Cansativa’s Expert Dialogue: Why cannabis flowers is not replaceable for some patients

How did you first come to use medical cannabis? 

I was diagnosed with multiple sclerosis in 2012. At first, I went through conventional treatment: disease-modifying therapy, pain medication, and other prescriptions. I experienced severe side effects, including breast infections that required several surgeries. At the same time, my pain medication kept being increased. In 2014, I brought up cannabis with my neurologist because I had read that it could help with MS. He was open to the idea, but he did not want to handle the application process. So I learned what was required and prepared the application myself. At the time, patients still needed a special authorization from BfArM (The Federal Institute for Drugs and Medical Devices) to access medical cannabis. After a few follow-up questions between the authority and my doctor, the authorization was granted. The next hurdle was finding a pharmacy willing to order cannabis at all.  

What changed for you once you started the therapy? 

I have been using medical cannabis continuously since 2014. Since then, I have stopped taking my MS medication entirely. I have not had any relapses since 2014, and I have not had any further breast infections. My physical condition is much more stable than it was before. For me, it is not about treating one isolated symptom. It is about maintaining balance. The therapy helps me better manage pain, cramps, concentration issues, and other symptoms. It has allowed me to take part in everyday life more reliably again. 

Why is this therapy not simply interchangeable for you? 

Cannabis is a highly individualized therapy. Many components of the plant work together, which is why different strains can have different effect profiles. That makes it possible to tailor treatment more closely to the individual patient.  For me, cannabis flower and extracts serve different purposes. An oral extract can provide a kind of baseline because its effects last longer, helping to reduce and smooth out pain peaks during the day. Inhaled cannabis flower, by contrast, works much faster. When pain, spasticity, or cramps occur acutely, I need a therapy option with a rapid onset of action. From my perspective, there is currently no equivalent alternative. 

What barriers do patients still face today, and what has improved since 2017? 

In patient counseling, I still see a lot of prejudice. Especially in rural areas and in Bavaria, the topic remains highly politicized. Many patients not only have to find a doctor; they also have to deal with skepticism in their families, workplaces, and social circles. On the positive side, more pharmacies and physicians have become open to medical cannabis since 2017. The reforms introduced in 2024 have reinforced that trend. I also see that the patient population has become older and more diverse. More women and more older patients are seeking support. At the same time, access remains difficult. Specific strains are not always available, and switching a patient’s prescribed strain without consultation can disrupt treatment. Reimbursement is still complex as well. Documentation requirements and concerns about financial recourse mean that some patients still struggle to access treatment, even when there is a clear medical need. 

What would it mean if cannabis flower were removed from statutory reimbursement? 

I see this as a serious issue for patient safety and treatment reliability. Flower is not simply replaceable. Especially with acute pain peaks, cramps, or spasticity, fast onset matters. Patients who rely on that effect cannot simply be switched to extracts. Extracts can provide an important baseline, but they do not replace the rapid onset of inhaled therapy in every situation. Many seriously ill patients cannot afford to pay for cannabis flower out of pocket on an ongoing basis. If flower were removed from reimbursement, it would create another barrier for those patients. There is also the risk that, without reimbursement, some patients may turn to unsafe sources. That cannot be in the interest of responsible healthcare. 

You have two wishes. What would you like to see from policymakers? 

I would like to see less polarization around cannabis. We need an open, fact-based approach so that medical cannabis can be understood as a normal treatment option. Many debates are still shaped by recreational use or public-order concerns. For patients, however, this is about access to care, participation in daily life, and treatment reliability. 

And what would you like to see from the industry? 

From the industry, I would like to see more factual education and less marketing-driven communication. We need information that truly helps patients, physicians, and pharmacies. That also includes prevention and a responsible approach to cannabis more broadly. If we can reduce fear and help people understand medical cannabis as a normal medical option, everyone benefits: patients, healthcare providers, and the broader public debate. 

 We sincerely thank Manuel Kralik for this open conversation and for sharing such important insights from the patient perspective. 

Anything else?

Do you have specific questions or suggestions for the Cannabis Briefing? Then send us an email to briefing@www.cansativa.de. If you are interested in revolutionising the cannabis industry with us, then stay tuned and follow our briefings!

We wish you a good read!

Best wishes from both of us,