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

DOI:10.1089/can.2017.0059
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Bas de Hoop
Bas de Hoop
Bas de Hoop
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Eibert R Heerdink at Utrecht University
Eibert R Heerdink
Arno Hazekamp at Hazekamp Herbal Consulting
Arno Hazekamp
  • Hazekamp Herbal Consulting
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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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... 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). ...
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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.
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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: 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.
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... 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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