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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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... Reimbursement status also plays a major role as this treatment might constitute a significant cost for patients . Awareness of existing research and recommendations and available formulations might also influence physicians' prescribing patterns (de Hoop et al., 2018;Schlag et al., 2020). ...
... Many sources indicate that even after the legalization of MC, numerous patients in Europe struggle to obtain a prescription (de Hoop et al., 2018;Grotenhermen et al., 2003;Schlag et al., 2020). The Netherlands was the first country in Europe to introduce MC on 1 st January 2003. ...
... (Transnational Institute, 2019). In the years 2003-2016, only 16 000 patients received a prescription for medicinal cannabis in the Netherlands, but it is unsure how many more purchase it in the coffeshops for medical reasons (de Hoop et al., 2018). According to a recent report, there have been only 60 prescriptions issued in the UK since medical cannabis was approved as an off-label medicine in 2018 (Schlag et al., 2020). ...
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.
... 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: Medical cannabis' importance in Poland increased dramatically following its legalization as the 12th country in Europe in 2017. However, no studies have been published to give insight into Polish physicians' opinions about medical cannabis. Objectives: To investigate physician's opinions about cannabinoids' utility in clinical practice, concerns regarding their safety profile, and their clinical experience with cannabinoids. Methods: The survey using a self-developed tool was conducted online; participants were physicians with or without specialist training. Participation was voluntary. Physicians were recruited through personal networks, palliative care courses, and Medical Chambers. Results: From June to October 2020, we recruited 173 physicians from 15/16 voivodeships. The largest age group (43.9%; n = 76) was 30-39 year-olds. A similar proportion declared they never used cannabis and did not receive any training regarding cannabinoids (60% for both). Only 15 (8%) ever prescribed medical cannabis, although about 50% declared knowing suitable patients for such therapy, and 53.8% had at least one patient proactively asking for such treatment in the last 6 mo. The most common indication chosen was pain: chronic cancer-related (n = 128), chronic non-cancer (n = 77), and neuropathic (n = 60). Other commonly chosen conditions were alleviation of cancer treatment side-effects (n = 56) and cachexia (n = 57). The overall safety profile of THC was assessed as similar to most commonly used medications, including opioids; NSAIDs and benzodiazepines were, however, perceived as safer. Conclusions: Polish physicians favored the legalization of medical cannabis. However, it is of concern that a limited number have any experience with prescribing cannabis. The creation of clear guidelines to advise physicians in their routine practice and education about pain management and the risks related to the consumption of recreational cannabis for medical conditions are needed.
... A small, yet significant number of participants noted an increase in both administered dose (13/52, 25%) and administration frequency (9/52, 17.3%) over time. Typically, tolerance to the efficacy of CBMs containing THC and CBD, has not been observed [35][36][37][38]. However, tolerance is developed to known effects from cannabinoid receptor agonism such as impaired neurocognition and cardiovascular changes [39]. ...
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Background Epidermolysis bullosa (EB) patient anecdotes and case reports indicate that cannabinoid-based medicines (CBMs) may alleviate pain and pruritus and improve wound healing. CBM use has not been characterized in the EB patient population. Objectives To evaluate CBM use among EB patients, including CBM types, effects on symptoms (e.g., pain and pruritus), disease process (e.g., blistering, wounds, and inflammation), well-being (e.g., sleep, appetite) and concomitant medications. Methods English-speaking EB patients or caregivers completed an online international, anonymous, cross-sectional survey regarding CBM use. Respondents reported the types of CBMs, subsequent effects including perceived EB symptom alteration, changes in medication use, and side effects. Results Seventy-one EB patients from five continents reported using or having used CBMs to treat their EB. Missing question responses ranged between 0 (0%) and 33 (46%). Most used more than one CBM preparation (mean: 2.4 ± 1.5) and route of administration (mean: 2.1 ± 1.1). Topical and ingested were the most common routes. Pain and pruritus were reported retrospectively to decrease by 3 points (scale: 0–10; p < 0.001 for both) after CBM use. Most reported that CBM use improved their overall EB symptoms (95%), pain (94%), pruritus (91%) and wound healing (81%). Most participants (79%) reported decreased use of pain medications. The most common side-effect was dry mouth (44%). Conclusions CBMs improve the perception of pain, pruritus, wound healing, and well-being in EB patients and reduced concomitant medication use. Nevertheless, a direct relation between the use of CBMs and reduction of the above-mentioned symptoms cannot be proven by these data. Therefore, future controlled studies using pharmaceutically standardised CBM preparations in EB are warranted to delineate the risks and benefits of CBMs.
Since the Dutch tolerance policy, allowing the purchase of cannabis in ‘coffeeshops’, is associated with problems of public order and safety as well as health risks, there has been a long debate about legalisation of cannabis production and supply. It was therefore decided to conduct an experiment with a controlled legal (‘closed’) cannabis supply chain for recreational use. This is of international relevance in view of the current illegal cannabis exports from the Netherlands, the importance of sharing knowledge about the effectiveness of cannabis policies, and the accumulation of evidence needed to evaluate and update international treaties. Here we describe and discuss the background, general approach and design of the experiment. An independent expert committee elaborated how the closed chain will operate and be evaluated, based on the experience with the medicinal cannabis chain, and round table discussions with stakeholders (mayors, coffeeshop owners, cannabis consumers, growers, regulators, scientists, and addiction experts). Ten trusted cannabis growers are contracted to produce and supply cannabis to the coffeeshops in intervention municipalities, with product quality control, law enforcement against criminal interference, and preventive efforts to reduce health risks being implemented. No changes will be made in the cannabis supply to the coffeeshops in participating control municipalities. A process evaluation will assess whether the chain from production to sale in the intervention municipalities was really closed. In a quasi-experimental study comparing intervention and control municipalities, the chain's effects on public health, cannabis-related crime, safety and public nuisance will be estimated. The fieldwork period is expected to start early 2024 and will take four years, including reporting to the government and parliament. These will then decide whether and what further steps towards legalisation of the production and supply of cannabis will be taken.
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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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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.
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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.