Fewer Opioids, More Perspectives – What Current Studies on Medical Cannabis Reveal
Observational Data from Germany: Indications of Reduced Opioid Use
A practice-based analysis (Gastmeier et al., 2022) examined what happens when elderly pain patients are additionally treated with cannabis-based medicines. The results are encouraging: opioid use dropped by roughly 50% on average, with no significant adverse effects reported. Most patients were over 70 years old, suffered from chronic pain, and tolerated cannabis preparations well; in most cases, low THC doses were sufficient. The potential to reduce opioid use is particularly relevant for older patients, for whom sedation, fall risk, and respiratory depression are major concerns. While the study cannot replace randomized controlled trials (RCTs), it provides real-world evidence that medical cannabinoids can be used safely in elderly patients and may be associated with a significant reduction in opioid consumption.
New York: Long-Term Cannabis Use and Opioid Dose Reduction
Similar trends have been observed in the United States. A study by the New York State Department of Health (Nguyen et al., 2023) followed more than 8,000 patients with chronic pain who received medical cannabis. The longer the treatment lasted, the greater the reduction in opioid dosage – in some cases by more than 50%. The effect was particularly pronounced among patients with high baseline doses, who were able to lower their opioid levels substantially over time. These findings suggest that medical cannabis could help reduce overall opioid exposure and thereby decrease risks such as dependence and overdose. However, questions remain regarding the specific role of different cannabinoid formulations and the causal mechanisms underlying the association between cannabis use and opioid reduction.
Population-Level Data: Cannabis Legislation and Prescribing Behavior in the U.S.
On a broader scale, a U.S. nationwide analysis (Lozano-Rojas et al., 2025) explored how cannabis legislation affects opioid prescribing among cancer patients. The results were significat: in states that allowed cannabis dispensaries to open, opioid prescriptions decreased by about 25%. Medical cannabis thus emerges as a subtle public health factor – fewer opioids, fewer risks, improved quality of life. The findings indicate that cannabis could serve as a partial substitute for opioids in managing cancer-related pain. Still, the data are correlational, not causal. Further research is needed to understand individual mechanisms and long-term effects. Yet the evidence supports the notion that broader access to medical cannabis may have positive population-level impacts on medication use and public health outcomes.
Medical Cannabis Can Change – and Possibly Save – Lives
The evidence base is still young, but it points in a clear direction. While cannabis does not replace classical opioid therapy, it may become a credible adjunct or substitution therapy in certain areas. It enables a gentler, safer approach to pain management, especially where conventional medications reach their limits. In an aging society where people live longer and approach medication use more consciously, medical cannabis could become a genuine opportunity – for greater quality of life, less risk, and a form of medicine that once again places the individual at its center.
Anything else?
Do you have specific questions or suggestions for the Cannabis Briefing? Then send us an email to briefing@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!
Cansativa Expert Dialogue – Behind the Scenes of Medical Cannabis Supply
How did you come into your current role?
I grew up in Mörfelden-Walldorf – the same place where our facility is located. I’ve followed Cansativa’s story from the beginning and was fascinated early on by how the medical cannabis sector was evolving. When the opportunity arose to join the company, it felt like the perfect fit — not just a job, but something I’m truly passionate about. In a way, it was destiny.
What does your daily work look like – is there any such thing as routine?
Routine is something we rarely have. We’re in a very dynamic phase: new processes, increasing volumes, changing regulatory requirements – no day is like the one before. I currently lead a team of around 17 people, split between logistics and operations. The expectations keep growing – not only professionally, but also in terms of leadership. Change is something you can’t just impose from the top; you have to bring your team along.
How do you ensure quality and safety in the supply chain?
We work strictly according to GMP (Good Manufacturing Practice) and GDP (Good Distribution Practice). This means we guarantee full traceability, all critical processes follow the four-eyes principle, and our entire warehouse operation is temperature-controlled. We intentionally go beyond what is legally required. If the benchmark is set at one meter, we aim to jump one and a half. Quality, safety, and precision are not add-ons for us – they’re at the core of what we do. We also use digital tools such as handheld scanners for every goods movement to minimize the risk of human error.
