates 5-HT 1A serotonergic receptors and vanilloid receptors. Its use in treatment-resistant epilepsy syndromes is approved in some countries. CBD does not produce the typical effects associated with THC and has anxiolytic and antipsychotic effects. Some of the most common adverse effects of CBD are diarrhea, somnolence, nausea, and transaminase elevations (with concomitant use of antiepileptics). The mechanisms of action involved in both the therapeutic and adverse effects of the phytocannabinoids are not fully understood, involving not only the endocannabinoid system. This "promiscuous" pharmacology could be responsible for their wide therapeutic spectrum.
Background Evidence details how cannabis can influence the use of other psychoactive substances, including prescription medications, alcohol, tobacco and illicit drugs, but very little research has examined the factors associated with these changes in substance use patterns. This paper explores the self-reported use of cannabis as a substitute for alcohol among a Canadian medical cannabis patient population. Methods Data was derived from a survey of 2102 people enrolled in the Canadian medical cannabis program. We included 973 (44%) respondents who reported using alcohol on at least 10 occasions over a 12 month period prior to initiating medical cannabis, and then used retrospective data on the frequency and amount of alcohol use pre-and post medical cannabis initiation to determine which participant characteristics and other variables were associated with reductions and/or cessation of alcohol use. Results Overall, 419 (44%) participants reported decreases in alcohol usage frequency over 30 days, 323 (34%) decreased the number of standard drinks they had per week, and 76 (8%) reported no alcohol use at all in the 30 days prior to the survey. Being below 55 years of age and reporting higher rates of alcohol use in the pre-period were both associated with greater odds of reducing alcohol use, and an intention to use medical cannabis to reduce alcohol consumption was associated with significantly greater odds of both reducing and ceasing alcohol use altogether. Conclusions Our findings suggest that medical cannabis initiation may be associated with self-reported reductions and cessation of alcohol use among medical cannabis patients. Since alcohol is the most prevalent recreational substance in North America, and its use results in significant rates of criminality, morbidity and mortality, these findings may result in improved health outcomes for medical cannabis patients, as well as overall improvements in public health and safety.
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Introduction: There is a large disparity between the ''cultural'' language used by patients using cannabis for self-medication and the ''chemical'' language applied by scientists to get a deeper understanding of cannabis effects in laboratory and clinical studies. The distinction between Sativa and Indica types of cannabis, and the different biological effects associated with them, is a major example of this. Despite the widespread use of cannabis by self-medicating patients, scientific studies are yet to identify the biochemical markers that can sufficiently explain differences between cannabis varieties. Methods: A metabolomics approach, combining detailed chemical composition data with cultural information available for a wide range of cannabis samples, can help to bridge the existing gap between scientists and patients. Such an approach could be helpful for decision-making, for example, when identifying which varieties of cannabis should be made legally available under national medicinal cannabis programs. In our study, we analyzed 460 cannabis accessions obtained from multiple sources in The Netherlands, including hemp-and drug-type cannabis. Results: Based on gas chromatography analysis of 44 major terpenes and cannabinoids present in these samples , followed by Multivariate Data Analysis of the resulting chromatographic data, we were able to identify the cannabis constituents that may act as markers for distinction between Indica and Sativa. This information was subsequently used to map the current chemical diversity of cannabis products available within the Dutch medicinal cannabis program, and to introduce a new variety missing from the existing product range. Conclusion: This study represents the analysis of the widest range of cannabis constituents published to date. Our results indicate the usefulness of a metabolomics approach for chemotaxonomic mapping of cannabis varieties for medical use.
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Background: A growing number of countries are providing pharmaceutical grade cannabis to chronically ill patients. However, little published data is known about the extent of medicinal cannabis use and the characteristics of patients using cannabis on doctor's prescription. This study describes a retrospective database study of The Netherlands. Methods: Complete dispensing histories were obtained of all patients with at least one medicinal cannabis prescription gathered at pharmacies in The Netherlands in the period 2003-2010. Data revealed prevalence and incidence of use of prescription cannabis as well as characteristics of patients using different cannabis varieties. Results: Five thousand five hundred forty patients were identified. After an initial incidence of about 6/100,000 inhabitants/year in 2003 and 2004, the incidence remained stable at 3/100,000/year in 2005-2010. The prevalence rate ranged from 5 to 8 per 100,000 inhabitants. Virtually all patients used some form of prescription medication in the 6 months preceding start of cannabis use, most particularly psycholeptics (45.5 %), analgesics (44.3 %), anti-ulcer agents (35.9 %) and NSAIDs (30.7 %). We found no significant association between use of medication of common indications for cannabis (pain, HIV/AIDS, cancer, nausea, glaucoma) and variety of cannabis used. Conclusions: This is the first nationwide study into the extent of prescription of medicinal cannabis. Although the cannabis varieties studied are believed to possess different therapeutic effects based on their different content of tetrahydrocannabinol (THC) and cannabidiol (CBD), no differences in choice of variety was found associated with indication.