Berlin, 2025-08-28: The Federal Government Commissioner for Addiction and Drug Issues, Prof. Dr. Hendrik Streeck, has spoken out in the media in favor of reforming the Cannabis Act (CanG) and, as part of this, banning the prescription of cannabis flowers: He justifies this, among other things, by citing fluctuating THC levels, potential lung damage, an increased risk of cancer, and the observation that the focus is often less on alleviating suffering and more on recreational use. For Streeck, capsules and drops—as opposed to inhalation—represent the medically sound form of administration, as they are “precisely dosable, evidence-based, and safe.”

The Medical Cannabis Alliance, consisting of professional associations of physicians, pharmacists, patients, and the pharmaceutical industry, strongly opposes this proposal. In this regard, the alliance first clarifies that the 2017 Medical Cannabis Act was enacted primarily with the goal of establishing the prescribability of medical cannabis flowers. To evaluate the effects of the law, a 5-year follow-up study was subsequently conducted. The final report from the Federal Opium Agency of the Federal Institute for Drugs and Medical Devices (BfArM)[1] clearly shows that, compared to all other cannabis-based medications, medical cannabis flowers are not only more effective but also better tolerated, lead to fewer treatment discontinuations, and result in a greater overall improvement in quality of life.

Scientific studies also show that the use of cannabis flowers not only enables effective pain management but also reduces the need for opioids: According to international publications, opioid requirements can decrease by up to approximately 50 percent.[2] “Patients must therefore continue to have reliable access to safe, quality-tested cannabis flowers. Patient care tailored to individual needs must not be restricted under any circumstances,” emphasizes Antonia Menzel, Chairwoman of the Board of the Federal Association of Pharmaceutical Cannabinoid Companies (BPC).

Cannabis flowers allow for a rapid onset of action

Inhaled cannabis-based therapy has a decisive advantage over oral treatment in that the rapid onset of action allows for very precise dosing. The effects begin within seconds to a few minutes and last two to three hours. This, however, is often not possible with oral treatment due to the significantly delayed onset of action. Furthermore, the bioavailability of cannabis flowers—at 15 to 35 percent—is significantly higher than that of oral preparations (three to twelve percent). For these reasons, inhalation therapy is indispensable—though not exclusively so—for the treatment of acute pain or spasticity. Unfortunately, very few alternative cannabis-based medications for inhalation are available to date, meaning that inhaled flower therapy is currently indispensable in cannabis treatment. Figures from the GKV Drug Rapid Information Service (GAMSI)[3] show that, in approximately half of the cases covered by statutory health insurance (GKV), cannabis-based therapies are administered using medical cannabis flowers.

Ensuring Patient Care and Preserving Medical Autonomy

Every treatment should focus on patient safety and quality-assured access to medical cannabis. “A ban on prescribing medical cannabis flowers would deprive a large number of patients of the opportunity to continue their long-established, effective, and medically supervised therapy. As a result, many patients—as was the case before 2017—would once again be forced to self-medicate with cannabis from illegal sources,” affirms Prof. Dr. Kirsten Müller-Vahl, Chair of the Working Group on Cannabis as Medicine (ACM).

The selection of the appropriate dosage form should be based on the symptoms, the mechanism of action, and the duration of effect—and always take into account the individual situation of the patients. “The final decision must rest with the treating physician—and to that end, all options should be available to select the most appropriate therapy,” says Michael Greif, Managing Director of the German Cannabis Business Association (BvCW).

It is important to note that inhalation therapy using medicinal cannabis flowers should not involve smoking joints, as this can damage the lungs and increase the risk of cancer. However, these risks can be significantly reduced by using a vaporizer for inhalation. Vaporizers that are approved and tested as medical devices allow for a low-toxicity, efficient, and validated method of administration. The THC doses are absorbed with each breath, and administration can be stopped at any time. Overall, inhalation allows for easier dose titration with fewer side effects.

Standardized Alternatives Instead of Blanket Bans

The federal government should create targeted incentives to actively promote investment in the research, development, and approval of standardized inhaled and oral preparations and to gradually integrate medical cannabis into standard care. Until such alternatives are widely available, the ability to prescribe medical cannabis flowers should be maintained to ensure the care of patients whose conditions require a rapid onset of action.

“As long as there are no additional alternatives to inhalation besides a few inhalable extracts—some of which are difficult to dose—removing the ability to prescribe medical cannabis flowers would be a significant step backward. Many patients would thus be deprived of a treatment option that has proven effective for years,” warns Daniela Joachim, chairwoman of the Board of the German Cannabis Patients Association (BDCan).

Clear Distinction Between Medical Cannabis and Recreational Cannabis

The cannabis professional associations advocate for a clear distinction between medical cannabis and recreational cannabis. “The misuse of medications should be prevented, but not at the expense of patients who depend on their therapy,” emphasizes Dr. Christiane Neubaur, Executive Director of the Association of Cannabis-Supplying Pharmacies (VCA).

The coalition also suggests that legal access for consumers should be established through scientific pilot projects under the research clause (Section 2(4) of the Cannabis Act). This would allow for a clearer distinction between consumers and patients while simultaneously generating scientific evidence to support future cannabis regulation.