October 30th, 2020
Denmark boasts one of the more open schemes for medicinal cannabis access in Europe. Virtually all cannabis products for therapeutic use can be prescribed and dispensed in the Nordic country, from magistral preparations with dronabinol or CBD isolate, to medical flower and full-plant extracts, which have been accessible since 2018 through a pilot scheme. However, medical cannabis products are subject to harsh regulatory requirements; stricter than EU-GMP, which hinders the launch of new products on the market. In addition to that, licensed pharmaceuticals such as Sativex and Epidiolex are also marketed, while special importation of unlicensed pharmaceuticals such as Marinol and Nabilone is also possible.
The Danish market has remained constrained both due to the restrictiveness of prescribing guidelines and to the limited availability of product formats. The removal of the extracts imported by Stenocare from Canada due to malpractice by its supplier CannTrust left many patients unable to access their medications. Data suggests that some patients turned to magistral preparations of dronabinol. Despite the introduction of high-THC capsules by Aurora earlier this year, which captured some of the demand for dronabinol, the market for full-plant extracts hasn’t yet recovered from the Canntrust event.
Data released by the Danish Health Authority also shows a quarterly increase in the number of unique patients enrolled in the pilot scheme, while the overall number of patients accessing any type of medicinal cannabis has fallen slightly. This suggests that medical cannabis extracts launched in the Danish market capture the demand of other products, like dronabinol. In the future, magistral dronabinol could end up with a smaller share of the market considering patients and prescribers may well prefer full-spectrum extracts, and that many of the two formats share many treatable indications. Sales of high-THC capsules by Aurora have increased by 400% from Q1 2020 to Q2 2020, while dronabinol has decreased 12.6% in the same time period.
The majority of the patients are older than 42 years old and women represent 62% of the patient base, closely following the age and gender distribution in the epidemiology of chronic pain and multiple sclerosis, given that the majority of prescriptions for medicinal cannabis in Denmark are to deal with pain and secondarily, spasticity resulting from MS.
Pilot products are rarely prescribed for epilepsy. Instead, magistral preparations with CBD isolate seem to be the preferred product for this indication with a growth of 42.5% from Q3 2019 to Q2 2020, reaching over 3.4 million milligrams of magistral CBD dispensed. Another boost for epilepsy patients is the arrival of Epidiolex in Denmark.
Canadian firms have recognised the potential of Denmark as a trading post in the global cannabis industry. This has led to the investment of CAD$400M in order to establish operations there. Among the investors are large cannabis names such as Aphria, Aurora, and Canopy Growth. Strict product requirements mean that growing cannabis in Denmark is not only a good decision for companies to get the product approved in more EU Member States, but also good for Denmark as they will have various sources of medical cannabis fit for domestic use. With the potential of large scale cultivation in the country, access to medical cannabis varieties could soon be made easier for the Danish population.