June 3, 2021

The Medical Cannabis Conundrum in Europe

24min read

Amidst a steady rise in demand in Europe, what are the medical cannabis opportunities and challenges for producers and distributors alike?

4th June 2021


 

Exports across Europe are at an all time high, with some North American companies already making moves to get into the market early. With increasingly progressive legislation on the horizon, in as little as 18 months the European landscape could look very different. However, much remains uncertain.

At Prohibition Partners LIVE in May, an expert panel – Alfredo Pascual, VP of Investment Analysis at FastForward Innovations, Tjalling Erkelens, CEO of Bedrocan, and Alex Agius Saliba, MEP for Malta – assessed the potential risk and reward for those entering the European medical cannabis market.

Below is a full transcription from the fascinating and insightful panel discussion.

Alfredo Pascual: Hello, and welcome everyone. My name is Alfredo Pascual; I am vice president of investment analysis at fast forward innovations. And today, I will be moderating this panel with Tjalling Erkelens, CEO of BEDROCAN, and Alex Agius Saliba, member of the European parliament. And let’s start by letting Tjalling and Alex say a couple of words about themselves and how they ended up involved in the cannabis industry or policy in the case of Alex.

Tjalling Erkelens: Thank you very much, Alfredo. Yes, my name is Tjalling Erkelens, CEO and the founder of BEDROCAN. BEDROCAN is one of the older companies, and we have a strong European focus.

Since 2003, we are contracted by the Dutch ministry of health to produce high-quality cannabis for medicinal purposes. So we’re doing that for 18 years already now. One of the core things of the company is that we always say we do work for patients, and we do work at the highest quality levels.

Standardization is one of those quality legs under the stool. But also having your certificates right, so GMP and all that kind of quality assurance things are taken care of in our company. That’s who I am.

Alfredo Pascual: Thank you, Tjalling. Alex?

Alex Agius Saliba: So first of all, thanks for this invite. I think it will be a very interesting discussion, touching upon some very important points that I think should be discussed also at European level. I’m Alex Agius Saliba, a new MP; this is my first legislature in the European parliament coming from the smallest member state Malta, part of the socialist and democrats group.

I’m also a full member in the internal market committee and consumer protection within the European parliament, and also in the petitions committee and the employment and social affairs committee.

Basically, I started delving into this subject because I had some experiences in my constituency when I was visiting people, visiting patients. And even in my member state, there were some hurdles, some issues which although legislation came into being when it comes to the production of medicinal cannabis.

There are still some barriers for patients in the supply chain, and basically having full ability basically to be able to make full use of medicinal cannabis when compared to other medicinal prescribed products.
Therefore, I kick-started this also, this initiative both within my political group but also by reaching out at EU level and European parliament level with other political groups, with other MPs, to try to, I think first of all to raise awareness about these hurdles, about these issues, to have real access both when it comes to physical access, but also when it comes to practical access.

When having a product which is ultimately affordable for patients and accessible for patients. And we started basically this initiative, a cross-party initiative. Collecting and bringing together MMPs from different member states, from different political groups to raise awareness, and also to raise political pressure and political awareness at EU level.
When it comes to having less stigmatization of patients using cannabis, more focus on research. And also, more focus on harmonization of national laws concerning access to medicine cannabis.

Alfredo Pascual: Alex, this is the European medicinal cannabis alliance that you called, right?

Alex Agius Saliba: Yes.

Alfredo Pascual: It is something that works, let’s say, inside the European parliament. It is for MMPs. And you found already support from different parties in parliament, can you tell us a little bit about that?

Alex Agius Saliba: Yes, as I said, this is a cross-party initiative bringing together many different MMPs from different political groups. I think that at EU level and in a political institution. If you don’t have cross-party support in an initiative like this, it would be very difficult to ultimately gain ground when it comes to pushing forward your agenda.

So I think that the numbers are very encouraging of the first members, first MMPs, who joined this coalition. Now we have more than 40 MMPs from nearly all political groups within the European parliament.

