Bundestag Public Hearing In-depth: Where the MedCanG is Possibly Headed

Note: Translated from German.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Yes, a very good day to you all, esteemed ladies and gentlemen, dear viewers, distinguished experts, and respected representatives of the federal government. The State Secretary will be joining us shortly. First, let me take this opportunity to wish you all a happy new year. All the best for the year ahead, and may we all stay healthy and achieve the goals we have set for ourselves.

We are now resuming our work for this year, and I welcome you to our first public hearing of the Health Committee, which, as always, is both an in-person and online meeting. Before we begin, I would like to ask the experts and all other participants joining us via Zoom to log in using their real names so we can properly recognize and document your participation. Also, as you all know, please keep your microphones muted for now.

Today’s hearing concerns the federal government’s draft bill for the First Act to Amend the Medical Cannabis Act, as set out in printed matter 21/3061. There are also proposed amendments from the parliamentary group Alliance 90/The Greens in committee printed matter 21/1457, which are also on today’s agenda. In addition, we will discuss the AfD parliamentary group’s motion “No Special Role for Medical Cannabis” in printed matter 21/773.

Ladies and gentlemen, for the public and as background: With this draft bill, the federal government aims to prevent the misuse of prescriptions for medical cannabis via purely online platforms, which has been observed since the Cannabis Act came into force. The core of the new regulation is to introduce a ban on mail-order sales of medical cannabis and to legally require a mandatory in-person doctor-patient contact. This is intended to ensure that prescriptions are once again based on a thorough physical examination and that dispensing takes place with personal counseling at the pharmacy. The goal is to guarantee therapy safety and to better protect patients’ health from the risks of uncontrolled online access.

The AfD’s motion seeks a fundamental overhaul of the current prescription practice for medical cannabis, specifically to prevent distribution via purely digital questionnaire models without physical examination. Furthermore, medical cannabis should be subject to the regular AMNOG process for benefit assessment and price determination, to fully integrate it into the existing system of drug reimbursement and quality control.

Today, we want to discuss the draft bill, the proposed amendments, and the motion with you, our esteemed experts, and hear your opinions.

Before we begin, I need to make a few remarks about the procedure. Some of you are already experienced with hearings, others may be here for the first time. We have ninety minutes available today. These ninety minutes will be divided into several question blocks according to the strength of the parliamentary groups and an internal committee agreement. This means: the CDU/CSU group has thirty minutes, the AfD twenty-two minutes, the SPD seventeen minutes, Alliance 90/The Greens twelve minutes, and The Left nine minutes.

I ask both the questioners and the experts to keep their statements as brief as possible so that we can ask and answer as many questions as possible. The hearing is being broadcast live on parliamentary television, and the transcript will be published on the committee’s website.

The experts participating online will appear on a video screen in the meeting room as soon as they are given the floor, and will be visible and audible. Even after you finish speaking, you may still appear on the screen until the next speaker is called.

I ask the experts, in accordance with Section 70, paragraph 6, sentence 3 of the Rules of Procedure of the German Bundestag, to disclose any financial interests related to the subject matter when first called upon. This is to make our public hearings even more transparent for both members of parliament and the public.

I also thank the experts who have submitted written statements; these will be published on the Bundestag’s committee website.

A note to guests in the gallery: expressions of approval, interjections, and recording the hearing with smartphones or other devices are not permitted.

With all formalities taken care of, we can now begin the hearing. The first questions will be asked by the CSU parliamentary group for twelve minutes. Professor Streeck, you have the floor. Please go ahead.

Prof. Dr. Hendrik Streeck – CDU/CSU
Thank you very much, and also many thanks to all the experts for coming today and for your extensive written statements. As I read through the statements, several things stood out to me, so I’d like to start with a general question. This is for the German Medical Association, for Mr. Reinhardt. Mr. Reinhardt, what evidence and necessity do you see, broadly speaking, for the use of medical cannabis in therapy, and how do you assess current developments in Germany?

M.D. Klaus Reinhardt – Bundesärztekammer (BÄK)
From the perspective of the German Medical Association, there is still no evidence for the necessity of using medical cannabis in treatment. At least, none that has emerged from recent studies published in the last few years on this topic. Therefore, we generally consider the ability to prescribe medical cannabis at the expense of statutory health insurance to be quite problematic from a medical standpoint.

Accordingly, Section 31 of the Social Code Book V, regarding the ability to prescribe at the expense of statutory health insurance, is regulated so that it is considered an individual therapeutic trial, not a standardized therapy procedure that can be routinely applied and reimbursed by statutory health insurance. It is only permitted when there are very specific, individual, and special circumstances, which must be examined on a case-by-case basis.

Therefore, we continue to demand, as reflected in the draft law, that personal contact is a matter of medical due diligence and is absolutely essential. Only under such conditions can one consider prescribing in individual cases. In summary, there is no standardized form of evidence from our point of view.

I forgot to mention that I am speaking for the German Medical Association and have no financial interests. Thank you.

Simone Borchardt – CDU/CSU
Thank you very much. The next question—following up on your point about in-person prescribing—goes to the Cannabis Industry Association and the Federal Association of Pharmaceutical Cannabinoid Companies. To what extent do you consider the use of existing digital security mechanisms, such as video consultations with qualified identity verification, to be sufficient for ensuring patient safety and preventing misuse, so that the criterion of personal doctor-patient contact can be considered fulfilled?

Dr. Tanja Machalet – Chairwoman of the Health Committee
Okay, first Mr. Heitepriem, then Ms. Menzel. Please go ahead.

Dirk Heitepriem – Branchenverband der Cannabiswirtschaft e.V. (BvCW)
Thank you, Dirk Heitepriem, President of the Industry Association. I have financial interests; I represent the cannabis industry and work for a company in the sector, so I am involved. To answer your question: For us, it is crucial that patients have the option to obtain prescriptions via video consultation. If safeguards like eID, PostIdent, or similar procedures are in place, we absolutely welcome this. It creates opportunities for patients, especially those in rural areas or with limited mobility, to access prescriptions through telemedicine. Thank you.

Antonia Menzel – Bundesverband pharmazeutischer Cannabinoid Unternehmen e.V. (BPC) 
Antonia Menzel, Federal Association of Pharmaceutical Cannabinoid Companies. I serve as chairperson on a voluntary basis for the association, but I am also employed by a medical cannabis company. That’s my disclosure.

In principle, we consider telemedical prescription options, with qualified identity verification, to be suitable for both preventing misuse and ensuring patient care. It is important that the decision as to whether contact is in-person or digital remains at the doctor’s discretion. The doctor should be free to decide whether to meet a patient in person for the first consultation or to use digital means.

