Luxembourg's Ministry of Health and Social Security recently announced changes to the medicinal cannabis access programme.
The ministry stressed the need to clearly differentiate medicinal cannabis from recreational cannabis, which is subject to separate regulations.
Luxembourg's medicinal cannabis programme has authorised health professionals to prescribe this treatment according to specific indications since February 2019.
This therapeutic option is intended for patients suffering from severe chronic pain, nausea or vomiting caused by chemotherapy or suffering from muscle spasms related to multiple sclerosis. The majority of prescriptions for medicinal cannabis concern the treatment of this pain (99% for the year 2024). The ministry noted that, pharmacologically, this pain is more effectively managed by treatment such as cannabis oil extracts, which have a long-lasting effect, rather than by flowering tops, which have a short-lived effect.
The following changes have been proposed, respecting the legal and regulatory provisions in force:
- reducing the maximum quantity of cannabis that can be prescribed for 28 days, from 100 grams to 60 grams;
- ceasing the provision of THC-rich flowering tops.
The ministry argued that there are dosage and administration difficulties linked to flowering tops, causing adverse effects and carrying certain health risks for patients. Influenced by multiple factors, the bioavailability is significantly more variable for THC in vaporised and inhaled cannabis flowering tops, it said. The ministry added that the potential for abuse and misuse compared to oil extracts was also considered.
As of 1 January 2025, THC-rich flowering tops will no longer be available. However, a THC-rich option will remain available in the form of oil extracts. These oils have also seen their prescription increase over the last two years, in the context of specific treatments (eighteen bottles prescribed in 2022 for 2,043 bottles in 2023 and 2,850 since January 2024), which has also contributed to the adjustment of the programme.
Patients will still have access to the following:
- CBD-rich flowering tops;
- THC- and CBD-balanced tops;
- cannabis oil extracts with three cannabinoid profiles (THC-dominant, CBD-dominant and THC/CBD-balanced).
The ministry said these changes aim to perpetuate the medicinal cannabis programme in Luxembourg and to support patients currently being monitored.
To ensure the continuity and adaptation of treatment, prescribers approved by the programme and hospital pharmacists received a letter on 16 October 2024 from the Health Directorate containing this information and the guidelines for continuing treatment.
Patients have since been informed by prescribers when visiting the doctor's office and/or pharmacy (mandatory visit at least every 28 days) and will have until the end of January to adapt their treatment. A final delivery of THC-rich flowering tops is planned for this month to ensure the continuity of treatment until the end of January 2025.
A first evaluation of this programme was carried out in 2022; a new one is planned for 2025.