Even geographically, there is a very good balance and very good representation from different member states. We are nearing also to agreement when it comes to the general objectives and specific objectives that we will be tackling as an alliance.

But basically, what we are aiming is to focus specifically. And I think that this is a starting point in our discussion. Focusing specifically on medicinal cannabis, we are not going to focus on issues of non-medicinal use.
Although, I have my strong views also on that point. But as an alliance, we are not going to touch upon those issues. But basically, we are focusing on stopping stigmatization of patients who basically are making use of medicinal cannabis. This is an issue; it’s an issue in a number of member states.

I would say practically in all member states, medicinal cannabis. Although, we know scientifically and medically speaking that it can give better quality of life to our patients. And also, it can offer also specific cure to a number of conditions. It is still considered as a taboo in a number of member states, so this is one of our priorities.

Facilitation of the excess of medicinal cannabis for patients in Europe. As I said, I’m coming from Malta. Basically, we have also one of the groundbreakers when it comes to legislation, which is also helping to thrive the industry of medicine and cannabis also. But at the same time, when you go on the ground and speak with patients, there are still a number of hurdles when it comes to the accessibility.

Price and cost, which I don’t always point fingers to the producers, but it is a problem and the challenge in the supply chain. And also, one of the biggest problems is also that of having different technical standardizations in different member states, which makes also the targeting of specific markets more difficult in the same supply chain.

So this will also be one of our priority areas, harmonization of national laws concerning the access to medicinal cannabis again. One of our priorities fostering research projects for the benefit of medicinal cannabis for patients; research is key in this area.

So we will also be pushing hard in that regard, especially when it comes to projects funded by EU funds horizon project. And also encouraging and detecting real patient needs, and also ensure the involvement of patients, and the procedures for harmonization, and also authorization procedures.

Alfredo Pascual: That’s a lot, Alex.

Alex Agius Saliba: Basically, these are our main objectives. There is a political push right now, especially after the integration of medical cannabis in the scope of directive 2010 for 24. And this is also one of the pushes that we are moving forward. But after also the removal of cannabis and cannabis resin from the 1961 UN convention.

There is a political push going on at EU level, which is also gaining also momentum within the European parliament, to push forward for better access to patient rights.

And as I said also, one of the priorities that we will be moving forward is that of including the access to medicinal cannabis also in the next EU for health program, and also making basically also cannabis, medical cannabis not basically to be seen and continue to be seen as simply this taboo when it comes, and when compared to other prescribed medicines that our patients have access to.

So that ultimately patient rights, which is our top priority also as an alliance, we are not advocating for the industries here. We are advocating directly for patient rights. Patients will have full access, adequate access, and better quality of life that is our main target.

Alfredo Pascual: Thank you, Alex. And that is a lot, and we will speak about more the specifics of it, what type of legislation, for example, you expect and other things.

But let’s go to Tjalling now for a second, and Tjalling, my question to you is, what do you expect that will come out of this initiative? What hope do you have? And just a clarification before that in case it was misunderstood.

Cannabis is not that it was removed from the 1961 convention; it was removed from schedule 4 but remains in schedule 1. So it was a great move, but just that the audience doesn’t misunderstand that. Yes, Tjalling?

Tjalling Erkelens: Yes, a lot is on the table right now. And I really appreciate the level of knowledge that appears here and the level of awareness that appears, and I’m very happy to hear that. Let me start with that.

Your first remark Alex, and that’s an important one to me, recreational versus medicinal cannabis. Although the product seems to be the same, it’s Apples and pears to my mind. And you’re totally right with the approach, where you say although you have an opinion on the recreational market, it should be separated from the medical market.

And that is a thing that I have been always saying. I’m not opposed, or I’m not opposed or against, recreational use of cannabis in that regard. Although, there are always issues.

