European Medical Ecosystem Published by the First Wednesdays network, with insights provided in partnership with Hanway Associates and Invest In (part of the Danish Ministry of Foreign Affairs).

PUBLISHED NOVEMBER 2020 Contents

Production Contributors Introduction 3 Georgia Glick Michael Prytz Laurence Busch Hansen Derek Light Inclusion Criteria 5 Pierre-Yves Gallety Dr Marco Ternelli Elisabetta Calabritto Marion Zammit Alastair Moore José Antonio de la Puente European Ecosystem 7 Jakob Sons Insights Dr Verónica Codesido Sampedro Trends and Insights 17 Lily Temperton Boris Baňas Kailey Jamieson Nethaji Gallage Charlotte Bowyer Dr. Steve Hajioff Opinion Leaders – What Lies Ahead 36 Tom McDonald Dr Saoirse O’Sullivan Franjo Grotenhermen Nick Pateras Medical Cannabis in Denmark 39 Pete Patterson

First Wednesdays European Medical Cannabis Ecosystem 2 Introduction

What is so special about the European Market projections and financial analysts We are already seeing signs that the Underpinning all this innovation is research. medical cannabis ecosystem is that it is point to the large population of Europe and sector is being taken more seriously by The Netherlands is home to approximately 30% talk about how demand will surpass all of Europe’s active cannabis and cannabinoid uniquely European. regulators and corporates alike. expectations in the years to come. But how clinical and Germany home to another 15% It has developed its own regional outlook does a nascent market struggling to find its State-supported cannabis startups and trials, with the UK following closely with 20% for how it wants to regulate cannabis and footing become the behemoth it is expected the appearance of more mainstream Whatever your thoughts about the market, implement access programmes, and in this to be one day? We decided to look under the pharmaceutical companies on the scene are the right foundations are being laid for a very process has developed its own entrepreneurial hood of some of the most exciting companies, two indications that this is happening. interesting journey over the coming years. flair. markets and trends to find out where the real potential lies. Two European states, Denmark and Greece, A mix of socialised healthcare, a which have recently embraced the medical pharmaceutical heritage, and being later to the The promise of foreign investment, job cannabis sector have already attracted Alastair Moore party than the US and Canada has created a creation and economic growth is alluring, proposed foreign investments of more than CO-FOUNDER, HANWAY ASSOCIATES strict medical approach to cannabis medicines but the journey towards a sustainable and €610 million according to recent reports. AND FIRST WEDNESDAYS – one that is (mostly) with the grain of the commercially profitable sector is a long medical establishment, not against it. one, and Europe is just at the beginning of From to Berlin, life science this journey. Without companies that tackle start-ups jostle for capital and new specialist Compare two investor decks from both sides regulators’ concerns around black market cannabis investment funds in Stockholm and of the Atlantic and you can quickly see the diversion, the lack of patient data, or doctors’ Paris stoke investor interest in the sector. differences in how we talk about cannabis as a unfamiliarity and cautiousness in prescribing medicine, how it should be controlled and the a medicine that has typically been consumed UK financial regulators have announced that regional-specific concerns its proponents need as a combustible, there will be no real long- British-based medical cannabis businesses to address. term growth in the sector. have a compliant path to the public markets in London, while Scandinavian stock The European medical cannabis ecosystem Companies solving these problems already exchanges signal they are open for business. is maturing quickly as experienced founders exist, and their presence is promising. Patient and investors move into the sector and shape data apps, medical devices, formulation Competition in crowded markets such as not only the discourse but also the value chain technologies and plant R&D are propelling the Germany pushes competitors to innovate around it. It is in this context that we are very sector towards its ambitious goals. The sector with their supply chains, breaking established excited to bring the first European medical is truly aspirational and full of problem solvers, monopolies; meanwhile, Spain, a world leader cannabis ecosystem map to our network. giving us great faith in its chances of success. in morphine production, dips its toes in the arena through traditional pharma routes.

First Wednesdays European Medical Cannabis Ecosystem 3 Mapping the Ecosystem

This section has been produced in collaboration with First Wednesdays.

First Wednesdays is a network of entrepreneurs and investors in the European cannabis sector. FW members benefit from news, insights, matchmaking and business support. Inclusion Criteria — General

INCLUSION CRITERIA

→ This list has been compiled primarily from → Vertically integrated companies active the First Wednesdays member database in multiple segments have been listed in and publicly available information the segment they are best known for. alongside targeted interviews with non- → In addition to these general members. requirements, companies must also → The ecosystem features the top 150 adhere to the relevant value-chain companies which are currently active in the specific requirements set out on page 6. legal, European medical cannabis market → Dispensing has not been included on the based on the following criteria. ecosystem map as this role is typically → We have only featured companies who undertaken by non-cannabis specific have headquarters or an important hub community pharmacies. Prescribing and in Europe, or otherwise have a key role in dispensing in Europe is discussed on supplying the market. page 18.

First Wednesdays European Medical Cannabis Ecosystem 5 Inclusion Criteria — Value Chain Step-Specific 01. GENETICS & 02. CULTIVATION 03. TESTING 04. RESEARCH 05. EXTRACTION / SEED BANKS PURIFICATION Commercial R&D → Provided seeds or genetics → Cultivating in Europe for medical → Hold an EU-GMP certification → Primarily focused on → Active R&D into agritech / to at least one company that purposes with required licenses cannabinoid extraction for → Must have ISO/IEC 17025 growing conditions, new is active in the European and/or awarded a cultivation medical purposes → Must have all the relevant product development or medical cannabis industry tender by a national authority licences medical efficacy → Providing genetics as → Already have seeds in the ground → Not a genetics company a service rather than → Contract cultivation for production an internal breeding of licensed pharmaceuticals has Research & Academic Groups programme not been included → European institution championing or actively → We have not included facilities researching medical cannabis under construction

06. FORMULATION / 07. BRANDED MEDICINES 08. TECHNOLOGY 09. DISTRIBUTION MANUFACTURE → Hold the required licenses and → Duplications from value chain → Developer of specialised → Distributing a medical EU-GMP certification segments permitted equipment, software, or cannabis product that medical devices for the → Ongoing manufacturing of → Must have sold branded requires a prescription to at medical cannabis market medical cannabis products or products to patients in least one European market APIs / active substances Europe → Hold required authorisations → Hold an EU GDP certificate and certifications → Producers of unlicensed → We have included the and WDA/WDL cannabis medicines that company that is listed as → Unlicensed cannabis manufacture and distribute owing the product (ie. not the companies that manufacture are listed as a manufacturer company that white-labelled) and distribute are listed as a if they formulate their own → We have included the parent distributor if they primarily medical cannabis products company or most relevant distribute other companies’ sub-division products First Wednesdays European Medical Cannabis Ecosystem 6 06. Formulation & Manufacture European Medical 09 Cannabis 08 Ecosystem 07. Branded Medicines

