By Elisa Battistella & Massimiliano Sfregola
Translated from Italian by Steve Rickinson

The Netherlands has been one of the leading European medical cannabis exporters for almost two decades, yet its domestic market does not seem particularly interested to indulge in it.

Germany, Finland, and Italy buy an abundance of medical marijuana from the Netherlands. In fact, in recent times, Italy has witnessed a surge in the (authorized) shipping of the product from the Netherlands: Italian minister Giulia Grillo recently increased the demand by almost 3 times compared to a few years ago: in 2019, the stock should reach 1000kg.

If Italy struggles to keep up with demand, problems would not arise in the Dutch Transvaal pharmacy in The Hague. Specialized in palliative care and drug preparation, it has an internal laboratory dedicated to cannabis preparations who, since 2015, has been producing an oil derived from the flowers of therapeutic cannabis: Bediol, Bedica, Bedrocan, and Bedrolite.

“The marijuana available only in the form of dry leaves”, explains the pharmacist, Paul Lebbink, “is not the best solution, since it is possible to take it only by smoking it or by preparing an herbal tea. For this reason, and due to the increased demand for cannabis to be given to children (for specific forms of epilepsy such as Dravet and Lennox Gastaut) we have decided to produce the oil prescribed so far on an experimental basis to about 10 thousand patients,” Lebbink tells 31mag.

In 2003, Holland was the first country in the world to have legalized medical use on a national level. Unlike the Marijuana sold in coffeeshops, which remains a product relegated to the grey area between legal and illegal, the medical version is cultivated through recognized standards and enjoys a special exemption from the UN’s ban of Single Convention on Narcotic Drugs. Despite being a perfectly legal product and accessible with a prescription, it has not become as popular as its semi-legal equivalent.

Who medicates with marijuana?

“The clientele is largely made up of men and women over 50 who are afraid of getting high,” Paul continues. Those who use prescribed Marijuana very often do not have a smoking history. “For this reason, the first question the patients ask is precisely on possible psychotropic effects,” the pharmacist tells us.

Transvaal Apotheek

What is the profile of the patient who uses cannabis? An average profile, in reality, does not exist: “from children suffering from epilepsy to adults being treated for nausea caused by chemotherapy up to multiple sclerosis and Parkinson’s disease, there are many patients for whom Marijuana seems to produce beneficial effects. More than 70% say they feel better”. On the scientific efficacy, however, there is no unanimity of judgment but it is certainly considered a valid alternative to painkillers

Medical cannabis but with a recipe

“More and more doctors are willing to prescribe buds,” says the pharmacist. “Sometimes their vision changes after talking to us about the benefits that can be derived from cannabis use.” Paul uses the term experiment because “this treatment can never be the first choice”. And he adds: “When other remedies are ineffective or have too many contraindications, then the Marijuana option becomes justified although no one can guarantee success.”

Also Dr. Vladan Ilić, a general practitioner at Amsterdam’s Westerdokters clinic was immediately in favor of testing the substance. And in his studio, he’s not the only one. “I’ve never heard any colleagues against in the beginning,” he tells 31mag. While remaining open to experimentation, Ilić remains firm in wanting to debunk some myths: there is no evidence that cannabis has healing properties. “Several patients come to talk saying they want to try therapeutic cannabis because they heard or read about cancer. “This is not true”, he cuts short. Although the doctor in Amsterdam prescribes cannabis as a painkiller, in the case of cancer, Parkinson’s and multiple sclerosis, he recognizes the limits. “People use it mainly to endure the pain caused by the disease.” Those who enter the study know what they are talking about even if sometimes they are uninformed about its “healing” aspect.

Not for everyone, however, it is a blessing: “No one has ever refused to try this treatment but the preference over other painkillers depends on the type of person and what the patient desires, because when someone is sick, the reactions can be different; some like the effect, while others prefer to remain more vigilant”.

The preference of one painkiller to another is, above all, a question of culture: “According to research conducted in Amsterdam, there were no differences between cannabis and other painkillers. Many patients, however, prefer the latter because it is natural”.

“The fact that insurances do not cover costs affects the choice of patients because, above all, the Dutch who knew the old health system before insurance, are not used to paying for medical services. Many exclaim “oh” when they are told the cost”. The expats, Ilić observes, are more open to use even if it is expensive.

Dr. Ilić is skeptical and does not see too bright a future for medical cannabis. “Healthcare cuts have reduced research capacity,” he says. “I doubt it will be included among the treatments covered by health insurance unless there is great demand from Dutch citizens”. The big pharmaceutical companies do not see much interest in cannabis research because it is not a profitable sector.