But what cannot happen to my mind is that we have a situation where let’s say, outlets for recreational type of product are now being used by patients to get access to a product that they really are in need of.

That separation is a very important thing. I would encourage the industry, in general, to go for that separation as well. If you bet on one horse, you cannot bet on two horses in that regard. Don’t do it; it doesn’t work.
And actually, we see a lot of examples already around the globe that the mix-up of medicinal and recreational in one company doesn’t work. Back to the EU, I have been saying it more times already, harmonization of regulations. It’s becoming a theme that everybody starts to see now, where the needs are.

We have one Europe; we have a number of countries that do everything basically the same, and then all of a sudden, we have a product that divides the entire Europe. We see different initiatives; Denmark is doing an experiment that is about to finish. France just started an experiment up.

No, Germany has its own program with reimbursement. Holland has its own program without reimbursement, all kinds of differences that at least the European level should be good to give attention. However, above and beyond, we have the world. And as cannabis is scheduled as a controlled substance, still it’s gone from schedule four, and I’m very happy about that, but it’s still a scheduled product.

And in that regard, as Europe, we should keep an eye on what is happening in the UN as well because the U.N is actually the legislator for controlled substances. So if we keep on looking there too and seeing what is happening actually there, because there are some very interesting initiatives from among others.

The INCB especially, that is already now preparing a more elaborate document for countries to give them guidelines on how cultivation, processing for cannabis products for medicinal use how that should take place. Those are very interesting initiatives I think for the European Union as well to take a look at.

And again, I have to make a compliment to Europe in that regard, where everybody, all those patients do suffer, I’m very aware of it right now. I think we are on a trek in Europe that will, in the end, provide the right access to products.
If you compare it to Canada and the US right now, North America in general, we see that access to what we call recreational cannabis has become maybe more easy. But patients are complaining still a lot also in those countries about the access they have or the problems with access they have.

And the problem with getting the right products, and product quality, it’s all an issues there. Yes, last thing that I want to mention with regard to what Alex was just saying price, pricing of products. It’s a very important thing, and we do see in Europe, especially that due to how it’s organized now, or better said, not organized now, we see massive increases of prices when products go cross-border.

So exporting of products is basically making it hard for patients to get access. If I see that Dutch patients in a pharmacy are paying, for one gram of product are paying just about six euros. And I see that, for instance, Maltese patients are paying up to maybe 20 euros a gram.

Those priced for the same product, and we’re talking Europe here. Then I’m always wondering what’s happening here. Is this a regulatory issue? Is this a greed issue? Anyway, what’s happening here? I really would like to emphasize that as well.
And again, as Alex said, it’s not he already know, and I’m very happy that you expressed that, it’s the producers by itself are not charging those prices, and we have never done that. Actually, the price in Holland, since inception of the program in 2003, price went down.

Patients were paying up to 10 euros a gram initially, and they are now back at 6 euros a gram, and we are 18 years further. So that shows that if a program runs well, more or less price can drop, and price must drop.

Alfredo Pascual: Alex, you mentioned harmonization, raising awareness, research being key as part of your initiative. And it reminds me a lot of European parliament non-legislative resolution that addressed the issue of medical cannabis in early 2019. I think it was in February or something like that.

And that was largely celebrated; look at how the European parliament now is supporting medical cannabis. It was all over the news, and a lot of noise was made with that resolution of early 2019.

But two years later, that resolution didn’t have any practical impact. And correct me if I am wrong, but it was a lot of nice words; yes, we should support research, we should harmonize, but nothing happened, right?

So let me be a little bit confrontational here; what are you going to do now so that the result of your initiative is not one more non-legislative resolution that says a lot of nice things but without any practical implications.

Alex Agius Saliba: This is one of the biggest challenges of the European parliament. We have a lot of resolutions, but ultimately from nice words and nice resolutions, we have to go to action.

And here, we are not dealing with simple resolutions as a number of resolutions that we have, and we vote during each and every committee; here, we are dealing with patients’ rights.

