What Germany Can Learn from Israel and Canada About Medical Cannabis Regulation | Research

The takeaway

A review of medical cannabis programs in Israel and Canada found that both countries tightly regulate access, limit approved conditions, and do not allow patients to grow their own supply, offering lessons for Germany's emerging program.

Readers interested in how different countries regulate medical cannabis and what lessons can be drawn.

Both Israel and Canada required conventional treatments to fail before allowing medical cannabis

What the researchers found

This review, written by physicians from Israel, Canada, and Germany, compared how Israel and Canada handle medical cannabis to inform Germany's policy development.

In Israel, the plant-based extract nabiximols could be prescribed for spasticity and cancer pain, while raw marijuana was permitted under strict government regulation for specific conditions including chronic neuropathic pain, cancer pain, IBD, and PTSD, but only after conventional treatments failed. Only designated physicians could prescribe it, and costs were not reimbursed by insurers.

Canada allowed synthetic and plant-based cannabinoids for neuropathic and cancer pain, HIV-related anorexia, and chemotherapy nausea, with insurance coverage. Medical marijuana authorization required a healthcare practitioner and could be used for any condition, though costs were not covered. Both countries maintained multiple contraindications.

Why it matters

As more countries develop medical cannabis programs, learning from existing systems can help avoid pitfalls and adopt best practices. This comparison highlights different approaches to balancing patient access, quality control, professional oversight, and cost management.

The numbers in context

Israel: specific conditions only, government-licensed growers, no insurance reimbursement for marijuana. Canada: synthetic cannabinoids covered by insurance, marijuana authorized by practitioners for any condition, costs not covered, licensed producers as sole supply source.

How the study worked

This was a review article authored by physicians with expertise in medical cannabis policy from Israel, Canada, and Germany. It described the regulatory frameworks, approved indications, prescription processes, and insurance coverage in each jurisdiction.

What this study cannot tell us

The review described regulatory frameworks as of 2016, which have since changed in all three countries. It focused on the policy and regulatory perspective rather than clinical outcomes. The authors' recommendation against patient cultivation may reflect specific jurisdictional concerns rather than universal best practices.

How to read the evidence

This is a policy review by expert physicians from three countries. It provides informed regulatory comparison but does not assess clinical outcomes.

When this study was published

Published in 2016. Medical cannabis regulations in Israel, Canada, and Germany have all evolved significantly since then.

The bigger picture

This review captures a moment when medical cannabis regulation was rapidly evolving globally. The experiences of Israel and Canada, both relatively early adopters of structured medical cannabis programs, have since influenced policy development in Germany and other countries.

Questions still open

How have patient outcomes differed between countries with strict versus liberal medical cannabis access? Does insurance coverage for cannabinoid medications improve patient outcomes compared to out-of-pocket marijuana purchases?

Common questions

Can patients grow their own medical cannabis in Israel or Canada?

At the time of this review, neither country generally permitted patient cultivation. Israel required government-licensed companies to produce medical marijuana. Canada had transitioned to a licensed producer system, though some patients with prior permissions could continue growing.

Is medical cannabis covered by insurance in these countries?

Pharmaceutical cannabinoid products (like nabiximols) had some insurance coverage in both countries, but raw marijuana costs were generally not reimbursed by health insurance in either Israel or Canada at the time of this review.

Read the original research

Medical use of cannabis products: Lessons to be learned from Israel and Canada.

Schmerz (Berlin, Germany), 30(1), 3-13

View on PubMed ↗Publisher’s paper ↗

Citation

Ablin, J; Ste-Marie, P A; Schäfer, M; Häuser, W; Fitzcharles, M-A. (2016). Medical use of cannabis products: Lessons to be learned from Israel and Canada.. Schmerz (Berlin, Germany), 30(1), 3-13. https://doi.org/10.1007/s00482-015-0083-4