06 05 01. Genetics & Seeds Banks

07 08. Technology

02. Cultivation

03 04 04. Research 09. Distribution

05. Extraction & Purification 03. Testing

02 01 First Wednesdays European Medical Cannabis Ecosystem 7 01. Genetics & Seed Banks HANWAY INSIGHTS

→ There are currently a limited number of European companies producing specialised seeds and genetics for the European medical cannabis market. → The majority of seeds are supplied by companies geared towards grey and recreational markets. → The need for reliable genetics and increasing R&D in this field will drive development of cultivar catalogues tailored for medical use. → Specifically we expect to see improved stability become a key focus alongside bespoke cannabinoid and terpene profiles. → Until this area of the market is fully developed, companies are likely to continue to source from grey market seed suppliers and licensed operators in Canada.

If you require support building your supply chain, contact us here.

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First Wednesdays European Medical Cannabis Ecosystem 8 02. Cultivation HANWAY INSIGHTS

→ European medical cannabis cultivation is undertaken by a number of operators across several countries. While many active operators are based in Portugal due to favourable growing conditions and licensing processes, we expect other South European markets such as North Macedonia and Greece to feature more prominently from 2021 onwards. → Europe does not have a harmonised approach towards cultivation licensing. While each country’s framework remains unique, several distinct models have emerged depending on the country’s motivation for regulating production. → Several European countries, such as Germany and Denmark, have licensed cultivation to reduce reliance on imports, ensure suitable supply for domestic patients and minimise public health insurers’ costs in the case of Germany. → Other jurisdictions have formed medicinal cannabis frameworks focused on commercial exports rather than domestic supply. Exports from Spain and Portugal indicate a wider European cultivation market is developing, with viable supply no longer limited to Bedrocan from the Netherlands. → The recent introduction of low-cost GACP producers into the European market, such as Uruguayan producer Fotmer, indicates the 02 start of a disruption in the market with the need to maintain top quality, differentiated offerings at a competitive price. First Wednesdays European Medical Cannabis Ecosystem 9 03. Testing HANWAY INSIGHTS

→ There is currently an undersupply of reliable, scalable testing companies across the region, evident by the limited number of companies presented on the ecosystem. → Inconsistencies in quality standards can occur, where different methods for testing can result in confusion regarding results. → Not all testing companies are accredited to an internationally recognised standard, such as ISO/IEC 17025. → Speeds of analysis can vary across companies. In some instances delays have been reported with samples sent internationally for final testing. → There is a clear space in the market for a reliable, accredited, fast and widely trusted testing company.

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First Wednesdays European Medical Cannabis Ecosystem 10 04. Research HANWAY INSIGHTS

→ Despite Europe’s leadership in biotech and agritech fields, companies in these sectors have been slow to engage with cannabis, both in terms of clinical research and process innovation. → Regulatory barriers have inhibited commercial research, with the financial and time cost of high-THC licence applications often deterring companies from this space. → Positive progress is underway however, as growing medical markets shine a light on research and IP opportunities within the sector. → Growing numbers of cultivators looking to increase output and optimise revenue are helping to drive this momentum and are eager to collaborate and engage with research companies. → Innovation grants and support from governments can be patchy and funding support varies across European countries. At times, cannabis falls between the cracks of medical and agro-food funding, and is sometimes explicitly excluded from funding opportunities. 04

First Wednesdays European Medical Cannabis Ecosystem 11 05. Extraction & Purification HANWAY INSIGHTS

→ Despite a growing number of sites capable of conducting EU-GMP standard extraction and purification, there is a shortage of contract extraction facilities in Europe with most facilities being built to meet internal capacity requirements. → To date, many producers have established or acquired their own extraction facilities in a move towards vertical integration. → There is a growing preference for oils and extracts in Europe due to the need for precise dosing and targeted formulations rather than the vaporising of cannabis flower. → In North Macedonia only oils and extracts are permitted for export, positioning extraction facilities as an essential part of the supply chain. Yet without viable third party facilities in place, Macedonian cultivators are resorting to freezing harvests of flower.

If you require support building your supply chain, contact us 05 here.

First Wednesdays European Medical Cannabis Ecosystem 12 06. Formulation & Manufacturing HANWAY INSIGHTS

→ In contrast to North American markets, manufacturing and formulation activities have grown in significance in Europe due to demand for dosable, pharmaceutical-style products. This has resulted in a growing market segment with a substantial number of companies focusing on such operations. → Developments in manufacturing techniques further enable targeting of specific conditions, in line with growing research into the conditions medical cannabis can be prescribed for. → Europe is expected to drive the next stage of product development. Specialised manufacturers are producing sophisticated product formats that lend to use in clinical trials, and will arguably allow medical cannabis markets to develop in countries that are skeptical of flower.

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First Wednesdays European Medical Cannabis Ecosystem 13 07. Branded Medicines HANWAY INSIGHTS

→ The past year has seen a surge in the number of branded cannabis products available to patients across Europe. → This increase has predominantly come from European innovators challenging the dominance of Canadian LPs and Bedrocan, who until 2020 supplied the vast majority of flower and full spectrum extracts to the European market. → White labelling has increased in prevalence with local companies processing and packaging flower and extracted products originating from Canada and countries with low cultivation overheads. → As the number of products available continues to increase, companies will need to establish novel ways to differentiate themselves, whether through clever branding (see Spectrum’s colour coded products), enhanced healthcare practitioner education or, ideally, thorough generation of valid clinical evidence. → Understanding country specific regulations and healthcare practitioner perceptions is vital to succeed in bringing 07 a new product to market in Europe. If this is something you require support with get in touch.

First Wednesdays European Medical Cannabis Ecosystem 14 08. Technology HANWAY INSIGHTS

→ To date, technological innovation within the European cannabis sector has been limited outside of a few key areas such as extraction and product formulations. → This is, in part, due to the relatively low patient numbers that make costly R&D activities less attractive than in more mature markets, such as the US and Israel who also benefit from a rich health tech ecosystem. In addition, technological innovation is likely to be limited by the need to develop products specifically for the medical market and the regulations associated with this. → Specific areas with strong promise for innovation in the coming years include: • Big data analytics to accelerate the drug development pipeline • Patient facing apps and wearables to maximise adherence and generate real world evidence • Intelligent agritech solutions to maximise the efficiency of European cultivation facilities → There is a clear opportunity to excel in this space as many non-European companies will focus on the local 08 opportunity for the foreseeable future and commonly struggle to meet the stringent European requirements for medical technologies.

