In Luxembourg, medicinal cannabis has been legally regulated since the introduction of the law on 20 July 2018. This legislation permits the prescription, dispensing and possession of medicinal cannabis within a medical context, integrating it into the country’s healthcare system. Following this law, a medicinal cannabis access programme was launched in February 2019. In 2024, over 1,100 registered patients have been .
Cannabis derivatives
The cannabis plant and its derivatives containing more than 0.3% of the active ingredient delta9-tetrahydrocannabinol (Δ9-THC) are classified as narcotics under the law of 19 February 1973. However, following the 20 July 2018 law, dried flowering tops of the plant, along with other cannabis-derived components such as extracts, tinctures and oils, are eligible for prescription for specific therapeutic purposes if they meet required quality standards. These substances are authorised for use within Luxembourg’s medicinal cannabis programme.
Medicinal cannabis
Medicinal cannabis in Luxembourg is available in various formulations, including THC-dominant, balanced THC-CBD and CBD-dominant products. The term THC refers to various forms of THC, including the naturally occurring Δ9-tetrahydrocannabinolic acid in dried cannabis flowers, and its psychoactive form, Δ9-THC, obtained through decarboxylation (heating). CBD refers to cannabidiol.
Although cannabis is classified as a medicinal product, it does not hold a marketing authorisation or a summary of product characteristics listing indications, dosages, methods of administration, precautions or contraindications. Instead, a ‘scientific leaflet’ may be provided by the cannabis producer, where applicable. Medicinal cannabis is considered a ‘magistral preparation,’ which means it is compounded on prescription and dispensed by hospital pharmacies under the ministry of health’s supervision. The ministry is also tasked with overseeing the monitoring, evaluation and financing of the pilot programme. Medical devices used for vaporising medicinal cannabis, however, are not covered under the programme.
Eligibility
To ensure responsible prescribing, certain criteria must be met for patients to be eligible for medicinal cannabis. Patients must either reside in Luxembourg, be a beneficiary of the country’s health insurance system or be a Luxembourg national. It is the prescribing doctor’s responsibility to confirm the patient’s eligibility. Only doctors who have completed specific training organised by the ministry of health are authorised to prescribe medicinal cannabis.
Medical conditions
Medicinal cannabis can be prescribed in Luxembourg for a limited number of medical conditions. These include serious chronic diseases classified as long-term illnesses under article 19bis, paragraph 1 of the social security code, in their advanced or terminal stages, causing severe chronic pain that has not responded to other treatments or where suitable medications are unavailable.
Cannabis is also prescribed for cancer patients undergoing chemotherapy that induces nausea or vomiting, as well as for individuals with multiple sclerosis who experience symptomatic muscle spasticity.
Dosage and consumption
The dosage and administration of medicinal cannabis are personalised for each patient. There is no universal dosage, as it must be adapted based on individual needs. The physician’s role is to select the appropriate product and determine the optimal dose, adjusting it gradually through titration. Titration involves finding the minimum effective dose that is well tolerated by the patient. Due to significant variability between individuals and a lack of scientific consensus, a standard dosage cannot be established. Initially, low-THC products, such as CBD-dominant formulations, are recommended.
Under Luxembourg law, the maximum allowable dose of medicinal cannabis is 60 grams per patient over a 28-day period, which equates to 2.1 grams of dried flower tops per day. A daily dose of less than one gram of dried cannabis flowers is generally considered to produce noticeable effects, according to Health Canada. A daily oral dose of 2.5mg of decarboxylated THC has been associated with therapeutic effects. Medicinal cannabis can be administered via inhalation or oral consumption. The onset of effects for inhalation generally occurs between 2 and 5 minutes, with the duration of effect lasting between 2 and 4 hours. Oral consumption takes between 60 and 180 minutes for effects to begin, with the maximum effect occurring between 1 and 4 hours, and the duration of effect lasting 6 to 8 hours.
Distribution
Since the programme’s initiation, the ministry of health has distributed 1,420kg of dried flower tops and 4,910 bottles of extracted oils to patients, totalling over 23,700 medical prescriptions over a six-year period.