Medicinal Cannabis on Prescription in The Netherlands: Statistics for 2003–2016

Abstract

In 2003, theNetherlands started one of the firstNational medicinal cannabis programs in the world, where patients are provided with pharmaceutical-grade cannabis of standardized cannabinoid composition. The program is overseen by the Office of Medicinal Cannabis (OMC), which is part of the Ministry of Health, while cultivation, packaging, lab testing, and distribution are performed by contracted specialized companies.Medicinal cannabis is available on prescription only and can be dispensed by all Dutch pharmacies. Currently, five different cannabis strains are offered, including THC andCBDdominant varieties, as well as indica and sativa types. Medicinal cannabis is recommended in the Netherlands mainly for treatment of chronic neuropathic pain, spasms and pain related to multiple sclerosis (MS), lack of appetite/nausea/vomiting related to cancer or HIV/AIDS, therapy-resistant glaucoma, and Tourette’s syndrome. Previously, we analyzed the prescribed cannabis use among Dutch patients for the first time. Prescription data were obtained from the Dutch Foundation for Pharmaceutical Statistics (in Dutch: SFK), an independent organization collecting detailed information from community pharmacies, covering over 90% of all prescriptions dispensed in the Netherlands, including cannabis. The existence of a continuous medicinal cannabis program combined with the comprehensive data collected by SFK provides a unique opportunity to learn more about medicinal cannabis use within a longterm stable national program. The main goal of our analysis was to provide physicians and prescribers in other countries, where medicinal cannabis is available, with objective reference data regarding average daily use, duration of use, or age distribution of patients using prescribed cannabis. In our current study, we compare the previously published data covering the period 2003–2010 (period 1; n= 34,023 dispensed prescriptions identified) with new data collected for 2011–2016 (period 2; n = 95,022 dispensed prescriptions). Results are summarized in Table 1. As shown, the age distribution of patients was very comparable between the two study periods, with patients in the age of 41–60 years making up the largest group. In addition, the average daily use did not change much over the years; in period 1, the study population used 0.64 g of cannabis per day, whereas patients in period 2 consumed an average daily dose of 0.73 g, with remarkably small differences across sexes or age groups. A small shift was witnessed in gender ratio: the percentage of female patients decreased from 57.1% (period 1) to 51.4% (period 2). Meanwhile, the average duration of use (time passed between the first and last dispensed prescription recorded for each individual) showed almost no change between study periods. In period 1 (covering 8 years), we identified a total of 5601 individuals who received at least one prescription for cannabis. In period 2 (covering only 6 years), 10,826 individuals were identified. The prevalence rate of patients using cannabis on prescription at least once per year was fairly stable from 6.4 (patients per 100,000 inhabitants) in 2003 to 6.9 in 2010, but then it rapidly increased to 24.6 in 2016. Since 2003, cannabis has been

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