1) No official source of

State-level tolerance to

U.S. - selected

- patients and caregivers

- not medicinal grade

It is rightful not to proceed with

medicinal cannabis

patient´s own cannabis

states (Alaska,

not criminalised for medicinal

cannabis

use and personal possession of

(patients exempted from

cultivation under

Hawaii,

cannabis use, own cultivation

- treatment follow-up

cannabis under the criminal

criminal procedures upon

medical certification that

Maryland),

and cultivation / administration

with the doctor not required

law.

doctor’s recommendation /

expands to caregivers

Canada

by a 3rd person

- no control on cannabis

certification (i.e. patient

diversion to the recreational

registry / cards)

market

2) Supply of medicinal

Specific state or county

U.S. - selected

- quality competition

- medicinal quality control

Non-adherence to 1961 U.N.

cannabis tolerated upon

level laws for medicinal

states (Arizona,

between producers

dependent on state-level

treaty on medicinal cannabis -

doctor´s recommendation

cannabis dispensaries

California,

- patients (caregivers)

regulations

the U.S. federal scheduling

Colorado, Delaware,

and suppliers not criminalised

- treatment follow-up

doesn´t recognise cannabis as a

District of Colombia,

for medicinal cannabis use, own

with the doctor not required

medicinal drug, and therefore

Maine, Michigan,

cultivation

- low control over

dispensing is not controlled by a

Montana, Nevada,

dispensaries and conflation with

prescription regime. It is,

New Jersey, New

recreational users´ market

however, rightful not to

Mexico, Oregon,

(prescription regime lacking due

proceed with use and personal

Rhode Island, Vermont,

to federal laws)

possession of cannabis under

Washington, Canada

the criminal law, and such

provision has been applied to

cultivation for own use.

3) Medicinal cannabis trial

Certified small-scale provisions of federally- cultivated marijuana

U.S. National Institute of Drug Addiction (NIDA)– selected states (Therapeutic Research Program)

 - control over the number and conditions of patients

 - medicinal grade product

 - low chances for diversion into recreational market on the wholesale level due to single production point

 - low chances for diversion into recreational market due to restricted no. of patients

 - limited patients´ access

 - monopoly-originated product, patients complaints about quality

In adherence with 1961 Single convention on medicinal provisions of controlled substances.

4) Outsourcing herbal cannabis / pharmaceutical preparations from abroad

(Option 1)

Herbal cannabis: Individual imports based on prescription and further administrative approvals (herbal cannabis from the Netherlands, Sativex from the UK)

Finland, Denmark

 - no specific regulatory system needed, administratively managed by the substance control act authority

 - medicinal grade herbal product

 - treatment follow-up with the doctor required as with any other medication

 - low chances for diversion into recreational market given the restricted no. of patients and lack of domestic production

 - individual imports are costly and a heavy administrative burden is imposed on the patient

In adherence with 1961 Single convention on medicinal provisions of controlled substances.

4) Outsourcing herbal cannabis / pharmaceutical preparations from abroad

(Option 2)

Pharmaceutical preparations: Prescription and pharmacy dispersion of synthetic cannabinoids

Dronabinol or marinol available in Austria, Canada, Germany, France, Spain, Switzerland, UK, U.S., Sativex available in Austria, Canada, New Zealand, UK, Australia

 - existing medicine regulatory system used

 - treatment follow-up with the doctor required as with any other medication

 - medicinal-grade product

 - low chances for diversion into recreational market (herbal cannabis not available)

- narrow range of available cannabis medication (lack of herbal products)

In adherence with 1961 Single convention on medicinal provisions of controlled substances.

5) Licensing of growers by an agency

(Option 1)

Agency that doesn´t take possession of all domestically grown cannabis; herbal cannabis dispensed via an auxiliary system on doctor´s recommendation

Israel, Canada

 - quality competition between producers (e.g. Canada has recently transferred from state-owned production to licensing system due to concerns of product quality under monopoly production)

 - low chances for diversion into recreational market on wholesale level given the control via agency

 - costs of setting up an agency or of assigning its tasks to one of the existing agencies within the country

 - medicinal quality not guaranteed by the system

 - treatment follow-up with the doctor not required

 - chances for diversion into recreational market on consumer level given lack of control via prescription

Partially in adherence with 1961 Single convention on medicinal provisions of controlled substances; control under prescription system is required by the treaty. The possession of cannabis by the agency is rather symbolic.

5) Licensing of growers by     an agency

(Option 2)

Agency that takes possession of all domestically grown cannabis ; herbal cannabis dispensed in pharmacies upon doctor´s prescription

The Czech Republic, The Netherlands, Uruguay, The United Kingdom (herbal production for Sativex)

- quality competition between producers (e.g. Canada has recently transferred from state-owned production to licensing system due to concerns of product quality under monopoly production)

 - full adherence to medical and prescription system (herbal cannabis classified as a source substance to compounding pharmacists)

 - treatment follow-up with the doctor required as with any other medication

 - low chances of diversion into recreational market on wholesale level given the control via agency and on consumer level given the control via prescription.

- costs of setting up an agency or of assigning its tasks to one of the existing agencies within the country

In adherence with 1961 Single convention on medicinal provisions of controlled substances.