Introduction – medical cannabis in Germany
After cannabis was removed from the Narcotics Act on April 1, 2024, and numerous new tele-clinics sprung up like mushrooms on the same day, it was not surprising that imports of medical cannabis flowers more than doubled in 2024 compared to the previous year, reaching 72 tons. The new figures for 2025 amount to a total of 120-140 tons.
Based on an older estimate by the German Criminal Investigation Officers‘ Association, which put the total demand in Germany at 500-700 tons, the medical cannabis industry already supplies a quarter of the potential market in Germany.
Obtaining a prescription and then receiving the prescribed cannabis products is not only fairly simple and unbureaucratic, but also extremely fast. The reason for this is that telemedicine platforms mainly use questionnaires that the patient must fill out, which are often sent to a doctor in another EU country. This doctor then approves the prescription, and the pharmacy selected in each individual case ships the product within a very short time. There is no personal contact with a doctor, either through a video consultation or email communication.
The draft bill
It was to be expected, albeit not too quickly, that the new Government would get involved in this practice. In June 2025, Federal Health Minister Warken presented a draft bill that aims to amend Section 3 of the MedCanG with regard to the prescription of cannabis, but only concerning dried flowers, and stipulates that at least one personal visit to a local doctor’s office per year is mandatory. Follow-up prescriptions would then be allowed to be issued online again. There would also be a ban on shipping dried flowers, so patients would have to get cannabis locally from their pharmacy. The reason for this change in the law is the asserted massive abuse of prescriptions for medical cannabis, which isn’t meant for recreational use, but only for people with serious illnesses. However, the draft bill doesn’t go into more detail about the abuse allegations.
Case law and literature
Legally, it appears that the main issues are the definition of treatment and lawful prescription in accordance with Section 3 MedCanG, and whether remote medical treatment, which takes place exclusively via communication media, is medically justifiable and maintains the necessary medical care, as regulated in Section 7 MBO-Ä (Model Professional Code for Doctors).
The Administrative Court of Giessen (judgment of April 28, 2021, 21 K 4779/19 GLB) and the Hamburg Higher Administrative Court (decision of December 15, 2022, 3 Bs 78/22) have already ruled in the case of certificates of incapacity for work that medical treatment does not exist if the sick note is issued solely on the basis of a completed and evaluated questionnaire.
Similarly, the Hamburg Regional Court (judgment of March 11, 2025, 406 HKO 68/24) and the Munich I Regional Court (judgment of June 2, 2025, 4 HK O 11377/24) ruled in connection with Section 9 HWG (Heilmittelwerbegesetz, German Law on the Advertising of Medicinal Products) that it is not in accordance with medical care to prescribe medical cannabis only as part of remote treatment. Previously, the Higher Regional Court of Cologne (judgment of June 10, 2022, 6 U 204/21) had already ruled similarly in the case of Shop-Apotheke, which provided treatment exclusively by means of questionnaires.
This means that there is a risk that prescriptions issued by doctors who do not carry out any prior treatment and prescribe cannabis solely on the basis of a questionnaire are already in breach of Section 3 (1) MedCanG, as a prescription without treatment cannot constitute a proper prescription. This would then constitute a criminal violation of Section 25 (1) No. 2 MedCanG, including on the part of the pharmacist who dispenses medical cannabis to patients on the basis of such a prescription. In this respect, the intention on the part of the pharmaceutical staff in the pharmacy is likely to be lacking in most cases. However, the situation is different for pharmacists who routinely work with telemedicine platforms, where it is obvious that prescriptions are issued exclusively on the basis of a questionnaire. Similarly, according to Section 25 (6) MedCanG, negligent conduct is also punishable by law. In addition, public prosecutors have a wide range of options for confiscating the proceeds of crime on a gross basis.
The platform operators themselves are then guilty of incitement.
This is in essence the position of the Association of Cannabis-Supplying Pharmacies (VCA), which published a criminal law opinion by attorney Dr. Matthias Brockhaus in June. Dr. Morton Douglas argues similarly in his article in A&R 2024, 304, „Im Rausch der Blüten“ (In the Rush of Flowers).