Telemedical prescriptions are already part of standard medical care and, if medically justifiable, are permitted under professional regulations. We believe that secure identity checks can ensure various safety criteria, especially for medical history, indication, and patient education about risks and contraindications. All of this is carefully documented, and follow-up is possible—all digitally. In some cases, having everything stored digitally may even be safer than seeing someone just once in person.

In summary, a video consultation with qualified identity verification, such as eID or VideoIdent, is a common and alternative way to ensure personal doctor-patient contact. The term “personal” should also apply to real-time video consultations. Thank you.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you.

Prof. Dr. Hendrik Streeck – CDU/CSU
My next question is for the German Pharmacists’ Associations. Could you describe the trends you have observed in terms of quantity and range of indications since the new regulations for medical cannabis came into effect in 2024?

Dr. Tanja Machalet – Chairwoman of the Health Committee
That’s Dr. Said.

Dr. André Said – ABDA – Bundesvereinigung Deutscher Apothekerverbände e.V.
Thank you. I am speaking for the Federal Union of German Associations of Pharmacists. I have no financial interests. The Federal Union of German Associations of Pharmacists has observed a sharp increase in quantities since 2024, especially for cannabis flowers. This growth is mainly concentrated in the private prescription sector or self-pay services via the established platform models, which are the focus today. We are seeing a strong blurring between recreational cannabis use and medically indicated cannabis prescriptions.

Anne Janssen – CDU/CSU
We view this very critically. There is a mixing of medical use and recreational use of cannabis by non-patients. I’ll continue. My question is for the German Society for Pediatric and Adolescent Medicine and for the individual expert Professor Dr. Kirsten Müller-Vahl. Unlike cannabis for recreational use, there is no age limit for medical cannabis. Are cannabis flowers used for medical purposes in the treatment of children, adolescents, and young adults?

Dr. Tanja Machalet – Chairwoman of the Health Committee
Dr. Rodeck, please.

PD Dr. Burkhard Rodeck – Deutsche Gesellschaft für Kinder- und Jugendmedizin e.V. (DGKJ)
Burkhard Rodeck, Secretary General of the German Society for Pediatric and Adolescent Medicine, present here, with no conflicts of interest. In very rare, carefully considered indications, cannabis is used for medical purposes in children and adolescents, but in standardized forms, not as flowers or flower extracts. These include treatment-resistant forms of epilepsy, chemotherapy-induced nausea and vomiting, and, even more rarely, chronic pain or conditions from the autism spectrum.

I used the term “very carefully considered indication” deliberately. This implies a high level of medical expertise in the relevant areas. For epilepsy, for example, this means a pediatric neurologist who knows and follows the patient’s entire course, including medication. A side note: In the Hospital Reform Adaptation Act, this pediatric neurologist is no longer included in the relevant service group, according to the current draft.

Personal doctor-patient contact is essential for a balanced decision for or against treatment. Randomized studies have shown that the risk of side effects, serious side effects, and therapy discontinuation due to side effects is significantly higher in children and adolescents compared to control groups. Long-term effects have not yet been studied. This must be medically monitored and controlled, as must any accompanying medication. Especially in epilepsy, there are several drugs that interact with cannabinoids, so special attention is needed. Only a true expert can handle this—not just any doctor. I want to make that very clear. Thank you.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Dr. Müller-Vahl.

Prof. Dr. Kirsten Müller-Vahl – Medizinische Hochschule Hannover (MHH)
Yes, Kirsten Müller-Vahl. I work as a doctor and researcher at Hannover Medical School and have potential conflicts of interest because I have been working on cannabis medicine for almost 30 years, giving lectures and advising companies.

Regarding children and adolescents, I fully agree with my predecessor. In rare and well-checked indications, we also treat children, because they can be very seriously ill and sometimes have no other treatment options. But this really belongs in the hands of an expert. As for medical cannabis flowers in children, I would say generally not. I wouldn’t say never 100 percent—over my long career, I have heard of one case where it worked, though I was not the prescribing doctor. I have never done it myself, but I wouldn’t rule out that there could be a rare case where it is the only thing that helps and is medically justifiable. So it is an exceptional therapy, and we would always first use other cannabis medications if we choose that route.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Okay, further questions?

Prof. Dr. Matthias Hiller – CDU/CSU
Yes, my question is for the German Society for Addiction Research and Addiction Therapy. It has already been mentioned that medical cannabis is prescribed and dispensed online. What do you know about the group of people who obtain medical cannabis this way?

Dr. Matthias Luderer – Deutsche Gesellschaft für Suchtforschung und Suchttherapie e.V. (DG-Sucht)
Thank you for the question. Matthias Luderer from the German Society for Addiction Research. I have no financial ties to the cannabis industry. I’d like to start with a personal experience: When my child leaves school in the afternoon, there are 100 other children at the bus stop, and directly across from it is a kiosk with a large screen and shop window, where there is constant advertising for a cannabis platform. This is the reality: between the schoolyard and the school bus, highly potent substances are presented as lifestyle products.

When medical cannabis is advertised like a movie at a bus stop, it shows what matters to the providers: increasing sales. We see this reflected in the data. There is a clear shift. The classic medical cannabis patient is seriously ill, multimorbid, older. But on online platforms and with private prescriptions, it is mainly a young, male clientele without serious physical illnesses. They also order high-THC flowers more often, which is not always pharmacologically justified. I think this is mostly recreational use under the guise of medical therapy.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. Now it’s the AfD’s turn for nine minutes. Ms. Schießel, please.

Carina Schießel – AfD
Thank you for being here today. My first question is for the GKV Central Association and the German Center for Addiction Issues. The draft law notes a clear negative trend in imports and prescriptions. Do you agree that this is not just a matter of prescription practice, but reflects a structural special status for medical cannabis outside regular drug evaluation, and therefore requires further reforms? If so, which ones?

Dr. Tanja Machalet – Chairwoman of the Health Committee
That would be Ms. Maser for the GKV Central Association, then Ms. Egartner, who is online, for the German Center for Addiction Issues. Please go ahead.

Corinna Maser – GKV-Spitzenverband 
My name is Corinna Maser. I am from the GKV Central Association and have no financial interests in this draft law. To your question: I think you are asking whether cannabis should be treated like any other medicine and subjected to the AMNOG process. We have to say that the approval situation is different from regular medicines. Cannabinoid-containing finished medicines have approvals and have gone through the AMNOG process, but medical cannabis, especially cannabis flowers, do not have drug approval, and the underlying evidence is still mixed.