Which technological or operational innovations are on your radar for the future?
We see great potential in further digitalizing our processes. We are evaluating the use of AI-assisted camera systems for automated quality control and RFID technologies to achieve even more efficient traceability throughout the supply chain. Of course, this only works if our partners are on board – from manufacturers to logistics providers. True efficiency gains can only be realized collaboratively.
How is your team evolving as the company grows – what mindset is needed?
Over the past two years, we have fundamentally restructured our team. This involved integrating many new colleagues with strong expertise. Now, it’s about incorporating their insights and shaping the next stage of development together. We have successfully evolved from a small family-run business into a structured, medium-sized company – while maintaining our hands-on spirit. It’s an exciting phase that requires strong communication and mutual trust.
Is there a particular moment from the warehouse that stands out to you?
In the early days, our daily deliveries were picked up with a small refrigerated van. Today, it’s a full-sized truck. I’m looking forward to the day we can fill that truck completely — that will be a powerful symbol of how many pharmacies and patients we now supply. It perfectly illustrates how far both our operations and the entire industry have come.
We thank Adrian Vicente for sharing his insights and for giving us a look behind the scenes of operations at Cansativa.
The Cansativa Expert Dialogue once again highlights that excellence in medical cannabis supply begins where passion meets precision.
Medical Cannabis on Its Way to Parliament – What the Cabinet Approval Means Now
What could change for patients?
As already proposed in the July draft, the core elements of the initiative remain unchanged in the version now approved by the Cabinet. Initial prescriptions of cannabis flower would still be permitted only after a personal consultation – either in a doctor’s office or during a house visit. For repeat prescriptions, at least one such in-person consultation per year would be required. The planned ban on shipping cannabis flower by mail also remains part of the draft. This point had already sparked debate in the earlier draft, particularly regarding access in rural areas and for patients with limited mobility.
Import figures, telemedicine – and a question of interpretation
The Federal Ministry of Health continues to justify its proposal by pointing to a sharp rise in import figures, which it links to growing use of telemedical platforms. But this is exactly where political and public debate begins. After all, the numbers tell more than one story. While cannabis flower imports rose by around 170% in the second half of 2024, the number of prescriptions issued through statutory health insurance (GKV) increased only moderately. This suggests that reclassification of medical cannabis – which is no longer listed as a narcotic – has opened access to therapy for many patients who were previously excluded. These may include those without a qualifying serious diagnosis under insurance regulations. At the same time, feedback from the field shows that patients with chronic illness or mobility issues in particular have benefited from mail-order access – especially in rural areas, where local pharmacies offering cannabis flower are often hard to find.
Legislation in motion: Parliament will have its say
With the cabinet’s approval, the draft bill is now on its way to the Bundestag – and it is widely expected that key aspects of the proposal will be amended in the legislative process. Early voices, including from within the governing coalition, have already indicated that revisions are needed – especially regarding the proposed shipping ban and the requirement for in-person doctor-patient contact. At the same time, a separate review process is underway at the EU level: the notification submitted to the European Commission allows both the Commission and other Member States to raise concerns, particularly around restrictions on telemedical services and potential conflicts with the EU’s freedom to provide cross-border services. While it remains to be seen when and in what form objections will be raised, one thing is clear: this is not the end of the debate.
Now is the time to get involved
This is a crucial time to stay engaged. While the public consultation phase has ended, the parliamentary process still offers opportunities to contribute – through professional associations, policy dialogues, or direct outreach to lawmakers. Those who support a balanced, patient-focused, and legally robust regulatory framework should make their voices heard now. Because once again, this legislative process shows just how narrow the path can be between political steering and the practical realities of care. That’s why it’s so important to help shape it constructively.
The Cannabis Act Under Review: What Can We Expect?
Germany: No increase among adolescents
The latest Drug Affinity Study shows higher use among 18–25-year-olds than a decade ago, while adolescent use has not increased. Frankfurt’s 2024 MoSyD survey points in the same direction, reporting new lows among 15–18-year-olds. In short: no youth “boom,” just a modest uptick among young adults — a pattern also reflected in the new figures from the Federal Institute for Public Health (BIÖG). At the same time, evidence at home and abroad suggests that clear legal channels can shrink the illicit market over time. Tracking this shift in sources of supply will be a core focus of the evaluation.
