The number of medical cannabis sales in the Netherlands declined in H1 of 2021, continuing a downward trend, which began in 2018 when insurance reimbursements were halted in the country. The number of medical cannabis patients has also been declining since this time. However, increasing overall value of sales and quantities sold to pharmacies from 2019 to 2020 suggest that individual patients may be consuming more medical cannabis each year.
Fewer patients are being prescribed medical cannabis in the Netherlands
Data released recently by the Dutch Foundation for Pharmaceutical Statistics (SFK) regarding the first half of 2021 show two major trends in the medical cannabis market in the Netherlands: the number of sales are declining, and the popularity of cannabis flowers, as opposed to oil, is increasing. The Netherlands is the third largest market for medical cannabis in Europe, behind Germany and Italy, and so trends in this country are important in understanding the industry across the continent. The number of medical cannabis dispensations in the Netherlands peaked in 2018, around the time the National Health Care Institute recommended against the prescription of medical cannabis on the grounds of a lack of evidence of efficacy. This had the dual effect of prompting the stoppage of insurance reimbursements for medical cannabis, as well as deterring doctors from prescribing treatment with medical cannabis.
From 2019 to 2020, in line with a reduction in dispensations, the total number of patients obtaining medical cannabis declined from 11,000 to 9,000. A spokesperson from the SFK told Prohibition Partners this week that ‘the number of first prescriptions dropped down harder than the number of follow-up prescriptions’, meaning the reduction is caused mostly by a drop in new patients, rather than by current patients discontinuing treatment. These patient numbers reflect a fraction of the total patient population in the Netherlands. In 2018, the Dutch Government’s Lifestyle Monitor survey showed that just one in ten medical cannabis patients obtained any cannabis by prescription, while the rest sourced from coffee shops, street dealers, and home cultivation.
Another potential reason for the drop in patient numbers and dispensations could be the presence of 564 coffeeshops in the Netherlands, which provide non-medical cannabis at affordable prices but under a legally grey governmental ‘policy of toleration’. Coffeeshops also have the advantage of offering a wider range of cannabis strains and product formats than pharmacies, which are limited to just five strains produced by the sole domestic commercial cultivator Bedrocan, on behalf of the Dutch Office of Medical Cannabis (OMC) who also have a monopoly on exports. Medical cannabis oil can be produced from these strains but is available at just four pharmacies, with only one offering oils with THC levels above 2%.
Reduction in medical cannabis prices in September 2021
As of September 2021, the government reduced the price of cannabis sold both domestically and exported abroad. Depending on the number of grams being dispensed, patients now pay €5.50 per gram of cannabis flower when ordering 5 grams, excluding VAT and prescription fees. Pharmacies have more reign over prices charged for oils. The OMC informed Prohibition Partners that cannabis is now exported at price of €5.30 per gram for a 5 gram order.
On behalf of the Dutch Office of Medical Cannabis, Nicole Groot Bruinderink told Prohibition Partners, ‘Due to the positive (financial) results of the OMC in recent years, the OMC has been able to reduce the price of medicinal cannabis.’ A wide range of prices are paid for cannabis in competing coffee shops; the EMCDDA placed the average in coffeeshops at €4.40, but Marian Hutten and Serge de Bruijn of the PGMCG have indicated that much cannabis in coffeeshops is sold between €7-20. Hutten has also indicated that due to the high quantities of medical cannabis needed by many patients, a small price reduction would not convince many patients to obtain medical cannabis by prescription, and that only full reimbursement could support this as well as the availability of more strains.
Patients have been left behind
Prohibition Partners spoke yesterday to Marian Hutten and Serge de Bruijn of the Dutch Patient Group Foundation (PGMCG) about these trends:
‘Netherlands has a backwards system of medical cannabis regulation,’ said Hutten. ‘When we look at Germany, with a younger system of medical cannabis regulation, they have around sixty strains of medical cannabis available, while we are stuck in the Netherlands with five. These five don’t work for everyone, they certainly don’t work for me and this places an unnecessary limitation on patients. On top of this, no reimbursement is offered to patients due to the recommendation of the National Health Care Institute, meaning cannabis remains unaffordable for many. The result is that many patients are left to fend for themselves, either growing their own or sourcing from coffeeshops and the black market. The lack of legal protection for medical cannabis patients in the Netherlands makes it very difficult to be a patient here. Medical cannabis patients are losing their homes for growing their own cannabis or losing their driving licences for driving after consuming legally sourced medicines and this has to change.’
Changing product formats
As can be seen in the above chart, the relative market share of medical cannabis flowers, as opposed to extracts, has grown to 55% as of H1 2021, from a low of 44% of sales in 2017. While the number of sales is dominated by flower, it should be noted that the market share in terms of value is still heavily weighted towards oils, as these carry a higher price in the pharmacy.
As a comparison, the market share of flower as opposed to extracts in reimbursed cannabis sales in Germany also sits at about 55%, but is declining, and was at 75% in September of 2019. The downward trend in the number of oil dispensations since late 2017 is likely due to the fact that the prices of oils are considerably higher than for treatment with flower and that only one pharmacy offers high-THC extract products.
Value of sales is increasing
While the number of patients and the number of dispensations are on the decline in the Netherlands, the quantity sold and the value of sales have been increasing in recent years. The latest data made available to Prohibition Partners by the OMC shows that the quantity of medical cannabis being sold to pharmacies for distribution to patients has been increasing, after a dip in 2018
In addition, the value of medical cannabis sales increased from 2019 to 2020, from €4.7 million to €5.1 million according to SFK data. Neither the OMC nor SFK could provide data from 2021 on sales value or weight. It should be remembered that the market share of the more expensive oils is decreasing, so the increase in value cannot be attributed to increasing costs of medical cannabis.
Instead, it seems that the quantities of medical cannabis being purchased by each medical cannabis patient increased from 2019 to 2020. Neither the OMC nor SFK were able to provide Prohibition Partners with an explanation of why individual patients might be consuming more legally prescribed cannabis.
Delays in progress of cannabis regulation
Several developments in the regulation of medical and adult-use cannabis have been delayed, not only by COVID-19 but also that as the ruling parties have failed to form a coalition; the Netherlands has been without a sitting government for over six months. The OMC had planned to have a tender for two growers of medical cannabis online by now, which would offer new strains to patients, but no progress has been reported on this for months and it is unclear when new growers will come online.
Similarly, the trial that would see 10 municipalities offering fully legalised adult-use cannabis is yet to come online (See The European Cannabis Report: 6th Edition for more information on this). Hutten of the PGMCG has indicated that this programme too has stalled due to COVID-19 and the lack of a sitting government.