First Wednesdays European Medical Cannabis Ecosystem 15 09. Distribution HANWAY INSIGHTS

→ Medical cannabis distribution is currently one of the most competitive segments of the European market. → Medical cannabis is typically distributed by cannabis-specific or specially unlicensed medicine distributors. However, Europe has started to see traditional pharma companies such as STADA also begin to enter the sector. → Distributors tend to only operate within one country in Europe, despite the same products being supplied across multiple jurisdictions. However, some distributors are emerging as multi-country operators and we expect this trend to continue as sales increase across Europe. → Licensed distributors typically supply licensed pharmacies, which in turn are able to fulfill patients’ prescriptions. Distributors are also able to supply other licensed wholesalers and distributors, as seen. → Many licensed producers have acquired national or regional distributors to secure 09 a vertically integrated supply chain, in some cases providing exclusive access to the distributor’s established network.

If you require support building your supply chain, contact us here.

First Wednesdays European Medical Cannabis Ecosystem 16 Trends & Insights

1. Prescribing and Dispensing 2. Isolated Cannabinoids 3. Catalysts for Change 4. Domestic Cultivation 5. Research and Clinical Trials 6. Opinion Leaders

This section has been produced in collaboration with Hanway Associates.

Hanway Associates is a strategic consultancy specialising in cannabis research, new market entry, commercial diligence and M&A strategy. Hanway Associates provide services to help open and enter markets, build brands and grow clients’ networks, as well as producing ready-to-buy reports to help companies navigate a complex and rapidly changing industry. 1. Prescribing and Dispensing — Extemporaneous Preparations

The prescribing and COMPOUNDING PHARMACIES dispensing landscape In European countries such as Germany Under the new interpretation, pharmacies will In Germany, cannabis supplied to varies between countries and Italy, pharmacists play a large role no longer be permitted to ship prescriptions pharmacies must be as a ‘bulk intermediate in Europe. We have in preparing formulations. This allows for to patients or produce oil in bulk, and will be product’ rather than a finished product, and outlined some of the key the provision of personalised medicines to limited in the product formats they are able compounding is a compulsory step. The differences including patients. The focus is therefore less on off- to process. Dr Ternelli explains, DAC/NRF (New German Formulary) states uptake of magistral the-shelf cannabis products, and more on the types of cannabis medicines pharmacists preparations and the targeting a patient’s specific need. The Italian can formulate, including oils and capsules compounding route, as Although there is no new law pharmacist Dr Marco Ternelli reports that in prepared using dried flower or . well as the importance or decree, the Ministry of Italy, Health has issued an absurd Flower may also be prescribed, and weighing of private and in driving and re-packaging by pharmacists constitutes patient demand and interpretation, denying The most prescribed and the required processing step. access to medical pharmacies the ability to preferred forms are oral oils cannabis in several produce cannabis extracts for and capsules, followed by European countries. non oral use (eg. eye drops, sachets for vaporising. creams, suppositories) and A recent interpretation issued by the Ministry shipping directly to patients of Health in Italy is believed to have a (home delivery) though negative effect on patients accessing medical courier. An appeal to court cannabis preparations. is currently being issued by some pharmacists.

First Wednesdays European Medical Cannabis Ecosystem 18 1. Prescribing and Dispensing — New Routes to Access

TRIALS PRIVATE & SPECIALIST CLINICS The UK has a unique clinic-focused ecosystem. → A lack of evidence is often cited by → Private prescribers and specialist clinics regulatory bodies as a key barrier to wider have been a key driver of industry growth Some of the operators include: medical cannabis adoption and access. in some countries where physician → There are currently several medical cannabis awareness is low or national cannabis trials taking place or due to start health insurance coverage is limited. in the near-future in Europe. It is hoped → Specialist clinics have enabled patient these, alongside the launch of patient access to medical cannabis in countries registries such as Project Twenty21 and with restrictive prescribing frameworks such the Sapphire Registry, will contribute to as the UK and Poland. In the UK, specialist evidence on the effectiveness and safety of clinics have allowed those with conditions medical cannabis. and symptoms currently not advised to be → Combined, specialist clinics, trials and prescribed medical cannabis under NICE registries are helping to overcome the guidelines such as chronic pain, cancer and barriers remaining in the European psychiatric conditions, to access medical medical cannabis industry. cannabis. → By contrast in Germany, cannabis-specific clinics are not permitted under healthcare regulations. Centres of knowledge for the treatment of a specific disease are permitted, however this is not the case for a specific medication such as cannabis.

First Wednesdays European Medical Cannabis Ecosystem 19 2. Isolated Cannabinoids — Synthetic and Plant Derived

Despite representing a significant percentage of Isolated cannabinoids present a strong medical cannabis prescriptions in Europe, isolated investment opportunity through the ability cannabinoids are often an overlooked product to develop IP and patent bespoke, targeted category compared to flower and whole plant formulations. In line with Europe’s status as a extracts. However, there has been an increase in pharmaceutical hub, European producers have European demand for isolated cannabinoids (both been a major driving force behind innovations synthetic and plant-derived), with dronabinol to synthesize and isolate rare and novel (isolated THC) playing a central role in Germany, cannabinoids, in addition to those typically Denmark, Austria and Switzerland. Synthetic required as an active pharmaceutical ingredient cannabinoids can be more palatable to regulators (API) for magistral preparations. and have enabled significant medical cannabis markets to develop in countries such as Austria, which currently prohibits prescriptions of flower and full spectrum extracts.

First Wednesdays European Medical Cannabis Ecosystem 20 2. Isolated Cannabinoids — Definitions

KEY INFORMATION

Synthetic Isolate Full-Spectrum

DEFINITION Synthetic cannabinoids are the result of Individual cannabinoids can be purified to Full-spectrum refers to a form of plant- chemical or biochemical synthesis methods to reach beyond 99.5% purity and can be either derived cannabis containing all naturally reproduce compounds found in the cannabis crystalline or oil form at room temperature. occurring cannabinoids, terpenes and plant, or artificial derivatives. This laboratory other compounds. The cannabinoid profile process produces a pure isolated compound, may vary due to difficulties standardising once the byproducts of synthesis have been composition. removed.

