LUXEMBOURG ROLLS OUT CAUTIOUS PILOT SCHEME

Luxembourg, nestled between France, Belgium and Germany, has long suffered from the domination of neighbouring countries. The end result is a proud national motto “Mir wëlle bleiwe wat mir sinn” which translates directly as “we want to remain what we are”.

However, when it comes to cannabis legislation, Luxembourg is following directly in the footsteps of their northern neighbours.

This week, we look at the the new two year pilot scheme announced in early 2018 and what patients can expect from the Grand Duchy.

 

State of the Union

For a country of 590,000 residents, Luxembourg has been an influential player in the European Union. A founding member since its inception as the European Community in 1957.

In the two decades prior to the global financial crisis, Luxembourg grew twice as fast as the European average, becoming one of the most prosperous regions in the OECD area, particularly in terms of incomes. The economy, including its financial sector, has weathered the financial crisis well, resulting in a reported €54bn economy in 2016.

Luxembourg offers an extremely appealing corporate tax rate and lucrative tax breaks to multinational companies, often at the ire of the wider European community.  

 

Healthcare and Public Spend

According to a Europa report, the health system has not changed substantially over the last decade. However, concerns around fiscal sustainability have triggered awareness about the efficiency of the health system and as of 2010, Luxembourg introduced a series of cost-containment policies.

Health spending in Luxembourg is one of the highest among EU countries. In 2015, Luxembourg spent €5,090 per head on health care, compared to the EU average of €2,797.

Unfortunately, Luxembourg has health issues often leading to high levels of alcohol consumption, smoking, diabetes and cancer. Additionally, as with most European countries, Luxembourg struggles with an ageing population and the rising costs of health services.

As we have discussed before, the rising costs of pharmaceuticals coupled with an ageing European population has created an urgent need for innovation and cost containment. Cannabis could and should play a defining role in the future of healthcare systems as Europe cracks on to the holistic benefits of both treatment and cultivation.

 

Only Qualified Candidates Need Apply

In November 2017, Prime Minister Xavier Bettel announced that Health Minister Lydia Mutsch would formalise access to medical cannabis having approved the use of Sativex five years prior.

 Dr Alain Origer (left) and Lydia Mutsch (centre), gouvernement.lu

Dr Alain Origer (left) and Lydia Mutsch (centre), gouvernement.lu

Minister Mutsch explained that research into cannabis and certain cannabinoids in Europe had shown that THC and CBD have had a positive effect on treating certain illnesses. While the government has been impressed with the scientific results of such research they remain cautious in its application.

This must be an exception in a controlled and secure setting [..] The authority to prescribe such treatment should be limited to certain specialists like oncologists, neurologists and internal doctors

We do not want to distribute cannabis for therapeutic purposes, but rather to turn to doctors to identify the potential beneficiaries of this product
— Lydia Mutsch, Minister for Health Luxembourg

The treatments are allowed for cancer patients undergoing chemotherapy. Neurological conditions such as Alzheimer's and multiple sclerosis will also qualify, as will conditions causing severe muscle spasms, pain, or epilepsy.

The cannabis flowers can be heated through a vaporiser and inhaled but there will also be a selection of cannabis oils, sprays and tinctures made available.

According to RTL, the government estimated that around 80-100 patients could benefit from the pilot scheme and would receive around 1 gram per day as part of their therapy.

 

Terms and conditions apply

The costs will be covered by the statutory health insurance, mimicking the plans for the German medical system. The Health Ministry's drugs advisor, Alain Origer, warned that visitors will have to be aware of their own country's laws if they enter Luxembourg for medical marijuana prescriptions and return home to use it.

The situation is complex, but even medicinal cannabis remains cannabis.

If someone is prescribed medicinal cannabis in Luxembourg and consumes it abroad, he risks being subject to the drug law of his country.
— Alain Origer, National Coordinator for Drugs

This is an important factor due to the transitory nature of the Luxembourgish workforce. Some 177,000 workers from neighbouring countries enter Luxembourg daily,  a country of 590,000 people.

Neighbouring France bans cannabis use, but Germany recently legalised it for medical purposes. Belgium tolerates limited personal cannabis use even if they have no medical purpose. The lack of a cohesive transnational agreement will surely inhibit the growth of the industry as we have seen with the discrepancies between US state law and the federal system.

 Norbert Eilenbecker and Andre Steinmetz of Cannad'Our, Wort

Norbert Eilenbecker and Andre Steinmetz of Cannad'Our, Wort

Hope for the Hemp Industry

For now, Cannad'Our in Kalborn is the only grower that markets hemp products. The cultivation of cannabis is permitted in Luxembourg provided that its THC content does not exceed 0.3%.

Cannamedica, a non-profit advocate, hopes to see an expansion of hemp cultivation on Luxembourg land. The group has already begun lobbying the various political parties for the parliamentary elections in October ‘18. Parties have proved rather receptive to the creation of a legal framework around medical cannabis according to Serge Schneider, President of Cannamedica.

Questions remain unresolved [...] for me, it is more useful to organise trainings, not only for neurologists or oncologists, but for doctors, pharmacists and patients. And it is time to develop cannabis cultivation in the Grand Duchy.
— Serge Schneider, President of Cannamedica

Cannabis offers new perspectives and opportunities for Luxembourg.

From an agricultural point of view, hemp would bring diversification. And this is an ecological plant, requiring little or no fertiliser.

Not to mention the economic spinoffs - there is a shortage of medical cannabis. Many countries face supply difficulties in view of the limited global supply.
— Serge Schneider, President of Cannamedica

Without doubt, Luxembourg is a unique territory but they are currently emulating their European cousins and lifting the shackles off a previously restrictive programme. What Luxembourg has is hindsight. A luxury to view others mistakes without paying the price.

Schneider and other advocates are acutely aware of the pitfalls of integrating medical cannabis policies. If Europe continues to move to a post-prohibition era we need to consider the far-reaching benefits of domestic cultivation, holistic treatments, export opportunities and sustainable agriculture. As with any gold rush, it’s long-term thinking that will separate the wheat from the chaff.


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