Canada: Youth stable; edibles as the outlier
The evaluation will ultimately show what this means for Germany, but Canada offers a useful benchmark: since 2018, the share of illicit purchases has fallen to around three percent — a strong sign that legal channels can displace black markets. Youth prevalence has remained broadly stable, while product use shifted after edibles were introduced — a pattern that matters less for Germany, where edibles aren’t permitted under the CanG. For Germany’s assessment, the key question is whether non-commercial clubs and home growing deliver the intended protections without introducing new risks.
Uruguay: A steady state model
A quick look at Uruguay rounds out the picture. As the first country to legalise adult-use in 2013, it provides valuable lessons. Despite early concerns, the state-regulated model — home grow, clubs and pharmacies — has not produced a sustained increase in youth consumption. In practice, design matters more than the legal label: channels, product rules and prevention make the difference.
Evaluation: Data before interpretation
How will Germany’s evaluation proceed? By law, there’s a phased timetable: an initial assessment is due by 1 October 2025, focused on consumption bans around schools (§5 KCanG) and their impact on child and youth protection. An interim report follows by 1 April 2026, including effects on cannabis-related organised crime. The final report is due by 1 April 2028. The EKOCAN consortium, commissioned by the Health Ministry, coordinates secondary data, original surveys and market monitoring.
Evidence-based adjustment, not symbolic debate
That sequence is right for evidence-based policy: measure first, then adjust. Expect sober findings — on real youth trends, child and youth protection, and easing pressure on the illicit market. The open question is how federal and state governments will weigh the data — and whether they’ll fine-tune policy consistently in line with the evidence.
Switzerland Moves Forward with Legalization
A Process Gathers Momentum
It comes as no surprise that Switzerland is following its own path. For several years now, pilot projects in cities such as Basel, Zurich and Lausanne have tested the controlled distribution of cannabis for recreational use. These scientifically monitored programs provide valuable data on consumption patterns, public health and the displacement of the black market. The new legislative draft builds directly on these findings. Unlike recreational cannabis, medical cannabis in Switzerland has already been regulated since 2022 and is dispensed via medical prescriptions through pharmacies.
The Proposed Market Model
The preliminary draft of the Cannabis Products Act sets out a series of strict rules. Adults will be permitted to purchase, possess and consume cannabis legally, but only through tightly regulated, licensed outlets. Distribution may not be profit-oriented. Advertising will be banned, packaging must be neutral and child-resistant, and an electronic tracking system will ensure transparency across the entire supply chain. In addition, a steering levy will make high-THC products more expensive, with the aim of encouraging consumption of lower-risk alternatives.
A Look at the Neighbors
In a European comparison, Switzerland is charting a very distinct course. In Germany’s Cannabis Consumption Act (KCanG), the focus is on cannabis clubs or so-called cultivation associations, complemented by the option of home cultivation. Possession has also been decriminalized by removing cannabis from the Narcotics Act. Switzerland, on the other hand, intends to continue classifying cannabis as a narcotic and to restrict sales exclusively to licensed outlets. A particular feature is the so-called online license: the federal government plans to grant only a single concession for digital sales. This would allow consumers to order cannabis products directly through a central, federally licensed online shop — in addition to purchases from local, licensed stores.
From Consultation to Law
The road to full legalization is still long. After the consultation period, parliamentary deliberations will follow, and in the end, a referendum could be held. Realistically, implementation is not expected for another two to three years. What is clear already, however, is that Switzerland aims to establish a comprehensive regulatory framework built on the experience of its pilot projects — a nationwide structure ensuring legal access to recreational cannabis. With this model, Switzerland could set benchmarks across Europe.
New GACP Guidelines Bring Stricter Requirements for Medical Cannabis
GMP and GACP – two parts of the same system
To put it simply: GMP (Good Manufacturing Practice) defines how medicines must be manufactured to ensure the highest levels of quality and safety. GACP (Good Agricultural and Collection Practice), on the other hand, governs the agricultural side – how plant-based raw materials are grown and harvested. These two frameworks are interconnected: only when GACP and GMP work seamlessly together can the pharmaceutical quality of cannabis flowers be guaranteed.