Legally, we are dealing with individual therapeutic trials, and therapy decisions are mainly made by doctors and patients. Cannabis flowers are not finished medicines; they are prescribed and dispensed as compounded or extemporaneous preparations and are available in various varieties. The scientific literature assumes they are not equivalent—cannabis flower is not just cannabis flower. There are not enough studies on these differences. The variety of strains creates further challenges for evaluation; you would need a separate AMNOG assessment for each strain or extract, which would mean a huge number of procedures, each with significant methodological challenges—choosing the therapeutic area, the evidence, and especially the comparator therapies. The AMNOG process does not seem suitable for this issue.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. Ms. Egartner, please.

Eva Egartner – Deutsche Hauptstelle für Suchtfragen e.V. (DHS) 
Thank you. Eva Egartner, German Center for Addiction Issues. I also have no financial conflicts of interest. I can’t make a statement for the Center on this. But I agree with the previous speaker that more research is needed; the research situation should be expanded. Otherwise, it is important to us that sick people have access to the medicines they need, including medical cannabis, and that a doctor’s contact is absolutely necessary—we see and support that. That’s all we can say. We also think that advertising control is important, as a previous speaker said—that advertising should be stopped in this area. Thank you.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Please go ahead, Mr. Bloch.

Joachim Bloch – AfD
I’ll continue. My question is for the Police Union. Do you agree that protecting health and preventing misuse would justify stricter national restrictions than the current draft law provides?

Dr. Tanja Machalet – Chairwoman of the Health Committee
Mr. Poitz, please.

Alexander Poitz – Gewerkschaft der Polizei (GdP)
Alexander Poitz, Deputy Chairman, Police Union. We have no financial interests in this topic. We are a bit of an outlier in this round, so forgive me for not giving a medical assessment, but at least a police perspective: We basically support the federal government’s draft law, though we have some minor comments based on police experience.

We have two approaches in police work: prosecution and, most importantly, prevention. We want to prevent dangers, which means avoiding opportunities for crime throughout the process—logistics, forgery, and misuse. We agree with previous speakers that we want a concrete doctor-patient contact first, and only as a second step a digital option.

Currently, the situation is very ambivalent. Why? Because drug-related crime is booming. Cannabis is the most consumed and most traded intoxicant, both under the recreational and medical cannabis laws. Online platforms and advertising are increasing, as are demand and consumption. But that’s the police perspective.

We support scalable and balanced regulations—considering consumption behavior and the need for rules. The medical purpose must not be neglected, but we must also monitor the black market, which is booming. Two-thirds of organized crime is in drug crime, and we’re talking about a triple-digit billion-euro market. I hope I’ve answered your question.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Ms. Schießl, please.

Carina Schießel – AfD
Yes, I have another question for the German Society for Addiction Research and Addiction Therapy. Is the consultation frequency proposed in the draft—once per quarter or once per four quarters—sufficient to reliably detect addiction developments?

Dr. Tanja Machalet – Chairwoman of the Health Committee
Dr. Luderer.

Dr. Matthias Luderer – Deutsche Gesellschaft für Suchtforschung und Suchttherapie e.V. (DG-Sucht)
That’s a good question. Basically, we would recommend more frequent consultations. Cannabis is a drug that can cause dependence and is prone to misuse, so medical due diligence is essential. Even medical cannabis carries a risk of dependence, so it’s important to pay attention.

Especially for risk groups—under 25s or people with psychiatric conditions—a thorough check is needed, and personal doctor contact is important, not just via webcam. In-person contact is essential to detect neglect, cognitive impairment, emerging psychosis, and so on—things you can’t easily spot as a pain specialist over video. So personal contact is important, and for an “ultima ratio” treatment, frequent monitoring is necessary.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. That was right on time. Now we move to the SPD group for eight minutes. Dr. Pantazis, please.

Dr. Christos Pantazis – SPD
Thank you, Madam Chair, and thank you to the experts for the opportunity to discuss the law with you today. My first question is for the German Cannabis Patients’ Association. In the last legislative period, the Medical Cannabis Act brought a necessary change in risk assessment for medical cannabis, making patient access much easier. At the same time, we see some uncontrolled growth online, which the current draft aims to address. How do you assess the proposed regulations from the perspective of patient care?

Dr. Tanja Machalet – Chairwoman of the Health Committee
Dr. Kambeck, please.

Dr. Michael Kambeck – Bund Deutscher Cannabis-Patienten e.V. (BDCan) 
My name is Michael Kambeck. I have no conflicts of interest. Basically, we welcome the clearer separation and re-regulation, which is urgently needed. At the same time, patients and the entire medical sector have greatly benefited from last year’s reform. For chronic patients—people with proven severe conditions—it is extremely important that these achievements remain and that only adjustments are made, not a complete rollback.

The main adjustment is the personal doctor contact, which we explicitly support, even though it means our members and other patients may have to travel in person, which is difficult for many. But overall, the harm to medical cannabis as a whole would be greater if we didn’t do this, including increased stigma.

This does not apply to other measures—returning to the Narcotics Act would be terrible and disproportionate. The main issue is advertising. The current rules in the Medicines Advertising Act exist, but many companies still take the commercial risk and advertise anyway. We urgently call for profit skimming—only then will it not be worth breaking the law. Otherwise, the main problem is advertising, and it must be addressed, or everything else will fall short. As for the personal doctor contact, we support it. Thank you.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. Mr. Mieves, please.

Matthias Mieves – SPD
Good day from me as well. My first question is for Professor Müller-Vahl. What medical criteria, in your view, justify stricter regulation of medical cannabis compared to, for example, sleeping pills, sedatives, painkillers, or certain over-the-counter drugs like ibuprofen 400, which have proven dependency and sometimes life-threatening risks?

Dr. Tanja Machalet – Chairwoman of the Health Committee
Dr. Müller-Vahl, please.

Prof. Dr. Kirsten Müller-Vahl – Medizinische Hochschule Hannover (MHH)
Yes, I think cannabis medicines have become part of care—not widespread, but for many who use them more often. Cannabis medicines do carry a risk of dependence, but we know many drugs with a much higher risk. So I don’t think we need special rules for a specific drug. As the previous speaker said, we shouldn’t throw the baby out with the bathwater. We don’t want to change medical care, and I don’t see a real need. We just want to prevent recreational users from obtaining cannabis via telemedicine platforms. So we need to be careful not to create major disadvantages for patients while trying to solve a different problem.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. Please continue.

Dr. Christos Pantazis – SPD
My next question is also for Professor Müller-Vahl. Patients who rely on medical cannabis often have serious illnesses. Could you describe the typical conditions and the monthly need for medical cannabis in these patient groups?

