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Why Is It so Difficult to Treat Diseases with Medical Cannabis in Italy?

In Italy, since 2006, people can have cannabis medicine prescribed to help them alleviate the symptoms of their ailments. Despite it, usually, patients cannot access this type of medication regularly and, as a result, do not complete their treatment.

Although demand for this product is high among patients in Italy, sales do not reflect this reality. Less than 1300 kilograms of cannabis inflorescences were sold in 2021 as stated by the Italian Ministry of Health. The amount is lower than what the ministry estimated at the beginning of the year of 1400 kilograms approximately.

These figures show that the level of sales achieved does not meet the estimated demand for cannabis inflorescences. According to figures from the International Narcotics Control Board, a UN agency, the total demand in Italy in 2021 would be around 2,900 kilograms. This figure is significantly higher than the sales achieved in Italy during that period.

Demand in Italy for this product will likely be higher. The Committee of Medical Cannabis Patients, a group that gathers and represents patients with medical prescription that entitles them to consume medical cannabis to treat their pathologies, surveyed a technical table held by the Italian Undersecretary of Health. They concluded that the annual requirement of 287 patients corresponds to 163 kilograms of cannabis inflorescences on average. The number of patients requiring medical cannabis in Italy is around 50 thousand, then one could say that the real demand for cannabis inflorescences is about 30 tons, far from the 1300 kilograms sold in 2021.

The gap between kilograms sold and the real demand for cannabis inflorescences is evident, and those most affected are the patients. As Santa Sarta, president of the Medical Cannabis Patients Committee, explains: "Having a medical cannabis treatment is crucial for patients, often it is the only possibility to provide relief from their severe physical suffering".

It is necessary to wonder about the cause that motivates this imbalance between the supply and demand of cannabis inflorescences in Italy. Not all dispensaries and pharmacies distribute cannabis-based products, nor do they know how to use the raw material used to make the drugs.

Secondly, the origin of the inflorescences marketed in Italy is important. The only producer authorized to cultivate the cannabis plant and produce its inflorescences in this country is the Military Pharmaceutical Chemical Establishment of Florence. It can produce only 400 kilograms of inflorescences annually, although as of this year its permitted production has been increased by 100 kilograms. However, the military establishment never managed to exceed the production of 150 kilograms.

Therefore, given the legal impossibility of growing the plant in Italy outside the Military Establishment, it became essential to facilitate imports. Unfortunately, the only country allowed is the Netherlands, whose specialized medical cannabis office authorizes only five distributors to sell it to Italian pharmacies. These imports represent the largest share contributing to the inflorescences sold in Italy, although they do not meet the demand either.

Pharmacies also suffer from shortages. As pharmacist Marco Ternelli explains, when a quantity of cannabis inflorescences is ordered, it is extremely difficult to receive what is initially required. Orders always come in smaller quantities, and after a long waiting time, sometimes after 6 months, by then patients' prescriptions have already expired in the doses initially required.

Italian patients will continue to await a solution

The problem of medical cannabis supply in Italy has existed practically since its beginnings. The authorization to the Military Pharmaceutical Chemical Establishment of Florence to produce cannabis inflorescences arose precisely to mitigate the lack of supply in the Italian market, an unsuccessful measure, at least the minimum production and import quantities were minimally increased.

In addition, Italy has its own BFP, a different and stricter standard for cannabis production than European regulations, making it impossible to import cannabis that does not meet Italian standards. "Extending imports to countries with the European standard," argues the pharmacist, "would be a feasible solution to the supply problems. It would also increase the quantities of cannabis that can be obtained through tenders and authorizing private local producers, although the latter route would take a long time," Ternelli adds that there is no evidence of willingness to make the required changes and increase the quantities of the amount needed to solve the supply problem in the medium and short term.

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