Access to medicines, to prescribed medicines by doctors. Although, again, this is also another big issue when it comes to prescriptions, and when it comes to the big hurdles that are still existent in a number of member states, which basically make it really difficult for doctors to prescribe medicine and cannabis because of the onus and the burdens that they have to basically carry, which again for me it doesn’t make sense.

And is continuing to put more pressure on treating cannabis medicine and cannabis as a taboo, as something which is out of the ordinary, as something which although prescribed not by an MMP, but by doctors who are competent to assess the medical situation of the patient. It is still treated in a reasonable way.

And yes, what we are trying to look at, and ultimately, what we are trying to achieve, is that from words, we move to action. And there is a lot that we have to do. Again, when it comes to the resolution, it was, I think, an important step, an important political message that the parliament has sent.

But as you rightly pointed out although, I’m here not to sound too pessimistic. A number of advancements have taken place in a number of member states. Germany and Portugal, and Malta.

Alfredo Pascual: And do you know if it was as a result of that resolution?

Alex Agius Saliba: I don’t think that this was, and I was going to that point, it wasn’t the result of this resolution. So member states are not continuing to look so much at medicinal cannabis as a taboo.

But still, I think that the biggest, and they always stress on this point. The biggest plus of the European project is the European single market. And Tjalling has made a very good point that it doesn’t make sense for patients in a particular member state to pay an X amount of money for having access to medicinal cannabis.

And then, in another member state, patients have to pay double the price; it doesn’t make sense. When we have the single market, when we have this free movement of goods, services, people, products, and we have these differences. Imagine having Malta, one of the smallest member state, Luxembourg, just not to bring only examples of my member state, small market.

I know that in the supply chain, to target directly smaller markets, it is more difficult. But imagine, producers have to produce their and market their products specifically upon unique regulatory standards for each and every 27 member states. How can a Maltese patient have the same price and access to the same price as a German patient?

As a Spanish patient, it doesn’t make sense. And that is why we have to do something about this. And that is why we have to use the European tools that we have at hand to fight against this injustice which is still happening. And that is why I said in my initial remarks, again, I am not representing producers here, manufacturers.

But we cannot continue to point our fingers all the time at producers, because of this problem of pricing, of having products out of stock, for example for three months, four months. I witnessed this, for example, also in my member state. Having one of the most popular products, we have very few products which are available in our market. But one of our products out of stock for three months.

It wasn’t because of the producers or the supply chain; it was because of the bureaucracy that still unfortunately exists. And we have to fight against this system. Because as I said, medicinal cannabis is a prescribed medicine like all the other medicines that we have available. And that I think should be, and must be, also this open the target also for our alliance.

Alfredo Pascual: Alex and Tjalling, I think the European Commission has already replied in the past that cannabis-derived medicines fall under the pharmaceutical legislation of the EU, just like any other medicine.

And nothing prevents companies from obtaining marketing authorization for cannabis-derived medicines, as it has already happened in the case of epidiolex with centralized procedure and then Sativa X in several EU member states.
And in that regard, there is EU harmonization because a company, if they have the clinical trials to support the efficacy and safety of a medicine, can go to the EMA and get an approval for a cannabis-derived medicine.

But I think what we are talking about here is that you would like to see a harmonized framework for access to cannabis products that do not have those clinical trials, right? And my question here is, in practical terms, do you think that there’s a chance for harmonization of access to medical cannabis in that regard?

Because article 168 of the treaty of the functioning of the EU largely leaves the responsibilities of health policy to member states, right? And I find it very hard to believe that we will be able to convince, I don’t know, Hungary to have the same type of access to medical cannabis that Germany does.

And when we talk about harmonization, are we talking that we want the whole EU to be like the Netherlands or Germany or one of the most advanced countries? Or do we want to find a middle term between these more advanced countries with medical cannabis and those that have nothing? Eventually, even making it worse for patients in the countries that have a better framework?