Prof. Dr. Kirsten Müller-Vahl – Medizinische Hochschule Hannover (MHH)
That’s the special thing about medical cannabis. We’ve heard—and I fully agree—that evidence is lacking in many areas. If we look back, I’ve said this in previous hearings: we need more evidence. We still don’t have it, and I fear we’ll be saying the same thing in ten years.

We rely a lot on experience-based medicine, but there are some established indications, and we have approved finished products. These show the main indications—primarily for THC-containing cannabis medicines—are nausea and vomiting from chemotherapy, appetite loss in cancer, and spasticity in multiple sclerosis. Cannabis therapy is also well established in pain management and increasingly in palliative and oncology care.

Beyond that, and this is what makes it difficult to generate evidence, there are indications that cannabis medicines can help with a wide range of conditions—across all of medicine, from ophthalmology to dermatology to psychiatry. We have case reports, case series, and patient feedback that they benefit, especially when there are no better alternative treatments.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. Another question? Please.

Matthias Mieves – SPD
The next question is for the Working Group on Cannabis as Medicine, who are online. How do you assess the draft law, especially the proposed ban on mail-order sales?

Dr. Tanja Machalet – Chairwoman of the Health Committee
Mr. Grotenhermen, please.

M.D. Franjo Grotenhermen – Arbeitsgemeinschaft Cannabis als Medizin e.V. (ACM) 
Thank you for the question. Franz-Josef Grotenhermen, Working Group on Cannabis as Medicine. There are two issues: the mail-order ban and the reduction of telemedicine activities.

Regarding the mail-order ban, I don’t see a real reason for it. The law says it’s to increase pharmacist counseling, but also says there’s no increased workload for pharmacists. For patients, it claims there are no extra costs, but that’s obviously not true—if you can’t have your medicine delivered, and the nearest well-stocked pharmacy is 50 or 100 kilometers away, that’s extra cost.

As for telemedicine, I personally invite all my patients for an in-person conversation. I’ve found that personal meetings are better than pure telemedicine. I opened a practice in 2012 because many patients couldn’t find a doctor willing to deal with this topic. That’s still the case today. So reducing telemedicine will restrict access to cannabis care.

Dr. Tanja Machalet – Chairwoman of the Health Committee
I’m afraid your time is up. Maybe we can discuss this further in the next round. Now it’s Alliance 90/The Greens for five minutes. Please go ahead.

Linda Heitmann – Alliance 90/The Greens
Yes, thank you. My first question is also for Professor Müller-Vahl. What role do you see for quality-assured telemedicine models in the provision of medical cannabis, and what would be the consequences of excluding these models entirely?

Prof. Dr. Kirsten Müller-Vahl – Medizinische Hochschule Hannover (MHH)
I think we are making slow but steady progress with digitalization in Germany, and that’s important. I don’t think it’s an either-or, but rather both-and. Every doctor must decide in each case: do I need to see the patient in person, or can I use telemedicine? We also have phone contacts, and that’s sometimes appropriate.

This is a matter of medical autonomy and decision-making. Is it a minor issue I can handle by phone, or do I need to see the patient in person? That depends less on the type of medication and more on the illness, its complexity, whether the patient is chronically ill, compliant, and so on. But in general, I would always say that every seriously, chronically, and complexly ill patient should be seen in person first before deciding on appropriate therapy. And cannabis is often not the only therapy—there are other medications and non-drug therapies to consider.

Linda Heitmann – Alliance 90/The Greens
Thank you. I’d like to ask the German Medical Association about advertising, which has been mentioned as a problem. We Greens see this too, not just for medical cannabis but also for other prescription drugs—there is still advertising, and legal loopholes are being exploited. You mentioned this in your statement. Do you see concrete ways to close these loopholes, or what would you like to see to counter this advertising?

Dr. Tanja Machalet – Chairwoman of the Health Committee
Dr. Reinhardt, please.

M.D. Klaus Reinhardt – Bundesärztekammer (BÄK)
Thank you very much for the question. From our perspective, there are no legal loopholes. Section 10, paragraph 2, sentence 1 of the Medicines Advertising Act applies to drugs with psychotropic substances that can cause dependence and are intended to treat insomnia or mental disorders or influence mood. Advertising is only allowed to professionals—doctors, dentists, etc.—not to the general public.

The issue is enforcement of violations of the Medicines Advertising Act, which is not happening enough for whatever reason. If it were enforced, I think the problem could be addressed. Still, it remains an expression of industrial marketing, mainly aimed at increasing sales rather than helping patients who truly need cannabis treatment.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. Please continue.

Linda Heitmann – Alliance 90/The Greens
I have another question for the German Center for Addiction Issues. We Greens also see it as a problem that this law will treat medical cannabis differently from other drugs, even though other drugs also have high dependency potential and risks. Can you tell us about medication dependence in Germany and which substances are particularly dangerous?

Dr. Tanja Machalet – Chairwoman of the Health Committee
Ms. Egartner, please.

Eva Egartner – Deutsche Hauptstelle für Suchtfragen e.V. (DHS) 
That’s not easy to answer quickly, but of course there are other substances that cause dependence. I agree with the previous speaker: advertising bans should be enforced more strictly. Everything in the area of sleeping pills and painkillers has already been mentioned. There are high numbers of unreported cases of medication dependence, as we often hear. More evidence is needed here as well.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. Now The Left, with four plus one, so five minutes. Mr. Gürpinar.

Ates Gürpinar – Die Linke
Thank you. Thank you for allowing us to ask questions at this hearing and for your advice and support. Thank you also for the written submissions. The first question is for Mr. Wurth from the Hemp Association. Rather than focusing on criticism, I’d like to look ahead: What measures does the German Hemp Association believe are needed to push back the illegal cannabis market and ensure the supply of medical cannabis?

Dr. Tanja Machalet – Chairwoman of the Health Committee
Mr. Wurth, please.

Georg Wurth – Deutscher Hanfverband (DHV)
Yes, Georg Wurth, German Hemp Association. I represent the interests of private supporting members and donors, and am paid by them, so that’s my financial interest.

First, I want to stress that among the thousands of new people with prescriptions, there are far more patients than some here assume. I can confirm what Mr. Grotenhermen said: doctor’s offices are a bottleneck. Many doctors are not willing to prescribe cannabis or even consider it. It’s a lot of research work that no one pays for. For years, we’ve heard from people who call every doctor in town and can’t find anyone willing to discuss it, even though they have had good personal experiences.

Patients with less severe illnesses are still patients—just like someone who buys ibuprofen 400 for a headache at the pharmacy is a patient, or a woman who uses cannabis for menstrual pain and nothing else is still a patient, even if it’s not a severe condition.

