April 23, 2021
Who are the medical cannabis patients in Europe?
The European medical cannabis market is still in its infancy, with much work to be done before patient access catches up to the levels seen in North America.
Conor O’Brien, Prohibition Partners
23rd April 2021
In order to best serve the medical cannabis patient population in Europe, operators need an understanding of who the patients are and why they rely on these medicines. Prohibition Partners has summarised the available data below, and provided more analysis in our recent European Cannabis Report.
Prohibition Partners has gathered data for European medical cannabis patients from national government agencies and independent research groups to investigate high-level statistics on patients being prescribed medical cannabis. One of the foremost sources of data in Europe is Project Twenty21, run by Drug Science in the UK, which is a patient registry that ‘aims to create the UK’s largest body of evidence for the effectiveness and tolerability of medical cannabis’ by facilitating patient access and subsequently publishing anonymised data.
Prohibition Partners spoke to Dr Anne Katrin Schlag, head of research at Drug Science, about the data in advance of an upcoming publication on UK patients in the Journal of Psychopharmacology. She explained that:
‘Our patient population comprises a huge age range (more or less from 18–80 years old). Their consistently high rates of comorbidity and low quality of life demonstrate just how unwell many of them are. So, any stereotypes of medicinal cannabis users as being 20-something, healthy recreational users looking for a legal source could not be further from the truth.’.
Drug Science also provided some updated information on the UK for the analysis below.
Medical cannabis shows promise in treating a wide range of conditions, being a modulator of the endocannabinoid system, and having a safe and effective anti-inflammatory profile. While cannabinoid medications are approved for a limited set of conditions, for example Epidiolex for rare epilepsies, physicians and patients make use of these medicines to cover many more conditions.
Producers of medical cannabis for the European market should take note of the conditions for which cannabis is being prescribed on the continent. The needs of patients vary widely by condition, for example where CBD/Epidiolex® is useful for epileptic patients, THC is more useful for the reduction of nausea. Below are the indications for which medical cannabis products are prescribed per country.
Pain is by far the most commonly cited reason for doctors to prescribe medical cannabis. Chronic pain affects as many as 1 in 3 people in developed countries, usually defined as pain occurring most days or every day for six months. European trends are comparable with North America in medical cannabis being prescribed most often for pain. This is also true in the UK according to data provided by Dr Anne Katrin Schlag:
‘Pain and anxiety disorders were the two most common disorders in both women and men; women were more likely to report a primary condition of chronic pain (61.5% vs 51.0%) while men were more likely to report anxiety disorders (38.0% vs 23.8%).’
Medical cannabis patients seeking to treat pain differ in their need depending on intensity of pain and frequency of use. Generally speaking, patients with pain prefer cannabinoid medications with high and balanced quantities of THC and CBD, with high-frequency consumers preferring high THC and lower CBD. This is reflected by the types of medical cannabis currently available in Europe, with most countries having a wider array of medications with high THC and balanced THC:CBD than high CBD alone.
The average age of medical cannabis patients in Europe is similar to that of the North American patient population, if somewhat older. In the largest market in Europe, Germany; the mean age of medical cannabis users in the country is 54. Denmark and Italy are notable for having an population of mature medical cannabis patients at an average of ~57 and 58 respectively. Early data from Project Twenty21 indicates that the patient groups in the UK are somewhat younger than in other European countries, with an average age of around 39.
People of different age groups are known to prefer different medical cannabis products. For example, data from the official survey of German patients indicate that the average age of medical cannabis patients using flowers is 46, while the average for extract usage is 57. The Federal Institute for Drugs and Medical Devices (BfArM) in Germany has noted that many prescriptions for cannabis flower go unreported, which could skew the data as these patients are known to be more often male and slightly younger than patients using other products.
The data on gender of medical cannabis patients in Europe suggest that the balance is more even between male and female than in North America, where the patient population is majority male. In the Netherlands and Germany, the gender divide is not large. Denmark and Italy are notable for their patient populations having a large female majority at 62% and 63% respectively. According to data from Project Twenty21, the UK’s patient population is more comparable to that in North America in terms of gender balance, with a 66% majority being male as of April this year. Germany and the UK are the only countries for which data for non-binary patients are available and to date around 0.1% and 0.6% of patients identify as such in each country.
As with demographics, gender plays a role in patient product choice. In Germany for example, 68% of patients receiving flower are male, while females dominate the use of dronabinol (58%), Sativex® (54%) and extracts (54%), as reported in the surveys of the BfArM.
The data presented here represents much of the available data on patients in Europe. It should be noted that the data represent a small portion of the total patient population on the continent, with millions of people still self-prescribing medical cannabis and large swathes of patients not being included in published data, such as the population in Switzerland. As these data become available, Prohibition Partners will provide relevant updates as part of ongoing efforts to support patient needs being met in Europe.
Prohibition Partners dive more deeply into this and other topics in their recently released European Cannabis Report: 6th Edition which looks at social, economic, regulatory and health trends including:
- The progress of medical cannabis access in Europe
- The progress of adult-use initiatives
- The opening of European capital markets to cannabis
- The impact of COVID-19 on patient access and the industry at large
- The patients in Europe and the products they are using
- The trends in product formulation towards extracts and isolates
- The diversification of the supply chain in Europe
Who are the medical cannabis patients in Europe?
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