The medical use of cannabis is currently only legal in exceptional cases. Proposed amendments are now available for consultation. The restrictions are to be relaxed, but there is no free pass for sick people.

The Federal Office of Public Health (FOPH) has granted many exemption licenses for cannabis medicine: From 2012 to 2018, there were more than 12,000, including 7,575 first-time authorizations and 4,500 renewals.

In principle, hemp medicine should only be approved in exceptional cases. Hemp is listed in the NarcA under the prohibited substances, which are actually subject to a comprehensive traffic ban (total prohibition). Only since 2011, with the then NarcA-revision, an exceptional use of hemp in medicine was made possible (this is a contradiction, of course, but it was the first step towards medical use of cannabis in Switzerland).

The numerous cases seem to worry the administration - but not because the sick still get their medicine only with difficulty and high costs, but rather because this number no longer has an exceptional character. Now a change in the law is needed in order to be able to continue.

As I said, the needs of the sick are not at the center of this bill. There will be no possibility for self-therapy or self-cultivation. This remains prohibited as before, just like the other handling of products containing THC.

The present proposal for an NarcA-amendment wants above all to remove cannabis as medicine from the total prohibition category in NarcA. This is the heart of the proposal - i.e. the removal of the traffic ban. This would put hemp on the same level as morphine or cocaine. It could then be prescribed by doctors without an exemption.

But: not all hemp, but only hemp for medical use. Now this would be a novelty in NarcA, that something would be divided like this (cocaine for example is simply in another category, without distinction of medicine/non-medicine). This still leaves non-medical hemp in this unspeakable total prohibition category….

What does this partial lifting of the traffic ban of hemp bring at all? Directly not much. It's about the legal background level: about opening a door so that recommended prescriptions can then be established in the next few years.

So after this change in the law, there would have to be some more steps: In BetmVV-EDI, medical hemp could be moved from list d to list a (from prohibited to controlled). Furthermore, the FOPH would no longer be responsible, but Swissmedic, which would then exercise supervision. Furthermore, the Swiss Pharmacopoeia would also be adapted (definition of safety and quality requirements for cannabis in medicine).

What the FDHA/FOPH and Swissmedic would prefer is for the pharmaceutical industry to conduct research on the topic and develop drugs: drugs that have been created for specific indications and validated for this purpose in double-blind clinical trials and could then be approved by Swissmedic. But this is simply not happening. So far, there is only one “real” cannabis drug: Sativex (a THC-containing spray for use in the oral cavity). This can already be prescribed by doctors without an exemption, but only in cases of moderate to severe spasticity in multiple sclerosis.

In most cases, extemporaneous preparations (tinctures or oils with standardized levels of THC) are produced in pharmacies and dispensed to patients (of course, only with exceptional permission). This will continue to be the case in the future, as long as no “normal” hemp medicines are developed. However, the big advantage would be that this could now be done without an exemption.

If this revision of the law were to be successful, doctors would have much more to say: they would then no longer have to obtain exemption permits for hemp prescriptions. Nevertheless, they would not be able to prescribe hemp completely freely.

There are no legal restrictions on dosage forms or preparations in the law. Nevertheless, they cannot prescribe just anything, but all regulations for drugs must be observed (standardized, reproducible, dosable and much more).

There is also no catalog in the law for which ailments such medical hemp may be prescribed (indications). This is also not a free pass for doctors to simply prescribe hemp to all sick people, because they must adhere to their duty of care. The FOPH, the cantons and the medical societies should develop treatment recommendations over time. This would then probably result in a list with the permissible indications as well as the preparations and dosages recommended for them.

Since the physicians are controlled by the respective cantonal physicians, there could well be regional differences in prescribing. Furthermore, many doctors could and would still refuse to prescribe hemp.

Very often sick people smoke hemp, because it guarantees the fastest effect. Vaporizing is also popular. Oral intake in drop form is slower. However, smoking is not a medical application for the FOPH, after all, vaporizing is not excluded for all time (and any hemp preparations for it would be exempt from tobacco taxation).

The health insurance companies would not have to cover the costs in the future (because the effectiveness has not been proven). At least there should be an evaluation project for it.

The consultation runs until 17.10.19, then the Federal Council will consider how to definitively bring the proposal before parliament.

The consultation for an easier handling of hemp as medicine has ended. Most of the respondents seem to be in favor of this proposal. Now, the Federal Council will have the definitive bill drafted and then handed over to the parliament for consultation. The concrete timing is still open, but the procedure will certainly take years. For many patients, these changes may simply come too late.

We have described the content of the amendment proposed by the Federal Council in detail in our Legalize it! 85 in detail. We participated in this consultation process and submitted a statement in October. In this statement, we welcome the present amendment to the law, as it is the most concrete thing that brings us a little further forward. However, we also propose some adjustments, in particular the complete deletion of cannabis from the list of total prohibition, because this status complicates many things (medical hemp, pilot trials). In our statement, we also emphasize once again that the amendment of the law is clearly too short-sighted and that only a small part of the patients will effectively benefit from it.

Our response to the consultation