This bottleneck was broken by telemedicine, so many with real medical needs can now get what they need, and online pharmacy prices make it affordable compared to the past, when a gram of cannabis cost over twenty euros at the pharmacy.

Of course, there are also recreational users among the new patients. We see this as a sign that people want tested quality, not adulterated or synthetic cannabinoids, and want regulated access, especially if they can’t grow their own at home.

If we now restrict things as planned, we’re talking about pushing up to two hundred tons of cannabis back onto the black market, with a turnover likely exceeding a billion euros, and losing over a hundred million euros in VAT alone. Everything would go back to the black market.

We also don’t think cannabis as a recreational drug belongs in pharmacies, but in specialty stores. If you don’t want regular users—who aren’t mainly sick—going to pharmacies or doctors and online platforms, then please create a legal access route for cannabis. I’m thinking especially of the pilot projects for cannabis distribution, like those proposed in Frankfurt and Hanover, which have not yet been approved. We now know cannabis users are not morally reprehensible—it’s like drinking beer. But the realization is growing that it has to come from somewhere, and there must be legal access. If there’s no other way, people will use telemedicine. Let’s prevent that by moving forward with specialty stores.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Mr. Gürpinar, please.

Ates Gürpinar – Die Linke
Thank you. My next question is for the Federal Union of German Pharmacists’ Associations. It’s been suggested that if cannabis is seen as a medicine, other medicines should also be considered when it comes to addiction issues, etc. The Greens’ question earlier was for the Center for Addiction Issues, but I’d like to ask you as the pharmacists’ association: Do you think it’s contradictory to implement a mail-order ban only for medical cannabis? Do you agree that there should be a uniform regulation for all such medicines?

Dr. Tanja Machalet – Chairwoman of the Health Committee
Dr. Said.

Dr. André Said – ABDA – Bundesvereinigung Deutscher Apothekerverbände e.V.
Thank you. We are discussing the mail-order ban here, especially in connection with the platforms. Overall, it is well known that for the Federal Union of German Pharmacists’ Associations, a mail-order ban on medicines is the most effective means of ensuring patient safety. It’s about individual patient counseling at the local pharmacy, pharmaceutical advice, and safe dispensing of medicines. Therefore, we see the mail-order ban as the most effective measure for patient safety in this context.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. That was the first round. Now we move to the second, shorter round. Each group has four minutes. The CDU/CSU group begins. Professor Streeck, please.

Prof. Dr. Hendrik Streeck – CDU/CSU
Thank you. My question is again for the German Medical Association. The aim of the MedKangG amendment is to clearly separate medical care from the use of MedKangG as a tactical procurement route for recreational cannabis, which we suspect is happening. How do you assess the measures in the draft law, especially the mandatory in-person first contact and the restrictions on mail-order sales?

M.D. Klaus Reinhardt – Bundesärztekammer (BÄK)
Yes, first—

Dr. Tanja Machalet – Chairwoman of the Health Committee
Ah yes, Dr. Reinhardt.

M.D. Klaus Reinhardt – Bundesärztekammer (BÄK)
Klaus Reinhardt for the Medical Association. Thank you for the question. I would say that the fact that in 2024 we have seen a 170 percent increase in cannabis prescriptions, mainly private prescriptions—only nine percent are statutory health insurance prescriptions—is, in our view, [unintelligible], because this use or circumvention [unintelligible] of medical cannabis, which is supposed to be for patients only, may happen in individual cases, but I find it implausible that the number of indications for individually prescribed cannabis therapy has increased so much. That seems completely unrealistic to me.

We are talking about medical cannabis, not recreational use or use by adults who want to consume it legally—that’s a different issue. When it comes to medical cannabis, we are dealing with a product that can help in individual cases and may be appropriate, but it is a product with psychotropic effects and dependency potential.

So, from a medical professional perspective, personal, individual care and treatment of patients is essential, also in terms of our professional regulations. Therefore, personal contact is a sine qua non for prescribing a cannabis product. That’s the first point. The second is that, for me, the same applies to tranquilizers and other potentially addictive drugs for sleep disorders—they should be used with great caution and rationality, if at all. And I also think they do not belong in mail-order sales. From a medical perspective, it would be completely inappropriate for such drugs to be distributed by mail.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. Who’s next? Professor Hiller.

Prof. Dr. Matthias Hiller – CDU/CSU
My question is for the ABDA. You have already made it clear that you support a mail-order ban. To what extent are your pharmacy structures prepared to ensure supply if mail-order sales are discontinued?

Dr. Tanja Machalet – Chairwoman of the Health Committee
Dr. Said, please.

Dr. André Said – ABDA – Bundesvereinigung Deutscher Apothekerverbände e.V.
Thank you. In our view, the measures in the draft law—mail-order ban for medical cannabis—are appropriate and do not in any way reduce access for seriously ill or immobile patients. Why? We have a network of local public pharmacies. We have pharmacy delivery services, carried out by pharmacy staff, which guarantee individual pharmaceutical counseling, therapy support, and safe dispensing of medical cannabis as a psychotropic, high-risk, and counseling-intensive medicine. We see no interruption in supply for patients, even immobile ones, and see the pharmacy delivery service as a key feature.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Okay, Ms. Dr. Baum for the AfD group.

Dr. Christina Baum – AfD
Thank you. I have a question for the German Center for Addiction Issues. When I was in the Baden-Württemberg state parliament from 2016 to 2021, we regularly had school classes visit, and I was always asked why we as the AfD are against cannabis. I always replied: we are against recreational use, not medical use. I would then ask: why do you want to escape reality, why do you want to use intoxicants in the best Germany ever? So my question: Could it be that social circumstances, fears about the future, etc., play a role in why people use this stuff recreationally? Is this discussed? Are we getting to the root of the problem? Again, we’re not talking about medical cannabis, since we’ve heard that much of the increase is due to recreational use.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Ms. Egartner, please.

Eva Egartner – Deutsche Hauptstelle für Suchtfragen e.V. (DHS)
That’s a very broad question, and as you said, it’s more about the recreational cannabis law. The German Center for Addiction Issues is not responsible for evaluating why people use recreational or addictive substances; it’s always an individual decision. For us, it’s important that people who use are not criminalized. Both laws are a step in the right direction: allowing sick people to use medical cannabis, and allowing recreational users to use cannabis under the recreational law. People have used recreational and addictive substances for thousands of years. For those who go down the wrong path, we need to provide the right help, and we need enough knowledge about everything. That’s all I can say.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. You have one minute left.

Dr. Christina Baum – AfD
Thank you. The same question for the German Society for Addiction Medicine. Surely it’s in our interest as a society to limit this trend, not just accept it. Especially regarding young people and advertising, which I wasn’t aware of. Shouldn’t we as a society do something to reduce addiction, not just let it increase? Are the causes discussed? Do young people say why they use it? I’d like to know.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Professor Dr. Preuss, please.