Change is coming after nearly 20 years
The European Medicines Agency (EMA) is currently revising the GACP guidelines, which have remained unchanged since 2006. After nearly two decades, an update is long overdue – the market for herbal medicines has changed a lot since then, including medical cannabis.
A closer alignment with GMP requirements is expected as part of the revision. While quality checks have always been necessary, the previous rules left room for interpretation. The new guideline is likely to spell out these requirements more explicitly, providing greater clarity. Documentation obligations are also expected to become more stringent. In the future, producers will need to demonstrate without gaps every step a plant undergoes from cultivation through to the finished product. Finally, more extensive validations will be required — a point that comes with investments, whether in systems, or digital tools for traceability in systems and tools for quality management.
“For us in Quality Management, the key point is this: the new GACP guideline does not fundamentally change our day-to-day operations, it simply describes existing requirements in a more precise way. This reduces room for interpretation and creates more clarity. It also makes it easier for us to coordinate with new suppliers to ensure that the highest quality standards are maintained. In the long run, the entire market will benefit from the more efficient availability of new, safe, and high-quality products.”
— Dr. Richard Böser, Vice President of Quality at Cansativa
More trust through clear standards
The new requirements are not a revolution — the quality of medical cannabis has always been safeguarded by the GMP process. What the revised GACP guideline does is shift the focus earlier in the chain: it ensures, better than before, that quality is consistently documented and secured right from cultivation.
For patients, this doesn’t change the end result — they have always been able to rely on safe products. But the added clarity brings greater transparency, reduces room for interpretation, and makes cooperation across the supply chain easier. For the young medical cannabis industry, this is an opportunity to further strengthen efficiency and trust — and to secure its place in the European healthcare system for the long term.
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,
Jakob Sons
Founder & Managing Director Cansativa
Benedikt Sons
Founder & Managing Director Cansativa
Jakob Sons
Founder & Managing Director Cansativa
Benedikt Sons
Founder & Managing Director Cansativa
On a personal note: Our Nomination for the Pioneer Award 2025
Our shared journey in a dynamic industry
For nearly a decade, we, as brothers, have been leading Cansativa through an industry that is constantly evolving—especially on the regulatory front. In a sensitive field like medical cannabis, which is still in the early stages of medical application, it is important to us to take responsibility and advocate for greater transparency and destigmatization.
Medical cannabis has been prescribable in Germany since 2017 and can be reimbursed by health insurance for seriously ill patients. Since then, there have been continuous adjustments that have simplified the prescription process for patients and helped advance the destigmatization of this form of treatment. At the same time, scientific research is steadily growing, more therapeutic uses are being incorporated into guidelines, and more countries across Europe and worldwide recognize medical cannabis as an effective therapy. We are proud to have actively helped shape this development in Europe and especially in Germany from the beginning, even though there is still much work to be done.
A modern family business with a course toward Europe
Cansativa is not a traditional family business that has been passed down through generations. Instead, as brothers, we took a bold step in 2017 together with our father to realize our dream of founding a joint business: Our father supported us in the beginning, providing medical expertise and backing. Jakob, as a lawyer, decided to navigate and actively shape the complex regulatory environment, while Benedikt, with his background as a strategy consultant, drives business development and growth. Today, as a family-scale-up in the German Mittelstand, we are building the infrastructure for a safe, responsible, and digital cannabis market in Europe—with clear values, regulatory depth, and technological precision. Our goal is to make Germany a hub for medical cannabis.
A strong signal for the European cannabis industry
Alongside renowned companies from the fields of industry, technology, tourism, and mobility, this nomination shows that the cannabis economy is also one of the forces actively shaping progress and responsibility in Europe. We are very pleased with this recognition—it is a powerful signal of the relevance and future viability of our industry.
A huge thank you to our team, our partners, and everyone who supports our mission.
The public voting is open until September 1, 2025, and we would be delighted if you support us with your vote.
Please vote for us! Click here to vote!
Medical Cannabis Under Scrutiny? The new draft bill from the German Health Ministry
What does the current draft bill say?