SOURCE Laboratory Laboratory or plant Plant

NUMBER OF Single Single Multiple COMPOUNDS

First Wednesdays European Medical Cannabis Ecosystem 21 2. Isolated Cannabinoids — Advantages

ADVANTAGES OF SYNTHETIC CANNABINOIDS ADVANTAGES OF ISOLATED CANNABINOIDS

SUPPLY CHAIN COST RESEARCH POTENTIAL TARGETED THERAPEUTIC PROPERTIES

Synthesis avoids supply The movement towards synthetic Single compounds are better-suited Unlike whole plant products, disruptions arising from compounds has already been for use in trials to identify the effects isolated cannabinoids make failed harvests and difficulties experienced with the likes of aspirin, of specific cannabinoids. Synthetic it possible to utilise minor transporting the controlled plant caffeine and multivitamins due to cannabinoids are typically easier cannabinoids with high matter. It enables manufacturers their lower production costs and the to obtain for research purposes therapeutic potential to target to scale production depending capacity for large-scale production. and are sometimes viewed more specific medical conditions, and on market demand and While the cost of synthetic favourably from a regulatory to avoid unwanted side effects changing national requirements cannabinoids is currently high standpoint, driving progress towards caused by the presence of THC and regulations. relative to plant-based production, the body of evidence needed for patients that express sensitivity. prices are falling with new market for wider adoption of medical entrants and increasing R&D. cannabinoids.

First Wednesdays European Medical Cannabis Ecosystem 22 2. Isolated Cannabinoids — Regional Popularity

WHY ARE ISOLATED CANNABINOIDS Several European countries introduced access to Isolated cannabinoids have gained significance MORE SIGNIFICANT IN THE EUROPEAN synthetic cannabinoid products (e.g. Nabilone and in Europe partly due to widespread adoption of MARKET THAN AT A GLOBAL LEVEL? Marinol) at an early stage, before implementing a the pharmacy compounding model, particularly in broader medical cannabis program or pilot. Dronabinol Germany and Italy. Several key European markets was the first cannabinoid product in Germany that allow pharmacists to prepare patient-specific could be prescribed by the country’s doctors and magistral preparations in accordance with national accessed through the traditional medicines system. monographs, offering doctors and patients a greater choice of formats and strengths. Magistral European medical cannabis access is largely through preparations are more easily and consistently conventional medical and pharmaceutical frameworks. prepared using active pharmaceutical ingredients As such there are greater requirements for product (e.g. isolated THC and CBD) rather than the standardisation, quality and evidence than North alternative method of performing in-house extraction American markets, where conventional pharmaceutical using plant material. standards do not apply to medical cannabis. Isolated cannabinoids are highly standardised and optimised to ensure consistency in trials, R&D and patient-specific formulations.

First Wednesdays European Medical Cannabis Ecosystem 23 2. Isolated Cannabinoids — European players driving the rise of isolated cannabinoids

→ C3, formerly a sub-division of Bionorica SE, is → Cantourage is a new entrant to the German the leading manufacturer and distributor of medical cannabis market, founded in 2019 by dronabinol, founded in 2014 and acquired by Dr. Florian Holzapfel and Patrick Hoffmann, Canopy Growth in May 2019. who previously sold Pedanios to Aurora. → Until recently, C3 held a monopoly in supplying → Cantourage is the first firm to challenge the German market with dronabinol, used the established C3 in the European market by pharmacies to produce patient-specific through its imports of dronabinol from formulations. Competition has increased since exclusive Israeli partner BOL Pharma, the introduction of Cantourage, and Tilray and has been supplying THC as an API to also intends to bring dronabinol to the market, German pharmacies since April 2020. though the supplier is not yet known. → Cantourage aims to increase product variety, → The Austrian Agency for Health and Food drive innovation and ensure reliable supply Safety (AGES) has a contractual partnership of product. with C3, with C3 performing extraction and manufacturing dronabinol from cannabis produced domestically by AGES.

First Wednesdays European Medical Cannabis Ecosystem 24 2. Isolated Cannabinoids — European players driving the rise of isolated cannabinoids

CBD is gaining attention in the We saw an opportunity to harness pharmaceutical and cosmetic industries. It synthetic biology to deliver new health → CBDepot is a pioneer can be extracted from the plant or chemically → Octarine is a synthetic care solutions. Many neurological and in the production of synthesized. Evidence of CBD’s potential biology company psychological conditions are poorly served cannabinoid ingredients. health benefits in scientific literature are developing cannabinoid by current drugs, leaving physicians from studies analysing pharmaceutical-grade and patients desperately seeking Its Novel Food application and psilocybin derivatives CBD, which is different from isolated CBD. alternatives. Cannabinoids are poised to for synthetic CBD was the We deal with synthetic CBD to be in line with through microbial offer breakthrough therapies for these first cannabinoid novel clinical data and ensure the quality needed by fermentation. conditions, but to realise the full potential food application to be regulatory bodies. → Octarine was awarded of these molecules, issues with their validated by the European the TWB (Toulouse White production and undesirable properties Producers getting CBD from the plant Commission, and is Biotechnology) award in must first be solved. must contend with impurities exceeding one of only three CBD 2020, granting access to levels that are standard in pharmaceutical Our platform is focusing on improving applications under review TWB’s technical platforms by the European Food practice. Synthetically produced CBD is well cannabinoids molecules through enzymatic characterised with no minor cannabinoids with a high level of scientific modifications and developing NCE’s Safety Authority (EFSA). and other impurities. support. targeting selective therapeutic indications. → CBDepot’s sister company BORIS BAŇAS – CSO AT CBDEPOT → Received funding from NETHAJI GALLAGE - FOUNDER AND CEO OF OCTARINE CB21 Pharma received EU- Bruce Linton in January GMP certification in June 2020, the former CEO and 2020 for its manufacturing founder of Canopy Growth, of Cannabidiol API. to fund R&D and strengthen existing IP.