M.D. Ulrich Preuss – Deutsche Gesellschaft für Suchtmedizin e.V. (DGS)
German Society for Addiction Medicine. I am biased because I prescribe medical cannabis for selected indications. The question is a bit off-topic, since we’re talking about medical cannabis, not recreational use. But it is part of addiction prevention, and in every consultation with affected people, we discuss the causes and try to treat them, and also prevent use from leading to risk and illness.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. Now it’s the SPD’s turn. Four minutes. Dr. Pantazis, please.

Dr. Christos Pantazis – SPD
Thank you, Madam Chair. My question is for the individual expert Dr. Weis. Dr. Weis, how should abusive prescriptions and the relevant online platforms be assessed under current law, especially in terms of pharmaceutical and advertising law? There is already relevant case law in the area of the Medicines Advertising Act. Do we have an enforcement problem?

Dr. Ferdinand Weis (Anwalt)
My name is Dr. Ferdinand Weis, attorney at Dr. Engelhardt, Wagner & Colleagues and on the board of the Cannabis Industry Association. I represent clients from the cannabis industry who pay me, so I have financial interests.

As previous speakers have said, medical cannabis is prescription-only, and advertising for prescription drugs is prohibited. According to Section 10 of the Medicines Advertising Act, you can only advertise to professionals—doctors and pharmacists. In practice, we still see very aggressive advertising violations, especially by telemedicine platforms. Cannabis is advertised with promises like “Get your online prescription in minutes,” for example for sleep disorders or back pain, with glowing patient testimonials.

Courts have already ruled such advertising illegal, as it focuses on sales rather than sober, factual information. As for telemedicine, advertising for remote treatment is generally prohibited under Section 9 of the Medicines Advertising Act, with exceptions only if professional standards are met and personal contact is not required. Remote treatment is only allowed under medical professional law if there are no disadvantages and professional standards are met. With cannabis, that is often not the case—for example, if a patient with back pain appears, whom I might need to examine physically. As a doctor, I don’t have all my senses available.

What is definitely not allowed is prescribing solely based on a questionnaire, without a consultation. That violates professional standards due to the risk of side effects and addiction. So, the problem is not regulatory, but a calculated violation of the law, or an enforcement deficit of existing laws. This is not unique to cannabis; similar problems occur with other prescription drugs, like weight-loss injections, which are also heavily advertised and prescribed online. We have already seen case law on this, for example from the Munich Regional Court.

Abuse can also occur with other drugs, like sleeping pills, which also carry significant risks. Authorities could intervene and stop violations, but they don’t. Unlike the recreational cannabis area, where advertising bans are enforced, we only see competition law cases, mainly by pharmacy chambers, not by authorities. In my opinion, if we addressed the enforcement deficit, we could largely get abuse under control without unduly restricting patient rights.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. Ms. Heitmann for The Greens, please.

Linda Heitmann – Alliance 90/The Greens
Thank you. I’d like to ask Professor Dr. Müller-Vahl: If the changes to the Medical Cannabis Act proposed by the federal government were to pass the Bundestag and become law, what risks do you see for youth and health protection in the future?

Prof. Dr. Kirsten Müller-Vahl – Medizinische Hochschule Hannover (MHH)
Several previous speakers have said that people who want to use cannabis will do so, and I don’t think any law in the world can prevent that. If we look back, we see that moving away from prohibition has led people to prefer and seek legal access routes. The first results of the EcoQian study from Hamburg and a survey by Professor Werse from Frankfurt show this. People want and use legal access routes. At the moment, unfortunately—and we all agree on this—this is happening via telemedicine platforms, which is not what we want. If we stop this, people will continue to use cannabis and will return to the illegal market. That’s clear and obvious, because that’s where we came from. I would always say: the more illegal market, the less youth protection. So, in my view, this is the wrong approach if we want to prioritize youth protection.

Linda Heitmann – Alliance 90/The Greens
Thank you. Another question for the German Hemp Association. You said earlier that there are more patients among those obtaining cannabis online than some might think. We Greens have proposed an amendment to reform the “exhausted all other options” criterion. Do you think this would improve and change prescribing practice, so that real patients could better access medical cannabis through regular medical channels?

Dr. Tanja Machalet – Chairwoman of the Health Committee
Mr. Wurth, please.

Georg Wurth – Deutscher Hanfverband (DHV)
Georg Wurth, German Hemp Association. I don’t think that’s a decisive point, because for private prescriptions—which is what telemedicine is mainly about—the “exhausted all other options” criterion doesn’t apply, nor does the criterion of serious illness. So it won’t have much impact.

What matters are the health insurance criteria, which are still very restrictive with cannabis as medicine—not just for minor illnesses, but even for serious ones. We keep seeing media reports of people with cancer and severe pain who get nothing from their insurance. I personally know cases of people with irritable bowel syndrome who are emaciated and get nothing from their insurance. We need to address this, and that’s why insurance reimbursement hasn’t kept up with increased demand—they mainly reimburse for pain, and for everything else, they resist and only respond to lawsuits.

So, for statutory health insurance, it makes sense to consider such things. The “exhausted all other options” rule doesn’t make sense now that cannabis is more widely available—requiring pain patients to try opiates first, for example, is something that should be abolished, but really with a view to statutory health insurance, not all prescriptions.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Okay, thank you. I think the remaining nine seconds aren’t worth using. Right. We have three more in the next round. Mr. Gürpinar for The Left, please.

Ates Gürpinar – Die Linke
Thank you. I’ll start and then hand over to Dr. Arndt. First, another question for Georg Wurth from the Hemp Association. Maybe a step back, because it seems as if everyone is already adequately supplied with medical cannabis. You’ve already hinted at this, but specifically: Can patients currently get adequate cannabis treatment in local doctors’ offices?

Georg Wurth – Deutscher Hanfverband (DHV)
Georg Wurth, German Hemp Association. Local doctors’ offices are definitely not able to meet the demand for medical cannabis at the moment. As I said, people contact us and call every doctor in town. To this day, as Mr. Grotenhermen said, this bottleneck exists, and restricting telemedicine would bring it back. People would again have to call every doctor, while at the same time there is talk of introducing a doctor’s fee to reduce contacts because doctors are overwhelmed. That makes no sense to me. So telemedicine platforms are a good alternative, especially since they are knowledgeable and provide advice. It’s not as if they refuse to advise. You deal with a doctor in an online consultation who knows about cannabis, while family doctors often have no idea and refuse to discuss it. They’ll prescribe painkillers, opiates, Ritalin for ADHD, but not cannabis.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. Dr. Arndt, please.

