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

Authors:
  • Hazekamp Herbal Consulting
LETTER TO THE EDITOR Open Access
Medicinal Cannabis on Prescription in The Netherlands:
Statistics for 2003–2016
Bas de Hoop,
1
Eibert R. Heerdink,
2,3
and Arno Hazekamp
4,
*
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
types.
1
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.
2
Previously, we analyzed the prescribed cannabis use
among Dutch patients for the first time.
3
Prescription
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
1
Bedrocan International, Veendam, The Netherlands.
2
Department of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht,
The Netherlands.
3
Division of Laboratory Medicine & Pharmacy, Department of Clinical Pharmacy, University Medical Center, Utrecht, The Netherlands.
4
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@
gmail.com
ªBas de Hoop et al.2018;PublishedbyMaryAnnLiebert,Inc. This Open Access article is distributed under the terms of the Creative Commons
License (http://creativecommons.org/licenses/by/4.0), 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
54
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.
References
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.
www.cannabisbureau.nl (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:
1575–1580.
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:
10.1089/can.2017.0059.
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
n%
Average
daily use (g)
Average
duration (days) n%
Average
daily use (g)
Average
duration (days) n%
Study population 5601 100.0 0.64 251 10,826 100.0 0.73 254 6720 100.0
Sex
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
Age
a
, 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
a
Recorded age at date of first dispensation.
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