HOW CROATIA PIONEERED MEDICAL CANNABIS TREATMENTS IN THE BALKANS

Most European countries have struggled to create highly functional systems for cannabis treatments. It is inevitable that the dismantling of archaic drug laws takes time and experimentation. Some countries push through legislation and expect the medical communities to play catch up. Others demand ‘more time’ to run rigorous tests in state run labs while debating public opinion.

So how did Croatia, a small Balkan country of four million people, manage to pass legislation to allow cannabinoid therapy and enact a functional program within less than one year?

This week’s review examines how Croatia cut the red tape and what we can learn from the Croatian approach to healthcare.

The Croatian Health Insurance Fund

The Croatian Health Insurance Fund

First in Line

As of 15 October 2015, Croatia became the first Balkan country to legalise medical cannabis after a team of doctors and medical professionals examined the research on therapeutic effects. The Ministry of Health officially legalised the use of cannabis based drugs for medical purposes for patients with illnesses such as cancer, multiple sclerosis, child epilepsy or AIDS.

To be on the outside looking in, it might appear that Croatia’s legislation was a surprising act, given the lack of urgency seen elsewhere in Western Europe. However, progressive legislation does not occur in a vacuum. The historic move is representative of Croatia's larger ambition to reform its healthcare system.

It all started on July 1st 2013 when Croatia joined the European Union,. This meant it was able to withdraw funds from the EU structural funds for development of its health sector.

Before this, the standard of healthcare in Croatia was in the main average. Although it suffered from lack of budget - especially in the context of rising costs and expenditure on drugs. The Ministry, acting as controller of the budget, created and implemented the National Health Care Strategy 2012 - 2020 with a view to creating alternative means of treatment.

In December 2014, the country launched a project referred to as ‘The Commission’. This involved the creation of a committee of medical experts, tasked with examining cannabis laws in other countries. The Commission travelled throughout Europe to research the therapeutic, social and legal effects of established medical cannabis programmes in order to understand the holistic implications of potential legalisation.

The Commission believed that the previous law preventing cannabis treatments only encouraged patients to use drugs illegally for which they risked prosecution.

 

The Commission, taking into account the latest scientific and medical knowledge, and the fact that patients in Croatia buy cannabis on the black market, has concluded that it is necessary to regulate the cultivation, processing, transport and regulation of cannabis for medical purposes,” the 2015 report from The Commission read. “The existing legislation should be altered and effective control mechanisms undertaken that allow for the use of cannabis for medical purposes, and prevent misuse.”

A Scientific Method

Croatia’s Committee for Medical Cannabis and its chairman, Professor Ognjen Brborović, managed to convince the government, police, media and general public that a new system would work in everyone’s favour. The public trusted the science and ignored the social stigma. There was no frenzy or hype but rather level headed efficiency.

Brborović and The Commission spent months at labs and discussions across the continent before settling on Croatia’s plan, which permits the use of cannabinoids in vegetable based oils.

Treatment in Progress

Under the new laws, patients with a doctor’s prescription can get legal access to cannabis teas, ointments and other cannabis extracts. Patients can receive up to 7.5 grams of THC per month.

The Croatian government wanted to change the common view of cannabis in the public domain and so provide THC drops and cannabis pills via a pharmacy. 

Croatia has one current problem - there is no domestic cannabis industry. The governing bodies have had to rely on overseas imports to supply patients with CBD and THC capsules. Since the system began operating in 2016, certain government bodies have suggested reviewing the cultivation laws in Croatia. Given the speed and pragmatism that the government have demonstrated in the past, there’s no reason to suggest that Croatia will not begin to develop a cannabis production industry in 2018.

We spoke to Professor Ognjen Brborovic, Head of The Commission, to understand what has happened since 2015:

Things in Croatia hasn’t moved much since 2016, and the main reason is change of three Government in two years...unstable, in other words.

Patients in Croatia have a guaranteed supply of cannabis drops (THC/CBD in equal concentration in 2 preparations)

It is interesting though, that there is not a big demand. Unofficial estimates are around 100-200 of  25ml bottles a month in whole Croatia, so I am free to say that the bootleg preparations are still a dominant majority of usage.

On the other side, here we could see a blooming entrepreneurship in hemp and CBD on agricultural level, on separation and extraction level, making cosmetics and food additives, marketing and medical level. That bloom was possible due to loosening of some cannabis/hemp rules that has happened in an almost unofficial way.
— Professor Ognjen Brborovic
Professor Ognjen Brborović

Professor Ognjen Brborović

What lies ahead?

Croatia have taken a sincerely apolitical approach to cannabis. The governing bodies hold science in the highest esteem. There has been no media outrage or public criticism as the majority of Croatians trust the research and the process. A refreshing attitude to a critical matter.

The nimble approach shows a stark contrast to the ‘we need more time’ excuses commonly heard in Western Europe (see Ireland and the UK for further reading).

Dr. Brborovic and The Commission believe a number of further illnesses can be treated with THC or CBD in the near future. As recent history suggests, the Commission and relevant agencies will wait for the ‘latest medical and scientific evidence’ to allow them to move forward. Croatia legislative and medical bodies have both shown an unusual keenness to expand the sector. We may well see Croatia leading the charge in European cannabis treatments this year.