Dr. Michael Arndt – Die Linke
Yes. Dr. Michael Arndt. I am a family doctor and treat some patients with cannabis. I have a question for Mr. Poitz from the Police Union. You said earlier that the drug market is booming, and it sounded as if cannabis has also boomed illegally since legalization, which contradicts Mr. Reinhardt’s statement that private prescriptions have shifted cannabis from the black market to the legal market. Do you have figures on how the cannabis black market has developed?

Dr. Tanja Machalet – Chairwoman of the Health Committee
Mr. Poitz, please.

Alexander Poitz – Gewerkschaft der Polizei (GdP)
Alexander Poitz, Police Union. I can’t comment on Mr. Reinhardt’s figures. What I can comment on is the police crime statistics and the Federal Criminal Police Office’s drug crime report. These clearly show that cannabis is the most consumed and most traded intoxicant in Germany and will likely remain so because the market is booming. This does not refer exclusively to medical cannabis; the statistics cover all cannabis, both recreational and medical.

So, to answer your question: I can’t provide figures specifically for medical cannabis. But the trend in the black market is clear—two-thirds of organized crime is drug crime, and cannabis accounts for two-thirds of drug offenses. The numbers are clear about where the money is made. The market is determined by price and demand, and the black market is still very large. But the criticism of the recreational cannabis law is clear. As for medical cannabis, we support the measures. However, regarding telemedicine and the initial doctor contact, we agree that we need to improve enforcement of the advertising ban. As mentioned earlier, we have a clear enforcement deficit, due to police staffing and the need for better laws. We are currently blind in the virtual space. Thank you.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you.

Dr. Michael Arndt – Die Linke
May I briefly add something?

Dr. Tanja Machalet – Chairwoman of the Health Committee
Very briefly.

Dr. Michael Arndt – Die Linke
Because drugs and cannabis are being mixed up again. Sure, it’s a narcotics offense, but there are, for example, 3,000 fewer narcotics offenses, and hard drugs are on the rise, as is generally known. In my opinion, the black market is being dried up by medical cannabis—by self-medication, people who used to grow or buy illegally. Or at least, that’s the trend.

Dr. Tanja Machalet – Chairwoman of the Health Committee
That was longer than brief. Please, very short answers.

Alexander Poitz – Gewerkschaft der Polizei (GdP)
It’s far from dried up. I’d like to make that clear. We have seizures in the ton range—very large quantities are being seized, so I can’t say it’s dried up. That applies to all types of cannabis included in the statistics.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. Now we move to block three. That’s the CDU/CSU group for ten minutes. Ms. Borchardt, please.

Simone Borchardt – CDU/CSU
Thank you. My question is for the Association of Cannabis-Supplying Pharmacies. Are you present? Perhaps you could comment on the mail-order ban as formulated in the law.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Dr. Neubaur, please.

Dr. Christiane Neubaur – Verband der Cannabis versorgenden Apotheken e.V. (VCA) 
Thank you for the question. The Association of Cannabis-Supplying Pharmacies is very critical of the mail-order ban. There are local German pharmacies with mail-order licenses that specialize in supplying medical cannabis. This requires a high level of expertise, which is not readily available in every local pharmacy and would have to be built up from scratch.

It’s about drug interactions, multimorbid patients with multiple medications, and cannabis as an add-on. This requires proper assessment by the pharmacy and pharmacist caring for the patient. It will be difficult for every local pharmacy to provide this. We also have a massive decline in the number of pharmacies, and in rural areas, there are sometimes no pharmacies at all. This would force immobile patients to travel long distances to get their medicine, which is unacceptable. Delivery services can’t make up for this, as they are only viable within a 10- or maybe 20-kilometer radius. Sometimes delivery is arranged by phone, with counseling over the phone, and then the medicine is delivered. So there’s little difference.

Pharmacies that specialize in cannabis are very experienced in counseling and provide telepharmaceutical or telephone counseling. They are deeply involved in the subject and spend a lot of time with patients, ensuring patient safety. I don’t see every local pharmacy being able to do this.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. Professor Streeck, please?

Prof. Dr. Hendrik Streeck – CDU/CSU
Just briefly, because it was mentioned earlier: The EcoCan report says nothing about a reduction in the black market so far due to medical cannabis, but we’re not talking about recreational cannabis here. I have a question for the Society for Addiction Research and Therapy, and perhaps also the German Society for Addiction Medicine. What requirements would you set for follow-up monitoring to ensure that treatment with medical cannabis is medically appropriate and addiction risks are minimized?

Dr. Tanja Machalet – Chairwoman of the Health Committee
That would be Dr. Luderer and Professor Preuss. Please go ahead.

Dr. Matthias Luderer – Deutsche Gesellschaft für Suchtforschung und Suchttherapie e.V. (DG-Sucht)
Thank you. The most important thing is that there must be no “prescribe and forget.” Every cannabis therapy is a time-limited trial with a clear goal, requiring close, personal, and frequent monitoring. Two things are crucial: first, a critical review of the dose, because if it increases, that indicates tolerance and possible addiction. Second, regular attempts to discontinue, to check if the indication still exists. Simply continuing to prescribe must not happen; regular, close, and personal monitoring is necessary.

M.D. Ulrich Preuss – Deutsche Gesellschaft für Suchtmedizin e.V. (DGS)
Professor Preuss, German Society for Addiction Medicine, I agree. Initially, a personal contact is needed, as well as regular review of the indication and correct medication. If telemedicine is considered, it should only be for follow-ups, when the patient is well known and there is a good therapeutic relationship.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Okay, thank you. Please continue.

Prof. Dr. Hendrik Streeck – CDU/CSU
I have a follow-up for both, and perhaps also for the Medical Association: What requirements for medical documentation do you consider necessary to ensure proper care with medical cannabis?

Dr. Tanja Machalet – Chairwoman of the Health Committee
Let’s do as before: Dr. Luderer, then Dr. Preuss, then Dr. Reinhardt. Please.

Dr. Matthias Luderer – Deutsche Gesellschaft für Suchtforschung und Suchttherapie e.V. (DG-Sucht)
It’s important that risk assessment for such an individual, last-resort treatment is not left to an automated online process or a questionnaire. That’s not medical practice, but commercial. The doctor must document why evidence-based standard therapies have failed, and the patient must be explicitly informed about the lack of evidence—because for cannabis flowers, there is almost none—and the risk of dependence. This must be documented, with follow-ups. We also have no package inserts or product information yet; we need those to ensure patient rights. Proper care requires more than just writing a prescription.