Tjalling Erkelens: If I may start, one of the major problems is indeed the lack of science. Because as Alex pointed out, it’s the doctor that is prescribing a medicine.
So there’s a number of products right now on the market that have little or no clinical evidence behind it to solve this problem. You were mentioning GW epidialects as a product that has been clinically tested and has market authorization.

Alfredo Pascual: At a new level.

Tjalling Erkelens: Yes. But one of the major problems is that the most wanted products and the most helpful products are right now is cannabis flour, dried flour. It’s one of the bigger products right now, for which it is almost impossible to get your clinical evidence on such a specific product, dried herbal product.

That it demands certain steps of purification etc., everything that GW did, I’m very aware of their process in that regard, and how long it took them to get this product to the market. Where there is a current need for certain type of products, including flour dried flour, that works best for certain patients.

That is where we have to come to an agreement and step over some hurdles here, where we have to actually say what is actually needed to approve a product, cannabis product, for the market. Which product can we approve, which product can we not approve from a pharmaceutical point of view?

And that is a decision we are eagerly waiting for, everybody. Because if we have that decision, so cannabis flower can be a true miracle product, but it has to be this, that, and that before we can allow it to market. And then, of course, clinical research is needed. Governments can step into the clinical research.

I know that the Netherlands has started up clinical research, as a government has started up clinical research in order to assess the quality of the products they bring to market. Although we are the producer, let me emphasize again, it’s the government that brings our product to the market.

So they have that responsibility, and they are taking it now after so many years, but they are taking that responsibility upon them. I applaud them for that, but in at the same time, it’s only the Netherlands.

So we need way more, and I would really applaud if, on the European level, this would be supported as well. Make a carve-out in the, let’s say in the pharmaceutical approach of cannabis, make that carve out that allows certain type of products that are most wanted by patients, make that carve out like Germany did, allow it to the market in a controlled way, it is a controlled substance.

And by the way, cannabis is not a harmless product, what everybody might be saying. But cannabis is not, and we actually all know it; it is for a reason that we have to treat cannabis carefully.

But I will not go to that point right now. But that is basically where I see a very important task for the European Union as well.

Alfredo Pascual: Question to both of you, just a second, Alex, question to both of you. Don’t you think that a first step towards an harmonized European medical cannabis framework would be to start with quality-related issues, in terms of what Tjalling was mentioning or hinting to of standardization?

Because I think that’s an easier step, right? To have an EU monograph for flower. Let’s define what we are talking about when we are talking about cannabis flower. Let’s define what we are talking about when we’re talking about full spectrum extracts.

And even this very small step, or seems small compared with having a whole European market, would be very useful. Because today different countries, even the Netherlands and Germany and Denmark, all next to each other, but one of these three countries has a different flower monograph.

They are very similar, of course, but they are talking about three different products when they’re talking about flower in the Netherlands, in Germany, and in Denmark.

Tjalling Erkelens: Technically, you were saying they are very similar, but technically, the differences are actually relatively big, I would say. But again, you are right.

Alfredo Pascual: That’s my point, right? So could we start with okay? If countries want to allow a special access scheme for medical cannabis products without clinical trials, let’s at least define what these products will look like in terms of quality, right?

Tjalling Erkelens: Yes.

Alex Agius Saliba: Alfredo, you are totally on point on this issue, and that is one of the things and one of the issues that we will be advocating. We have this vacuum, there are small differences when it comes to defining in each and every member states, but these small differences make big impacts, let’s put it like that.

So we are not even agreeing on basic definitions here. So it’s really important for us to continue to invest in research. I think this is the most important thing, that there is more focus from each and every member state, from the union per se.
We have the horizon Europe program, which can continue to help in this regard, to continue to push our industries, to continue to give that push to the standardization authorities in each and every member state.

To have more knowledge and to work together, and I think that is key, working together and not working in vacuum in different silos. Because ultimately, this is the issue. And also, as I said also in my initial regards, I think that we would be sending a very strong message.