First Wednesdays European Medical Cannabis Ecosystem 25 3. Catalysts for Change — Gradual Acceptance

The past decade has seen the emergence of medical by limited insurance coverage. Robust reimbursement NUMBER OF MEDICAL CANNABIS PATIENTS cannabis programmes across the globe, with a policies and favourable prescribing criteria solidified IN THE CZECH REPUBLIC, 2018 - JULY 2020 growing number of European nations expanding Germany’s position as Europe’s largest medical market, their conventional medical frameworks to provide and the number of patients in the Czech Republic has 1250 access. European reform has progressed through risen significantly since public health insurance coverage different legal frameworks to those established in in was mandated early this year. 1000 North America, where ballot initiatives and political We expect to see increased acceptance and adoption of manifestos provided the catalyst for reform. Patient medical cannabis programmes as the clinical evidence 750 advocacy groups have played a substantial role in base continues to develop, allowing prosperous shifting public opinion in favour of medical cannabis domestic industries to develop and the number of 500 through high-profile cases, and political barriers to eligible conditions and patients receiving treatment to reform are steadily being dismantled. increase throughout Europe. 250 Several countries (e.g. France & Denmark) have opted to introduce medical cannabis through time-limited Many patients are now able to access 0 cannabis medicines legally, and ‘pilots’ rather than permanent regulatory frameworks, 2018 January 2018 December 2019 December with their success partly reliant on the budget and advocacy groups have been instrumental 2019 January 2020 January in engineering this change. There is resources allocated to the scheme. However, cost Introduction of public health insurance coverage still work to be done and we believe that remains a hurdle for patients in Europe. cross-jurisdiction communication and Source: SAKL The Netherlands was the first European nation to collaboration will continue to improve introduce access to medical cannabis, yet patient the lives of patients. adoption rates and market growth have been hindered PAUL NORTH, DIRECTOR OF VOLTEFACE

First Wednesdays European Medical Cannabis Ecosystem 26 3. Catalysts for Change –

Key Moments UK NORTH MACEDONIA June 16, 2010 February 9, 2016 Sativex is first Macedonian Parliament ADVOCACY GROUP licensed by Health Committee MHRA for treating approves the legalisation of Espoirs (Im) spasticity in medical cannabis, effective patients patients with MS June 2016 Families 4 Access AUSTRIA CROATIA LUXEMBOURG Volteface July 9, 2008 October 15, 2015 November 7, 2017 Cannamedica Parliament approves Legalises medical 2 year medical Luxembourg cannabis cultivation cannabis for specific cannabis pilot project Cannabis and use for scientific purposes, limited to approved for a limited Danmark and medical purposes 0.75 grams of THC per number of patients patient per month MAMAKA – SWITZERLAND GERMANY Mothers for July 1, 2011 March 10, 2017 Cannabis Narcotics Act is Amendment to the Hanf revised to allow Narcotics Drugs Verband Federal Office of Act enables wider Public Health to issue medical cannabis exceptional licenses prescriptions for medical cannabis without requiring exceptional permission from BfArM. NETHERLANDS ITALY CZECH POLAND GREECE January 1, 2001 January 23, 2013 REPUBLIC June 22, June 30, 2017 Legalised medical Legalised medical April 1, 2013 2017 Legalised medical cannabis and established cannabis for Legalised Legalised cannabis for the Bureau Medicinale prescription through medical medical prescription Cannabis, responsible for Ministerial Decree cannabis for cannabis for overseeing production prescription prescription following a landslide vote in the lower house of parliament

First Wednesdays European Medical Cannabis Ecosystem 27 3. Catalysts for Change – Key Moments

CZECH LUXEMBOURG IRELAND REPUBLIC June 28, 2018 June 26, 2019 Legalised medical Minister for Health signs January 1, 2020 cannabis for legislation enabling the Law mandates public MALTA prescription by any GP Medical Cannabis Access health insurance to Programme as a 5 year reimburse 90% of the March 23, 2018 pilot project prescription price Legalised medical up to 30 grams per cannabis for month, significantly prescription through expanding patient an amendment access to the Drug Dependence Act PORTUGAL CYPRUS EUROPEAN UNION July 18, 2018 February 15, 2019 September 23, 2019 Legalised Legalised cultivation Epidyolex receives EMA DENMARK medical cannabis and medical use of approval for the treatment January 1, 2018 for prescription cannabis through of seizures in childhood- Four year medical amendments to the onset epilepsy cannabis pilot Drugs and Psychotropic project commences Substances law

UK LITHUANIA FRANCE October 11, 2018 October 11, 2018 October 25, 2019 Regulatory Parliament approves a law National Assembly amendment enables allowing for medical use of of France authorises the prescription of cannabis, with an effective plans for a two-year medicinal cannabis date of 1 May 2019 medical cannabis trial, due to commence in 2021

First Wednesdays European Medical Cannabis Ecosystem 28 4. Domestic Cultivation — Exploring the Models

Alongside medical cannabis treatment The number of countries with significant cultivation FOUR OVERLAPPING APPROACHES programmes, a significant number of European capacity is expected to increase sharply in the next TOWARDS LICENSING CULTIVATION countries have introduced domestic cannabis five years. The global flow of medical cannabis is likely ARE EMERGING IN EUROPE: cultivation for medical and scientific purposes. to shift as facilities in Europe and the global south become operational, providing viable alternatives to 1. Production solely for domestic patients European cannabis markets have often faced supply from the Netherlands and Canada. shortages of readily available flower or formulated 2. Export-focused production products. To date, a limited number of licensed European countries are moving away from a state- 3. Production exclusively for producers have been able to meet EU-GMP issued monopoly approach to cultivation towards pharmaceuticals standards required for prescription to patients public tenders for a designated capacity or issuing 4. Hybrid production model through the conventional medicines framework. open-ended commercial licenses. In Southern Europe There is no harmonised supply chain model ensuring there is an increasing trend towards an open market patient access to products in Europe, despite the model with no cap on the number of producers or same products being nominally available in many total cannabis output. jurisdictions across the continent.

First Wednesdays European Medical Cannabis Ecosystem 29 4. Domestic Cultivation — Production Solely for Domestic Patients

Through this model, production is licensed for the purpose GERMANY ITALY CZECH REPUBLIC of ensuring stable supply for FRAMEWORK → State-issued commercial tender → State-controlled monopoly → State-issued commercial tender domestic patient requirements. CULTIVATORS → Aphria, Aurora, Demecan → The armed forces, Military Chemical and → Elkoplast Slušovice Cultivation may be overseen Pharmaceutical Plant (SCFM) by a state body, or contracted QUANTITY → 10,400kg over a four-year period → 200kg estimated current capacity → 40kg over a four-year period to commercial companies CONTRACTED → 13 lots of 200kg were issued, totalling 2,600kg per → Health Ministry authorised expansion up to 500kg through state issued tenders. year in 2020 The contracted quantities QUANTITY → N/A → 157kg supplied to pharmacies → 25kg supplied to the government have tended to be lower SUPPLIED IN 2019 → First harvest expected Q1 2021 → 17kg sold by pharmacies than the volume of medical cannabis required by domestic PRICE PAID → Estimated average of €2.30 → €6.88 → CZK 139 plus VAT (~€5.11) TO DOMESTIC patients, maintaining a need CULTIVATOR PER to supplement production with GRAM' imports. INSIGHTS → An estimated 6,500kg was imported for dispensing → Domestic production remains insufficient → Elkoplast Slušovice was the only bidder in the to domestic patients in 2019. Imports will still be compared to patient demand. Just 11% of cannabis most recent tender in 2017, and previous tenders required to supplement domestic supply. sold in 2019 was produced by SCFM. were reportedly cancelled due to no applications → The government may purchase a larger → Production is supplemented by imports from being made. quantity depending on the size of the harvests, Bedrocan and a state-issued tender of which → In 2019, imports from Bedrocan and Canadian at a potentially lower cost than the previous Aurora was the sole winner. producers still occurred despite production government estimate of an average €2.3 per → SCFM has signed a three-year joint venture with volumes being greater than demand. This is gram. the Italian region of Tuscany, in part exploring thought to be the result of both quality and → The first tender was issued for just 6,600kg over a production of flower and standardisation of oil logistical challenges. four-year period, but was cancelled due to legal extracts. challenges.