M.D. Ulrich Preuss – Deutsche Gesellschaft für Suchtmedizin e.V. (DGS)
I agree. Addiction medicine expertise is important to distinguish between use and use disorder, and to consider drug interactions. All these elements are part of medical due diligence and should be documented at each patient contact.

M.D. Klaus Reinhardt – Bundesärztekammer (BÄK)
I can confirm that. I’d add: This is an absolutely individual form of therapy, and the individual situation must be properly documented. That’s not achieved by ticking boxes on a standard questionnaire. That’s a minimum standard for any treatment, including with cannabis products. The Medical Association has generally opposed medical cannabis treatment with flowers, because there are no standards or product information for patients. These are compounded medicines that don’t follow any basic standard, even if done well. If cannabis is to be used as a medical agent, standardized products should be required.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. Another question, please.

Prof. Dr. Hendrik Streeck – CDU/CSU
Yes, I have a question for the GKV Central Association and perhaps also the Medical Association, if time allows. The G-BA links exceptions to the health insurance approval requirement for medical cannabis to certain medical specialties or additional qualifications. Do you think it makes sense to tie prescribing more closely to qualifications and specialties?

Dr. Tanja Machalet – Chairwoman of the Health Committee
Ms. Maser, please.

Corinna Maser – GKV-Spitzenverband 
This is about the general question of who is qualified to prescribe cannabis. In the G-BA regulation on exceptions to the approval requirement, the GKV Central Association argued that both a specific specialty and an additional qualification should be required. For special prescribing conditions for cannabis medicines without approval, we believe both the specialty and the specific qualification in the relevant field are needed—to assess disease severity and the lack of alternative treatments—as well as additional training for cannabis therapy, to assess the likelihood of success. However, the decision was made that either a specialty or an additional qualification is sufficient. This decision is to be evaluated based on developments in the various medical groups and the number of voluntary pre-approvals requested, to see if the regulation needs to be adjusted.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. Now it’s the AfD’s turn for seven minutes. Ms. Hess, please.

Nicole Hess – AfD
Thank you. My question is a follow-up for the German Center for Addiction Issues. I’m curious, and I’m not distinguishing between recreational and medical cannabis, since it’s clear that recreational cannabis is also being obtained via medical routes. That’s why we’re here today. What confused me was your answer in the last round, where you said you support access to medical cannabis, and that you intervene when someone “takes a wrong turn.” My question is about your self-understanding: Is your role preventive, or do you wait until someone has taken a wrong turn? How does the Center see its role? Thank you.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Ms. Egartner, please.

Eva Egartner – Deutsche Hauptstelle für Suchtfragen e.V. (DHS) 
Thank you. The German Center for Addiction Issues deals with all questions around prevention, counseling, and treatment. Of course, we are very active in prevention and support further preventive measures for all intoxicants, including alcohol. I think the earlier comment was about recreational cannabis—that some people use it for pleasure and may not realize it’s an intoxicant, and over time may develop addictive behavior. Then the right help must be available. In schools, we need to educate in advance about the risks. That’s undisputed, and as I said before, we strongly support advertising bans for all intoxicants, including cannabinoids, and that the existing advertising ban should be enforced. As the police representative said, it’s hard to enforce, but we would strongly support better enforcement, so that children and adults are not bombarded with advertising at bus stops or online. That should be pursued and not be so widely accessible.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. Ms. Schießel, please.

Carina Schießel – AfD
Yes, I have a question for DG-Sucht, DHS, and DGS. Do you agree that the draft law is a necessary but incomplete step, and that treating medical cannabis like any other medicine would better ensure patient protection, cost transparency, and prevention of misuse in the long term?

Dr. Tanja Machalet – Chairwoman of the Health Committee
That’s Professor Preuss, right?

M.D. Ulrich Preuss – Deutsche Gesellschaft für Suchtmedizin e.V. (DGS)
I’ll start. We have submitted a statement with some suggestions for improving the draft law. In principle, we support the draft, but recommend reviewing whether certain forms of cannabis prescribing should be made stricter. The advertising ban is also very important to us. We also emphasize that finished medicines are preferable to cannabis flowers from a medical perspective, because they are more defined. Instructions for use and package inserts are also important for patient protection and education.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Dr. Luderer for DG-Sucht as well.

Dr. Matthias Luderer – Deutsche Gesellschaft für Suchtforschung und Suchttherapie e.V. (DG-Sucht)
I agree with the previous speaker and would like to add a comment. I don’t know who said earlier that family doctors are generous with ADHD medications like methylphenidate. The experience is quite the opposite—ADHD is under-treated, especially in adults. Also, the ADHD guidelines, which I am helping to revise, have said since 2018 that cannabis should not be used to treat ADHD. I don’t rule out that it may be effective in individual cases, but we need much more research to assess efficacy and side effects.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. Ms. Egartner, if I’m not mistaken.

Eva Egartner – Deutsche Hauptstelle für Suchtfragen e.V. (DHS) 
Yes, thank you. We also support the draft law and would like to keep mail-order options for the reasons already mentioned—especially in rural areas, it’s difficult for chronic patients to access care. We also support stricter enforcement of advertising bans, and if the police need more regulations for this, they should be included.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Thank you. Now, Mr. Mieves for the SPD group. Five minutes.

Matthias Mieves – SPD
Thank you. My next question is for Mr. Wurth. How do you assess the federal government’s claim that patient care would not be endangered without mail-order sales, since any local pharmacy could order medical cannabis?

Georg Wurth – Deutscher Hanfverband (DHV)
When it comes to the ban on mail-order sales, I don’t see the situation as quite as dramatic as with the ban on telemedicine platforms, because doctors really have a kind of bottleneck that can’t be bypassed. People simply won’t be able to get prescriptions anymore, at least in part, whereas getting cannabis from the nearest pharmacy is, in principle, still possible. They just have to order it and then pick it up. Although, even today, there are still pharmacies that refuse to order cannabis. But I assume that if the platforms disappear, that will decrease. The problem is, it’s much more effort for patients. In rural areas, they’ll have to drive around, usually twice—once to order, once to pick up—because pharmacies, unless they specialize, won’t have a wide range of cannabis products in stock. And above all, the prices are much higher, because online pharmacies buy in bulk and pass those savings on to patients, so getting cannabis only from brick-and-mortar pharmacies will make it significantly more expensive. And, of course, there’s the extra travel involved. So, we’re against shutting down these online cannabis pharmacies. But things would get really dramatic if cannabis could only be prescribed in local doctors’ offices. Prescription. Thank you.

Dr. Tanja Machalet – Chairwoman of the Health Committee
Yes, Mr. Yüksel.