We are very ambitious when we are speaking about harmonization of standards; I think this is the ultimate role that we want to achieve. We cannot achieve it from today until tomorrow, this takes time, and we acknowledge that.
But patients cannot continue to wait and remain in this vacuum that we have, and therefore we would be sending a very strong signal, a very strong message. If we include the access of medicinal cannabis in the next EU for health program, that will be a very strong message.

It would be a strong message towards working together more. Although, when it comes to health, the EU has restricted competencies. I still believe that, and there were very good examples in the past, that if we coordinate better together. If we work more closely together, especially when it comes to the standardization authorities in different member states.
Because ultimately, they are all members and work together with EMA. But ultimately, I think that a lot of problems that we are seeing, I’m not an expert in this field. But when I meet with patients, with the industry, with investors who want to invest in these sectors.

I think that some of the biggest loopholes that we have, some of the biggest struggles that we have when it comes to medicinal cannabis and access to patients, is also coming directly from lack of coordination between different standardization authorities.

Which all form part under the umbrella of the European medicine and of EMA. So it’s really important to have this higher level of coordination based upon research, based upon common basic definitions.

Alfredo Pascual: Tjalling, do you think that?

Tjalling Erkelens: I couldn’t agree more. It has to be divided indeed in certain levels of let’s say there is a political level in this regard, where indeed politicians will have to step over their own shadow, and that’s the stigma. By now, I think it’s more than proven that cannabis has its own efficacy in certain patients, okay.

Having said that, then we need, but it is an action by itself to convince politicians on this matter. Get a broad support on this whole matter. The second thing is indeed on the level below that, below the political level, to coordinate indeed the quality levels that we need in this industry.

And I’m getting back to the beginning, therefore, we need at least, and for sure, we need to separate from recreational, but also from wellness products. So wellness is not medicine; medicine is not wellness. Although sometimes there is an overlap, we have to be very careful in that.

So what is true medicine, what are wellness products? What are certain compounds in cannabis? So CBD, THC, all those compounds, how do we separate that. We are kind of well on our way, at least what the European Union also did create at least common sense on THC in CBD products, that is, I think the very clear statement of the EU in that regard.

However, does it comply with the international standards in this regard? So what is being said by the WHO, Incb, UN in general? What are their standards? So it is an effort that has to be done here, but in the meantime, patients need access, and I totally agree on that.

So we need also some sort of a quick fix in Europe now, that says okay, this is this basic level, this is where we start. This is what is at least needed, and then we will increase the level. Holland is going to do that.

We had a, and I’m just using it as an example. We had a standard deviation allowance in our cannabinoid levels of 20%, and this is a technical issue, but I want to mention it. It means that if you say my product, is always contains always ten percent of CBD. The twenty percent standard deviation allows the product to be in between eight percent.

So twenty percent less and twenty percent more of the declared value. So between eight and twelve percent. Holland is now saying we will soon, and I think it’s European-driven also. We will go back to what is the pharmaceutical standard, 10% deviation.

Alfredo Pascual: Which is the case in Germany.

Tjalling Erkelens: Which is now already the case in Germany. So you have to be between 9 and 11. And those kind of things, and it’s again very technical. But those are the things that we need harmonization on in Europe and starting in Europe. I think a good working group with experts in it could basically define those rules.

Cannabis has been a long time, and that’s another statement that I would like to make. Cannabis has been so long outside the regulated world. Inside that bubble, a lot of things have been found out in the past.

We know a lot about cannabis. However, the regulatory organizations don’t know anything about cannabis; they have to learn from scratch what cannabis is. So that is where I would also really would like to see an expert working group within the European Union that is able to help EMA to set up those standards, and to set up quality levels for this product, and also to define patient needs.

What does the patient and his doctor want? What is actually asked for? One more example, cannabis test; in the beginning 20 years ago, cannabis tea was promoted by the Dutch government.