First Wednesdays European Medical Cannabis Ecosystem 30 4. Domestic Cultivation — Export-Focused Production

Several countries have legalised PORTUGAL SPAIN MALTA NORTH GREECE cannabis cultivation with an eye to MACEDONIA capture the export market, driven by opportunities for foreign direct INSIGHTS → Emerging as a European → Developing as a → Viewed as a strategic → Likely to become an → Significant number of investment and economic growth. Most cultivation hotspot due cultivation, research and entrypoint into export hub if regulations licenses have been issued to a favourable climate, manufacturing hub for Europe and hub for are amended, due to for production. of these countries have limited domestic low production costs export. manufacturing due climate, low costs of → Many sites are still under markets and in some instances no and an efficient licensing → No licensed medical to accommodating production and intention development or awaiting framework for medical access. In order framework. cannabis scheme regulations. to join the EU. regulatory approval. → A framework for - patients access → Many companies based → Currently restricted by for an export-driven market to succeed, domestic patient access cannabis through a non- outside of Europe plan regulatory barriers and originating countries must implement a is in place, although no commercial, quasi adult- to export to Malta for inability to export dried framework requiring quality standards products have yet been use model. processing prior to for EU flower. approved. distribution. to at least the level of the destination country. However, not all jurisdictions with an international focus have the requisite frameworks fully in place, and it remains to be seen which countries will succeed in capturing market share.

First Wednesdays European Medical Cannabis Ecosystem 31 4. Domestic Cultivation — Production Exclusively for Pharmaceuticals

In these markets, no dried flower is currently produced as an end product UNITED KINGDOM AUSTRIA for either domestic patients or exports. PURPOSE → Production of Sativex and Epydiolex → Production of Dronabinol (isolated THC) Aside from research, cultivation MANUFACTURER → GW Pharmaceuticals → Bionorica Ethics (C3) is currently licensed solely for the purpose of producing APIs and licensed pharmaceuticals. We expect this model to shift towards a hybrid one over the next year as local demand for medical CULTIVATORS → Contract growers → AGES - Institute for Sustainable Plant Production cannabis increases and reputable businesses apply for licenses. INSIGHTS → World’s largest exporter of cannabis pharmaceuticals supplying → Dried flower cannot be prescribed to patients in Austria. global markets. → Dronabinol is supplied to domestic patients in addition to export → Domestic market is limited by restrictive prescribing guidelines markets including Denmark, Germany and Switzerland. through the National Health Service (NHS), but private clinics are → Production has significantly scaled up in recent years, from driving increased patient uptake. 59.19 kg in 2015 to 361.78kg in 2018 according to a response to a → In July 2020, the NHS announced plans to manufacture medical parliamentary inquiry in 2019. cannabis oil for a clinical trial for children with severe epilepsy, although no further detail has been provided.

First Wednesdays European Medical Cannabis Ecosystem 32 4. Domestic Cultivation — Hybrid Production Model

In these markets, production is authorised for a dual purpose of THE NETHERLANDS DENMARK supplying domestic patients and FRAMEWORK → State-controlled monopoly → Four-year development scheme to supply domestic patients and driving economic growth through export markets commercial exports of EU-GMP CULTIVATORS → Bedrocan → Uncapped medical cannabis.

INSIGHTS → The Office of Medicinal Cannabis (OMC) purchases all cannabis → The domestic production pilot runs in parallel with the four-year produced by Bedrocan at a mandated price and facilitates medical cannabis pilot programme. distribution and exports. → No cap on production volumes or limit to the number of licensed → The OMC has an ongoing tender application process for a producers. maximum of two new suppliers. → Producers must follow strict requirements including additional → The Netherlands now exports significantly more cannabis than is restrictions on pesticide use and required levels of product sold domestically. 2,150kg was exported to Germany alone in 2019, consistency. compared with 580kg supplied to domestic patients. → A number of international cannabis companies have established facilities in Denmark with a view to develop an export hub to the wider EU.

First Wednesdays European Medical Cannabis Ecosystem 33 5. Research and Clinical Trials — A Demand for Data

A lack of clinical data has been widely cited as the Additionally, regulators’ preference for Despite these barriers, there is evidence of a main factor limiting widespread medical cannabis evidence derived from randomised controlled shift towards companies and research institutes adoption by most European national regulators. trials (RCTs) has also limited uptake by actively engaging in and supporting the Despite this being a well-known issue, the industry researchers due to complexities standardising development of clinical data, with over 27 trials has been slow to rise to the challenge of providing cannabis plant products. As UK medical ongoing in Europe. Such trials will contribute clinical data. This is most likely due to the perceived cannabis expert Dr. Steve Hajioff believes to a wider clinical understanding of medical issues with IP, high investment costs, a lack of cannabis. This, combined with attempts to reduce clinical research experience, the long lead times One of the key barriers to research costs should enable a larger number of patients of developing clinical data, and because cannabis into cannabis- derived medicines in to access much needed medical cannabis continues to remain strictly controlled and subject Europe is the lack of standardisation products in Europe. Dr Saoirse O’Sullivan said, to various rulings in the majority of countries. within proposed studies. We need a Franjo Grotenhermen of the International clear target group of patients, a trial ‘Phase 3 research which leads to Association for Cannabinoid Medicines explains using a single product with a single regulatory approval, changes in that delivery mechanism and a xed dose. clinical guidance and increased clinical With this sort of standardisation, In Europe and especially in Germany con dence in novel products is very researchers will be much more keen there is a growing interest in expensive and generally only carried to do further studies. the medical use of cannabis and out by pharmaceutical companies cannabinoids. In addition, large looking to develop licensed products, pharmaceutical companies are and unfortunately we do not have conducting research on synthetic enough companies like GW carrying modulators of the endocannabinoid out phase 3 research, although this is system, in particular inhibitors of the one of the fastest growing sectors in degradation of endocannabinoids. biotech at the moment.