The Federal Ministry of Health's draft bill provides for stricter regulation of the prescription and dispensing of cannabis flowers for medical purposes. Specifically, the initial prescription of cannabis flowers will only be permitted after personal contact between doctors and patients, either in the doctor's office or during a home visit. For repeat prescriptions, personal contact with a doctor is also required at least once every four months. Furthermore, the bill proposes a ban on shipping medical cannabis flowers.
What are the reasons behind this?
According to the BMG, these changes are due to a sharp increase in cannabis flower imports. The ministry links this increase to the growing use of telemedicine platforms. There was a 170% increase in cannabis imports in the second half of 2024, while prescriptions covered by statutory health insurance only increased by 9%.
While this development may appear problematic at first glance, it also shows that more patients are gaining access to medical cannabis therapy, even without a prescription from their health insurance provider. Reimbursement by statutory health insurance remains reserved for seriously ill patients, such as those with chronic illnesses, cancer, or multiple sclerosis. Since medical cannabis was reclassified as non-narcotic over a year ago, access has become easier and less stigmatized. In the further legislative process, it will be crucial to differentiate between undesirable developments and improved patient care and refine where necessary.
What happens next?
The public consultation phase is now beginning. Stakeholders from the healthcare sector, pharmacies, industry, and patient organizations have been invited to submit comments on the draft. Experience has shown that important suggestions from practitioners are considered during this phase, so this step is crucial. The draft will then be voted on in the cabinet before going through the parliamentary process in the Bundestag and Bundesrat. As the saying goes, "No law leaves the Bundestag as it entered it." Currently, this is only a proposal that may change significantly during the process.
The new government had already announced an open-ended evaluation of the Cannabis Act (CanG) for the fall. This evaluation will examine the effects on youth, consumers, and health protection, as well as the effects on cannabis-related crime, based on data. At least, this was provided for in the coalition agreement.
This is an opportunity to help shape the future.
The current phase offers all stakeholders an opportunity to play a constructive role. Rather than resorting to fear-mongering rhetoric, it is time to propose objective suggestions for improvement. The goal is to ensure the long-term supply of medical cannabis is secure, patient-focused, accessible, and comprehensive. We look forward to hearing the various interest groups' views and seeing which changes will ultimately be incorporated into the final draft law.
Medical Cannabis in Europe: Latest Developments and Germany’s Role in 2025
Europe Radar – Quick Country Check: Who’s Leading, Who’s Catching Up?
In May 2025, Denmark permanently anchored its previous pilot program into law. Although this is positive news, criticism remains regarding difficult reimbursement processes for patients. i
France extended its medical cannabis pilot study until the end of July 2025 and is now working on a comprehensive regulatory framework that could significantly ease patient access.ii Meanwhile, Italy has surprisingly banned all CBD and cannabis-light products, sparking protests. iii
In the United Kingdom, reimbursement for medical cannabis remains challenging. However, the country is currently supporting cannabis product research, opening up new perspectives for medical applications.iv The Czech Republic has permitted medical cannabis prescriptions for several years, but recent news concerns a new law passed by the government aimed at decriminalizing recreational use, set to come into effect in 2026. v
Further European Markets in Focus
There are exciting developments elsewhere in Europe too: Greece is evolving into a significant exporter and has already shipped 49 kg of medical cannabis to Germany in the first quarter of 2025. Additionally, after a seven-year wait, Greece has now started issuing its first legal prescriptions for medical cannabis products, significantly improving patient access as well as boosting local production and investment. vi Albania has recently given the green light for medical cannabis cultivation in 138 villages, significantly expanding its domestic cannabis industry and signaling new economic opportunities. vii In North Macedonia, all licenses are currently under review following revelations of illicit activities. viii
Ukraine, having legalized medical cannabis in August 2024, has now approved its first imports of medical cannabis products, which are expected soon to be available for patients with severe conditions like PTSD and chronic pain. ix
Germany as a Pioneer and Its Potential
Germany remains the undisputed leader in the European medical cannabis sector. With clear regulatory structures, high-quality standards, and a rapidly growing patient base, Germany serves as a model for many countries. Its clear and stable legislative framework continues to make Germany the most significant target market and driving force for innovative cannabis companies and investors in Europe. The ongoing developments remain exciting and could position Germany as Europe's cannabis hub in the long term.