So make a herbal tea of cannabis. All the active compounds in cannabis only get there on temperatures of about 150 till 200 degrees Celsius. Guess what? Tea is not going above 100 degrees Celsius; it’s cooking water. So no efficacy from that product.

But they didn’t know; there was technically no knowledge. So that is where you need a strong herbal and a strong working group based on cannabis.

Alfredo Pascual: Last question to finish the conversation, and since you mentioned it, let’s finish the conversation with so-called wellness products. So non-medical CBD products that are being sold largely freely across Europe. But where again, there’s no harmonized framework.

Or at least there’s no harmonized enforcement of the EU rules, I would say. But within Europe, we have Switzerland, a very special case, not your country. But in the case of Switzerland, a case where CBD rules are quite unique. And basically, Switzerland allows the sale of products with CBD.

So as long as they have less than one percent THC, in the case of Europe, it’s much more complicated. Not only is the THC level for it not to be a narcotic, although it changes a little bit in some countries.

But also, there’s a noble food issue that requires producers to obtain that authorization before marketing the products.
Both of you, do you have any concerns with the situation as it is right now, and what changes would you like to see? And one, two minutes each because we need to close the panel.

Tjalling Erkelens: Very short comment on my end, and then Alex can. CBD as a wellness product, I am fine. I would be careful; CBD is entering the blood; it’s going through the blood-brain barrier.
So CBD does something in the brain, and we need more research on that. But as far as it comes to wellness products and the levels that are set, I’m fine.

Alex Agius Saliba: Again, this is also a result of the confusion that we have. At EU level and the lack of harmonization that we have at EU level. So we are putting all these hurdles when it comes to a prescribed product, where there are a lot of standards being gathered there too by the industry.

But again, when it comes to CBD products for fitness reasons, for medical reasons. We basically have an open door policy in the EU. I have nothing against these products. But at the same time, it shows that when you have and when you treat this subject in an uncoordinated way, when you treat medicinal cannabis per say, as they continue to treat it as a table, you will end up with all these problems and all these issues.

Again, I think that when it comes also to these products, there needs to be standard to continue to protect consumers and patients not to buy them from having access to the product.
But ultimately, to study more, to research more, to have correct standards, always to have the best protection for our users, patients, and consumers.

Alfredo Pascual: Thank you, Alex. Thank you, Tjalling. If you want to say some final words.

Tjalling Erkelens: I can keep on talking, no. I think we are kind of on our way; I’m very happy with all the initiatives I see arise also on a country level. I think most countries in Europe that want something are trying to do their utmost best to make something out of this.

But I’m very happy with the European approach right now as it will harmonize everything in Europe in the end. And I really support all your efforts, Alex, in that regard.

And definitely, open to discuss more and also outside this setting. I’m definitely open to discuss more and see how we can help in one way or another.

Alfredo Pascual: Thank you.

Alex Agius Saliba: Just to conclude, Alfredo and Tjalling, first of all, thanks for this discussion. It’s always very interesting for us to hear different perspectives.

And also to have this direct contact also with the industry, to see what’s going on not only in Europe, but we have to compare also our situation with other regions, with other continents and with the developments taking place there.
And I think that we should look up to continents which ultimately are regulating better than us, are doing a better job than we are doing. A number of initiatives are taking place systematically in different member states.

But ultimately, there is no coordination. So EMA, at the European Commission, horizon 2020 when it comes to the direction of funds when it comes to attention when it comes to prioritizing on our health policies.

I believe that medicinal cannabis should take a more prominent role to have more coordination, better protection for our consumers, patients and more accessibility because it is their fundamental right.

It is their fundamental right for each and every patient throughout our union to have adequate access to prescribed medicines. And medicinal cannabis, yes, it is also a prescribed medicine.

Alfredo Pascual: Thank you both, it was a great conversation, till next time.

Tjalling Erkelens: Thank you Alfredo.

Alex Agius Saliba:Thanks.

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