First Wednesdays European Medical Cannabis Ecosystem 34 5. Research and Clinical Trials — The Statistics

There is a clear growing interest SPONSORS OF ONGOING NUMBER OF CLINICAL TRIALS in research into cannabis and CANNABIS & CANNABINOID RESEARCHING MEDICAL CONDITIONS CLINICAL TRIALS IN EUROPE 1 2 3 4 psychiatric disorders such as Psychiatric schizophrenia, PTSD, fear and 7.4% 70.4% Disorder 27 Government Academic Alzheimer’s ongoing clinical trials phobias. Research Diseases across Europe for a Cancer wide range of medical Over conditions such as: Neuropathic Pain → Multiple sclerosis (MS) Cancer Pain → Neuropathic pain Tic Disorders and % Tourette Syndrome 70of these trials are → Tic disorders and Spasticity Tourette Syndrome sponsored by academic or Driving → Cancer pain research institutions such as King’s College London, Cannabis Abuse → Chemotherapy induced or Dependence Universiteit Utrecht and nausea and vomiting 22.4% MS Maastricht University. Private Chemotherapy Induced Nausea and Vomiting Endometriosis

Epilepsy

Cardiometabolic Disease Brain Functioning Source: www.clinicaltrialsregister.eu

First Wednesdays European Medical Cannabis Ecosystem 35 6. Opinion Leaders — What Lies Ahead

HEAD OF THE MEDICAL CANNABIS CLUSTER CEO Marion Zammit José Antonio Malta Enterprise de la Puente Linneo Health

Malta continues to attract and approve projects with the intent of setting up The EU medical cannabis industry is ready to operations in this sector. The first jump to the next stage. The pharmaceutical manufacturing licenses have been industry needs more sophisticated products awarded, both in third countries, as under pharmaceutical standards. It is time in Israel, as well as in Malta. Soon to move from a production focus to a focus on the country shall see its first medical product development. The cannabis industry cannabis products being exported should evolve with that vision, from cannabis from our shores. It is our imperative to growers to pharmaceuticals companies, but continue adding layers and depth to this without losing their agility and flexibility to European ecosystem we are a part of, in navigate in a new world. A robust business order to ensure its long term viability, model, full range of products, scale up competitiveness and success. capabilities and competitiveness will be the key assets for suppliers to be on the ground.

First Wednesdays European Medical Cannabis Ecosystem 36 6. Opinion Leaders — What Lies Ahead

GENERAL COUNSEL AND CO-FOUNDER MANAGER OF CULTIVATION AND BREEDING Jakob Sons Dr Verónica Codesido Cansativa GMBH Sampedro Phytoplant Research S.L.

We observe that the European market is not depending on overseas anymore. The medical cannabis market is still in Pharmaceutical cannabis products its early stage due to a lack of regulatory cultivated and processed in the European consensus in the EU. However, the effort of Union already were launched successfully in scientists, researchers, breeders, lawyers Germany and in 2021 the German domestic and patients are getting heard. When it cultivation will be available for German comes to researching cannabinoids and how pharmacies. Local production facilitates to produce them, fantastic work is being many steps on the pharmaceutical supply done in Europe on the manufacturing of chains and is challenging existing pathways synthetic cannabinoids and the breeding of especially from Canada. However, we phytocannabinoids, both key to increasing the assume that the next game change is quality and safety of cannabinoids to be able already in sight once low-cost production to develop cannabis medicines. can be tapped.

First Wednesdays European Medical Cannabis Ecosystem 37 Medical Cannabis in Denmark

The Danish market has become a In order to accelerate the development biotechnology European ecosystems, uniquely European model for the of the infrastructure and facilitate the with university spin outs, state funding regulation of medical cannabis. In development of cannabis medicines for innovation, and a high concentration 2018, Denmark announced a 4-year for patients in the country, the Ministry of pharmaceutical R&D campuses. program to assess the effectiveness of of Foreign Affairs engages with the In collaboration with Invest in Denmark, cannabis based medicines, and build private sector to inform investors of part of the Ministry of Foreign Affairs the base of what could be a supply of the framework in which Denmark of Denmark and the First Wednesdays pharmaceutical-grade cannabis grown operates in the context of its medical network, Hanway has produced this domestically. cannabis access programme and deep dive into the Danish market. the development of its industry. The Danish model echoes life science and

This section has been produced in collaboration with Invest in Denmark.

Invest in Denmark is part of the Danish Ministry of Foreign Affairs. They provide tailor- made solutions for foreign companies looking to set up or expand business or research activities in Denmark. www.investindk.com 38 Introduction to Medical Cannabis in Denmark

The Danish medical cannabis program is actually scope to explore business models, breeding two parallel four-year trials – one for domestic approaches, and improving cultivation medical use and another for domestic cultivation. techniques. The trial program was launched in 2018 and A clear framework has been set but many backed by a unanimous vote of the country’s opportunities remain to be explored. This parliamentarians. 2020 marks the halfway point of means that cultivators need to engage with the the programs, and an evaluation is pending. The local ecosystem of plant scientists, breeders, Michael Prytz country’s parliamentarians will decide on further INVESTMENT MANAGER, AgTech, and pharma engineering firms to courses of action on whether to extend or adjust MINISTRY OF FOREIGN bring the standards up to higher levels of the program after 2022. The Danish framework was AFFAIRS OF DENMARK medical grade cultivation. It is not a quick copy- developed on a hybrid model, bringing together paste process. Some of the know-how from the “patient-driven model” based on the needs North America and elsewhere in Europe has Derek Light of patients and their doctors, and the “cultivation SPECIAL ADVISOR, been really valuable to the development of a for export model”. This is where the Danish hybrid LIFE SCIENCES, Danish model, but it has required a process model is especially interesting. In Denmark, MINISTRY OF FOREIGN of incorporating and also developing Danish AFFAIRS OF DENMARK cultivation is structured in an open-ended system expertise to help the industry. with no cap on production volumes and no limit to the number of licenced producers. Berit Chavez Azeri INVESTMENT MANAGER, It is based on a pharma paradigm that requires MINISTRY OF FOREIGN serious planning to achieve minimum standards, AFFAIRS OF DENMARK, but the transparent requirements offer significant LONDON

First Wednesdays European Medical Cannabis Ecosystem 39 The Danish Ecosystem

This map has been compiled by Invest Cultivation Specialist Clinics in Denmark to highlight diverse activity across the value chain.

