Medicinal cannabis success leads Dutch to put out second tender

Rapidly increasing demand for medicinal cannabis in the Netherlands and abroad means the Dutch government is to put a second lucrative manufacturing licence out to European tender within days – 16 years after it issued the first.

The only company authorised to produce cannabis for medicinal use is Bedrocan International, based in Emmeloord in the north of the country. It has increased its output fivefold over the past five years to 2,604kg a year – but even this is no longer adequate.

The Bureau of Medicinal Cannabis (BMC) – which was set up by campaigning D66 health minister, the late Els Borst, in 2000 – is expected to start the European tendering process for the second licence early in June, and will act as the regulatory authority for both companies.

In a business model unique to the Dutch healthcare system, the BMC issues the manufacturing licence, oversees the licencee as it sets up and operates, and then buys the entire stock of medicinal cannabis produced by the new company.

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Clinical quality

The BMC then distributes the cannabis to Dutch hospitals and pharmacies – with about half of what's currently produced going to other European countries where medicinal cannabis is already legal, including Germany, Italy and Poland.

The main benefit of growing marijuana specifically for use in medicinal cannabis is that the quality is higher and more consistent, both requirements for clinical use. In particular, it has no contact with “real world” impurities, such as pesticides.

Bedrocan produces the five types of medicinal cannabis available on the Dutch market, containing different quantities of the two main ingredients used in medical applications: tetrahydrocannabinol or “THC”, the psychoactive compound that gives the ‘high’, and cannabidiol or “CBD”.

Treatment of seizures

CBD, which has no psychoactive effects, was approved by the Food and Drug Administration in the US last year for the treatment of Dravet syndrome, which causes epileptic seizures in infants and young children, often with multiple seizures daily.

There is growing acceptance in the Netherlands of the use of medicinal cannabis as a painkiller – in the treatment of cancer, for example – although groups such as the Dutch Association of Family Doctors say more reliable research needs to be done to show beyond doubt that it improves patients' quality of life.

Prof Albert Dahan, head of anesthesiology at Leiden University Medical Centre, says he would like to see more research in particular into the use of medicinal cannabis in combination with other drugs, such as morphine.

“I was fairly sceptical at the beginning and so we decided to investigate and found that yes, THC had a visible effect,” Dahan says. “As a result, I can certainly see more scope for using medicinal cannabis in the future.”