[i]https://businessofcannabis.com/denmark-legalises-medical-cannabis-permanently-but-ludicrous-subsidy-gap-remains/
[ii]https://www.rfi.fr/en/france/20241222-france-extends-medical-cannabis-trial-to-help-patients-find-alternatives
[iii]https://www.reuters.com/world/italy-cracks-down-protests-squatters-cannabis-2025-06-04/
[iv]https://www.theguardian.com/us-news/2025/may/10/cannabis-medical-research-bill
[v] https://www.senat.cz/xqw/xervlet/pssenat/hlasy?G=23215&O=15
[vi]https://cannabishealthnews.co.uk/2024/02/28/greece-welcomes-new-era-of-medical-cannabis-after-seven-year-wait/
[vii]https://cannareporter.eu/en/2025/07/07/North-Macedonia-government-to-review-company-licenses-after-seizing-cannabis-destined-for-the-illicit-market/
[viii]https://balkaneu.com/albania-greenlights-medical-cannabis-cultivation-in-138-villages/
[ix]https://cannabishealthnews.co.uk/2025/06/19/ukraine-approves-first-medical-cannabis-imports/
Cansativa Expert Dialogue: Antonia Menzel (BPC) on the Role of Lobbying in the Cannabis Industry
The BPC unites numerous companies throughout the medical cannabis supply chain. How do you develop common positions?
The Federal Association of Pharmaceutical Cannabinoid Companies represents companies involved in the cultivation, processing, distribution, and research of cannabis. Naturally, different interests converge in this process. While there is much overlap, it is the association’s task to professionally moderate the dialogue between members and maintain the focus on our common goal: ensuring the quality supply of medicinal cannabis in Germany. Transparency, commitment, and a shared vision are the keys to developing strong, professional, and politically viable positions together.
How can you legitimately represent interests in such a sensitive area as cannabis or medical cannabis?
At our association, we represent interests in the field of medical cannabis by communicating responsibly, objectively, and in a solution-oriented manner. As an association, we navigate the tension between health policy, social debate, and economic development. Our central task is to distinguish the medical benefits of cannabis from its recreational use and highlight where legal hurdles are hindering an adequate supply. We engage in dialogue with political decision-makers, experts, and authorities, offering realistic, well-founded proposals rather than maximalist demands. To be taken seriously, one must be credible, transparent, and technically sound.
What are the industry’s biggest challenges currently, and what is needed to further advance medical cannabis in Germany?
The biggest challenge remains access to medical treatment with cannabis. Many patients still encounter obstacles when trying to obtain prescriptions and have the costs covered by health insurance companies. Additionally, there is growing uncertainty regarding prescriptions issued via telemedicine, despite their potential to bridge significant care gaps, particularly for chronically ill and mobility-impaired individuals. Therefore, Germany needs a modern, patient-oriented healthcare system; comprehensive education and training in the medical field; and a political framework that promotes investment in quality, research, and security of supply. The BPC is actively contributing to the political debate with concrete proposals. Medical cannabis is no longer a niche topic but an integral part of modern, evidence-based healthcare.
Thank you very much for the interview!
Changes are to be expected with the start of this new legislative period. In this context, the work of the BPC is particularly important to advance patients’ interests. Thank you, Antonia Menzel, for the interesting conversation, and best wishes to the association for continued success!
Upcoming BPC events:
- Educational webinars: July 9, 2025, on “The Start and Course of Cannabis Therapy” and “Cannabis Medicines: From Theory to Practice”
Registration: https://bpc-deutschland.de/fortbildungs-webinare/
- BPC Symposium 2025 “Cannabinoids in Medicine” for physicians and pharmacists on November 8, 2025, in Düsseldorf – save the date!
Click here to view the association’s position papers.
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,
Jakob Sons
Founder & Managing Director Cansativa
Benedikt Sons
Founder & Managing Director Cansativa
Jakob Sons
Founder & Managing Director Cansativa
Benedikt Sons
Founder & Managing Director Cansativa