This view is fundamentally understandable, although the term „treatment“ is not mentioned in § 3 MedCanG. No court rulings have been issued on this matter yet. But as we have seen, law enforcement is very flexible in its interpretation of the elements of an offense and sometimes even overzealous when it comes to cannabis. We saw this with CBD flowers, with the enforcement of the Novel Food Regulation for CBD oils, and most recently with cuttings. And as soon as an initial ruling is handed down in criminal proceedings, case law can sometimes manifest itself very quickly.
Based on the current legal situation, it would therefore already be possible to take action against this business model. If the legal situation does not change, for example because the coalition cannot agree on a change in the law, this is also to be expected.
Prescribing physicians are therefore strongly advised to conduct at least some form of mandatory communication with the patient as standard practice. Pharmacists are advised to refuse to cooperate with telemedicine platforms that only issue prescriptions based on questionnaire solutions. This will at least avoid the criminal risk of failing to provide treatment and prescribing in violation of § 3 MedCanG. And pharmacies do not need to fear a possible violation of § 7 (4) MBO-Ä, as it does not address them.
Communication as a solution?
In view of these enormous risks for market participants, the opportunity presented by a change in the law should be used to ensure legal certainty in the supply system for medical cannabis.
A simple and proportionate solution, compared to the draft bill, would be the tool of mandatory video consultations, which should be introduced by law and must be carried out at least at the beginning of treatment, or once a year. This would also mean that treatment has been carried out, so that follow-up prescriptions can once again be issued online. And doctors, pharmacists, and platforms would not have to fear being prosecuted at some point due to the interpretation of the term „lawful prescription“ in accordance with Section 3 MedCanG if the law enforcement were to take serious and concerted action against this business model.
The problem of lack of treatment affects not only the prescription of medical cannabis, but applies to telemedicine as a whole. Legislators should therefore find a solution that covers all cases in this problem area, rather than just a lex specialis „medical cannabis flower.“ If video consultations are expressly enshrined in § 3 MedCanG or in another general solution (e.g., in the AMG – German Medicines Act), this will also ensure that they are compatible with medical standards and medical care within the meaning of § 7 MBO-Ä, which also offers doctors additional legal certainty.
The accusation of abuse made by Federal Health Minister Wacken would then also no longer be tenable.
Mail order
The ban on mail order does not make any sense and would be a deterioration of the situation prior to the CanG coming into force in 2024. It is not clear why patients who, after receiving „treatment“ and a prescription for medical cannabis flowers, are forced to go to their local pharmacy or possibly even further afield, as the nearest pharmacy may not always have the product in stock. Neither for health policy nor legal policy reasons is a ban on mail order necessary, let alone proportionately!
There are enough laws!
Further violations by the companies involved in supplying the population with medical cannabis, such as advertising bans, the prohibition of referrals in exchange for payment by doctors and pharmacists, establishment requirements, and violations of medical independence, can be avoided through intelligent and legally compliant business models; the existing legal instruments for this are available and sufficient.
If competition, associations, authorities, and ultimately the courts consistently ensure compliance with and enforcement of the existing legal framework, the current heated discussion would slowly but surely calm down again, especially with a clarification on mandatory annual video consultations.
The end of dried flowers?
The additional demands made by certain pharmacists and medical associations to remove medical cannabis flowers from the list of prescription drugs are way off the mark. In 2016, seriously ill patients won the right in court to grow their own medical cannabis flowers, which led to the introduction of the Cannabis as Medicine Act in 2017. Since 2017, medical cannabis flowers can be prescribed and dispensed through pharmacies, even though they have not been clinically approved under the Medicines Act. In 2024, with the removal of cannabis from the BtMG, the legislature made a conscious decision for the second time to allow cannabis as a prescription drug with even fewer requirements (no longer requiring a narcotics prescription, normal security measures, no risk assessment anymore, etc.).
Compared to the regulations for approved finished medicinal products that have been in force since the 1970s, whose safety and efficacy must be proven in extensive clinical studies, this represents a break with the system.
We now have to live with this break with the system and learn to deal with it, because medical cannabis flowers for inhalation are proving their medical effectiveness every day with countless patients, even if this has not yet been conclusively proven in clinical studies.
The dogged fight against medical cannabis flowers and the defense of the holy grail of drug approval are hardly rational anymore and are incompatible with modern medical care that is open to new therapies.