Company information has been gathered from government lists of license holders and publicly available information. Invest Public Agencies Extraction & Purification in Denmark has focused on companies that have made clear progress, although there are a number of other license Research holders at varying stages of development. Formulation & Manufacturing

An interesting medical cannabis ecosystem is developing in Denmark, centred around establishing a viable domestic supply chain. Collaboration Testing & Quality Assurance Ancillary Equipment Suppliers between licensed cannabis operators and leading non-cannabis companies COPENHAGEN has been necessary to achieve the ODENSE required high standards of production, Distribution & Logistics Investment which is evident through the engagement of leading equipment suppliers, logistics and professional services companies. Associations Professional Services Denmark’s pharmaceutical industry is based in the Copenhagen region, while key cultivation sites are clustered around the Odense region.

First Wednesdays European Medical Cannabis Ecosystem 40 Deep Dive: Denmark

HANWAY INSIGHTS

A UNIQUELY EUROPEAN HYBRID MODEL

To date, timelines for facilities to become licensed and Producers must follow strict quality standards to Access to medical cannabis in Denmark is not limited active have been longer in Denmark than in other operate in the Danish market; cultivators must comply to the pilot scheme, and finished pharmaceutical jurisdictions. The Danish cultivation trial has been with Good Agricultural Collection Practices (GACP) products (Sativex, Nabilone and Marinol) can be purposefully designed to the benefit of domestic and post-harvest manufacturers must abide by Good prescribed outside of the pilot. Magistral preparations patients. Cultivation is not licensed simply for the Manufacturing Practices (GMP). Strict planning and of oils and capsules (using isolated THC and CBD) purpose of producing a valuable export product Quality Assurance is required to achieve the required remain the leading route by which patients access for international markets, but as a vital, highly- product standards, which include a permitted standard medical cannabis. After CannTrust’s supply of the regulated stage of the pharmaceutical supply chain. deviation of ±10% from the THC and CBD content only full-spectrum oil available through the pilot was A prerequisite to being able to export bulk product is stated before harvest. Pesticide use during cultivation suspended, the Danish preference for formulated that the company must have delivered products to of cannabis primary products was initially prohibited, products over flower became clear from the the Danish market, which is currently subject to some but was amended in January 2019 due to the limited sharp increase in prescriptions for isolated THC oil of the strictest standards in the world. Producers are number of products approved for patient use under preparations through the compounding route. unable to profit from their investments into facilities in the pilot program. Selected use of plant protection Denmark without also ensuring patients are supplied methods is now permitted for imported oral-use with high-quality products. products.

First Wednesdays European Medical Cannabis Ecosystem 41 Deep Dive: Denmark

HANWAY INSIGHTS

STRUCTURAL ADVANTAGES

Denmark’s strong business ecosystem offers investors Producers also benefit from sustainable access a plug-and-play model for establishing and rapidly to low-cost renewable energy, which is highly scaling operations in the pharma-oriented European advantageous for indoor production to ensure the market. Denmark has been quick to attract investment required consistency levels for EU-GMP certification. as a result, with Canadian producers driving a large Denmark’s proximity to major markets, particularly proportion of direct expenditure. Initially announced the UK, Germany and France, alongside excellent foreign direct investment into the sector totalled infrastructure for transport and shipping is over CAD$407 million, according to estimates by advantageous from an export-focused perspective. Denmark’s Horticultural Association and Invest in Cannabis producers can leverage Denmark’s optimal Denmark, although some facilities have subsequently location as has historically benefitted pharmaceutical ceased activities. manufacturers, combatting Europe’s historical Investors can draw on expertise from both reliance on Canadian and Dutch imports. pharmaceutical and horticultural industries, with strong Danish heritage in agriculture and greenhouse production and 2.6% of national GDP originating from pharmaceutical manufacturing. Denmark benefits from a highly-trained talent pool, readily-available land and deep expertise in product development and Quality Assurance.

First Wednesdays European Medical Cannabis Ecosystem 42 Deep Dive: Denmark

HANWAY INSIGHTS

PHARMACEUTICAL APPROACH AND DATA COLLECTION

Alongside offering a favourable environment for Denmark has ongoing active research projects in Healthcare professionals in Denmark emphasise production, Denmark’s domestic trial program every national university hospital, with six ongoing European doctors’ demand for doseable, pharma- encourages patient feedback, product development, randomized controlled trial (RCT) studies into style products. Aurora Nordic’s ‘Sedamen’ softgel and research. The country has also ensured financial indications including arthritis, multiple sclerosis and capsules are viewed favourably by prescribing support is available to support patient enrollment. pain induced by chemotherapy. Additional research physicians and are the only product format aside As of January 2019 terminally ill patients have had projects, including a number of observational and RCT from flower currently authorised through the pilot their prescriptions fully reimbursed, with the financial studies, are planned to commence throughout the program, containing 5mg THC per capsule for simple supplement program covering 50% of medical domestic trial program. dosage. As contract extractors, manufacturers and cannabis spending for all other patients up to an research laboratories become fully licensed and Close monitoring and relationships between annual reimbursement of DKK 10,000 (~EUR 1,350). operational, Denmark is expected to drive product patients and doctors facilitate deeper analysis of development towards sophisticated, pharmaceutical Denmark has consolidated access to medical cannabis patient preferences, when considering product products with proven efficacy for specific conditions within its well-reputed pharmaceutical industry, types, formulations and delivery systems. Engaging and therapeutic areas of treatment. placing high emphasis on data collection from patients physicians has been a key focus in Denmark, with and doctors to demonstrate efficacy and build upon a dedicated national Klinisk Cannabis Forum (KCF) anecdotal evidence. composed of prescribing doctors and around 60 scientific researchers planning to launch courses for doctors this year.

First Wednesdays European Medical Cannabis Ecosystem 43 First Wednesdays is a network of entrepreneurs and investors in the European cannabis sector. FW members benefit from news, insights, matchmaking and business support. Firstwednesdays.eu

Hanway Associates is the leading European strategic consultancy, specialising in cannabis research, new market entry, commercial diligence and M&A strategy. Whether you are looking to understand the market, pivot your existing business, expand to new markets, apply for licences, protect your reputation, find the right partners, or start a business from scratch, our multidisciplinary teams can help. Our clients include listed-pharmaceutical companies, global FMCG consumer brands, top tier cannabis companies, investors, and innovative biotech / R&D startups. If there are any companies in the report you want to speak to please drop us a line. hanwayassociates.com