Decline in sales of medical cannabis in the Netherlands in 2021
Conor O’Brien, Analyst, Prohibition Partners
October 15, 2021
The number of medical cannabis sales in the Netherlands declined in the first half of 2021, continuing a downward trend that began in 2018 when insurance reimbursements were halted in the country. The number of patients with medical cannabis has also been declining since that time. However, the increase in the overall sales value and quantities sold to pharmacies from 2019 to 2020 suggests that individual patients may consume more medical cannabis each year.
Fewer patients are prescribed medical cannabis in the Netherlands
Data recently released by the Dutch Foundation for Pharmaceutical Statistics (SFK) for the first half of 2021 shows two major trends in the medical cannabis market in the Netherlands: the number of sales is declining and the popularity of cannabis flowers, as opposed to oil, increases. The Netherlands is the third largest market for medical cannabis in Europe, behind Germany and Italy, and trends in this country are therefore important for understanding the industry across the continent. The number of medical cannabis dispensations in the Netherlands peaked in 2018, around the time that the National Institute of Health Care recommended not to prescribe medical cannabis due to a lack of evidence of effectiveness. . This had the dual effect of causing insurance reimbursements for medical cannabis to stop, as well as deterring doctors from prescribing treatment with medical cannabis.
From 2019 to 2020, along with the reduction in exemptions, the total number of patients obtaining medical cannabis fell from 11,000 to 9,000. An SFK spokesperson told Prohibition Partners this week that “The number of first prescriptions has decreased more sharply than the number of follow-up prescriptions”, which means that the reduction is mainly caused by a decrease in the number of new patients, rather than by the discontinuation of treatment by the current patients. 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 only one in ten patients who used medical cannabis obtained prescription cannabis, while the rest came from cafes, street vendors and home growers.
Another potential reason for the decline 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 gray government ‘tolerance policy‘. Coffee shops also have the advantage of offering a wider range of cannabis varieties and product formats than drug stores, which are limited to just five varieties produced by the only domestic commercial cultivator Bedrocan, on behalf of the Dutch Office for Medical Cannabis (WTO) which also has a monopoly on exports. Medicinal cannabis oil can be produced from these varieties, but is only available at four pharmacies, with only one offering oils with THC levels above 2%.
Decrease in medical cannabis prices in September 2021
In September 2021, the government reduced the price of cannabis sold both domestically and exported abroad. Depending on the number of grams delivered, patients now pay € 5.50 per gram of cannabis flower for any order of 5 grams, excluding VAT and prescription costs. Pharmacies have more control over the prices charged for oils. BMC has informed Prohibition Partners that cannabis is now exported at a price of € 5.30 per gram for an order of 5 grams.
On behalf of the Dutch Office for Medical Cannabis, Nicole Groot Bruinerink told Prohibition Partners: “Thanks to the positive (financial) results of the WTO in recent years, the WTO has been able to reduce the price of medicinal cannabis. ‘ A wide range of prices are paid for cannabis in competing cafes; the EMCDDA placed the average in cafes at € 4.40, but Hutten and de Bruijn of the PGMCG reported that much of the cannabis in coffeeshops sells for between € 7 and € 20. Hutten also indicated that due to the high amounts of medical cannabis needed by many patients, a small price reduction would not convince many patients to obtain prescription medical cannabis, and that only a full reimbursement could support this as well. that the availability of more strains. .
Patients have been left behind
Prohibition Partners spoke yesterday with Marian Hutten and Serge de Bruijn about Dutch Foundation of Patient Groups (PGMCG) on these trends:
“The Netherlands has a backlog of medical cannabis regulation” Hutten said. “When we look at Germany, with a younger medical cannabis regulatory system, they have around 60 strains of medical cannabis, while we are stuck in the Netherlands with five. These five don’t work for everyone, they sure don’t work for me, and that places an unnecessary limitation on patients. Additionally, there are no reimbursements offered to patients due to the recommendation of the National Health Care Institute, which means cannabis remains unaffordable for many. The result is that many patients are left to fend for themselves, either cultivating themselves 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 lose their homes because they grow their own cannabis or lose their driver’s license after using legal drugs and that needs to change.
Modification of product formats
As can be seen in the graph above, the relative market share of medical cannabis flowers, as opposed to extracts, increased to 55% in the first half of 2021, from a low of 44% of sales in 2017. So as the number of sales is dominated by flowers, it should be noted that the market share in value is still heavily weighted towards oils, these being more expensive in pharmacies.
For comparison, the market share of flowers versus extracts in reimbursed cannabis sales in Germany is also around 55%, but is declining and was 75% in September 2019. The downward trend of The number of oil waivers since late 2017 is likely due to the fact that oil prices are considerably higher than for flower treatment and only one pharmacy offers products based on extracts rich in THC.
Sales value increases
While the number of patients and the number of dispensations are declining in the Netherlands, the quantity sold and the value of sales have increased in recent years. The latest data made available to Prohibition Partners by the BMC shows that the amount of medical cannabis sold to pharmacies for distribution to patients has increased, after a drop in 2018
In addition, the value of medical cannabis sales increased from 2019 to 2020, from 4.7 million euros to 5.5 million euros according to data from SFK. Neither the WTO nor the SFK were able to provide data from 2021 on the value or weight of sales. It should be remembered that the market share of the more expensive oils is declining, so the increase in value cannot be attributed to the increase in the costs of medical cannabis.
Instead, it appears that the amounts of medical cannabis purchased by each patient who consumed medical cannabis increased from 2019 to 2020. Neither the WTO nor the SFK were able to provide Prohibition Partners with an explanation of the reasons why individual patients might consume more legally prescribed cannabis.
Delays in advancing cannabis regulation
Several developments in the regulation of medical and adult cannabis have been delayed, not only by COVID-19, but also because the ruling parties have failed to form a coalition; the Netherlands has been without a government for over six months. The WTO had planned to launch an online tender for two producers of medical cannabis, which would offer new strains to patients, but no progress has been reported for months and it is not known when new producers. will be online.
Likewise, the trial which would see 10 municipalities offering fully legalized adult cannabis has yet to go live (see The European Cannabis Report: 6th Edition for more on this). Hutten of the PGMCG indicated that this program too stalled due to COVID-19 and the lack of a government in place.