New data shows that the market for medical cannabis in Italy continued to grow in 2020 despite COVID-related disruptions. However, patient accessibility remains a major issue in the country.
Most of the growth over 2020 was facilitated by private pharmacy wholesalers who import medical cannabis produced by Bedrocan in the Netherlands. Private wholesales accounted for 59% of the medical cannabis sales during the year, with 21% coming from the Stabilimento Chimico Farmaceutico Militare (SCFM) and 19% coming from hospital pharmacies. The amount being imported by hospital pharmacies shrank by 15% over the year, possibly as more patients were treated outside of hospitals owing to COVID-19.
These figures mean Italy remains the second largest market in Europe – using 1.2 tonnes of medical cannabis serving what is likely to be well over 20,000 patients in the country. This is far lower than in Germany where we estimate over 120,000 active patients were served medical cannabis yet considerably more than in the Netherlands where there were 9,000 active patients during 2020.
We asked Dr. Viola Brugnatelli, scientific director of Cannabiscienza, an e-learning academy for Italian health care professionals on Medical Cannabis, about the growth of the market in Italy. “There’s an on-going cultural shift, where more and more health care professionals are learning about the benefits of medical cannabis and how they can support patients with these medicines” she said.
The administrative regions of Italy maintain some autonomy over medical cannabis regulation, contributing to an imbalance of distribution across the country. The north west of the country is where most prescriptions are dispensed, with the regions of Emilia-Romagna, Liguria, Tuscany and Lombardy all exhibiting high patient numbers.
Supply Issues Persist
Throughout 2020 and into 2021, there have been several issues regarding accessibility to medical cannabis, with supply for different varieties of cannabis sporadically drying up. Currently, 17 of 20 administrative regions in the country are experiencing some kind of medical cannabis shortage as monitored by MonitorCannabis.
Dr. Brugnatelli explains that these shortages are largely being caused by current restrictions on the production and import of medical cannabis. Only the SCFM is authorised to produce bulk medical cannabis in the country, and private sellers may only import from Bedrocan in the Netherlands. In addition, licences to import are tightly controlled, with no new licences being granted recently. In the opinion of Dr. Brugnatelli, allowing the import of medical cannabis from more companies would be the first step in overcoming supply shortages, and is a more attainable goal than the granting of new licenses for domestic cultivation in the short-term.
Distribution is also limited by the healthcare facilities, including the limited number of pharmacies that handle cannabis products. Fewer than 600 pharmacies make the magistral preparations of medical cannabis needed to serve the patients, which number over 20,000. One solution to this issue has been for pharmacies to send medical cannabis to the homes of patients, remotely.
However, the Ministry of Health indicated late in 2020 that this practice was not permitted under their interpretation of current laws. Dr. Brugnatelli says “This is already causing huge trouble for patients who live in more remote areas, who simply cannot travel the distances required to get to their nearest magistral pharmacy”. Patient and healthcare professional groups such as the one led by Dr Marco Ternelli are currently appealing this interpretation of the law on the grounds that it will unnecessarily impede the ability of patients to access the medicines they depend upon.