Limited knowledge and high costs are barriers to accessing medicinal cannabis in the Netherlands

Dutch patients who use cannabis to manage health symptoms face significant barriers to accessing medicinal cannabis through the healthcare system, according to a new study by the Trimbos Institute. Based on responses from more than 1,000 participants, the research reveals a systemic disconnect: although patients would prefer to obtain medicinal cannabis via a doctor’s prescription, many feel forced to turn to coffeeshops or home cultivation instead. The study provides the first comprehensive insight into why such a large group of medicinal cannabis users remain outside the regulated healthcare framework. A shortage of doctors willing to prescribe cannabis and affordability of prescribed products emerged as important barriers.

Barriers to accessing prescribed medical cannabis:

• Perceived high cost
• Limited availability of prescribing physicians and restrictive medical guidelines
• Lack of accurate and accessible information
• Poor fit between services and patient needs
• Stigma

Limited prescription of medicinal cannabis

Medicinal cannabis has been legally available in the Netherlands since 2003 for patients with a doctor’s prescription. Despite this, access remains highly restricted. An estimated half a million people in the Netherlands use cannabis to alleviate physical or psychological symptoms, yet only a small percentage – around 7,000 patients – receive prescribed cannabis. The vast majority of medicinal users obtain cannabis outside formal healthcare channels. “These are patients who often suffer from serious and long-term health conditions,” said Lisa Strada, the study’s project leader. “Like everyone else, they want access to a medication they know helps them, instead of having to rely on unregulated or illegal sources. It is deeply frustrating for them to know that medicinal cannabis is legal in the Netherlands, yet they still can’t access it.”

1. Perceived high cost

Financial barriers are a major factor limiting access to prescribed cannabis. Since 2018, medicinal cannabis has no longer been reimbursed by Dutch health insurance, placing a significant financial burden on patients. This is particularly problematic for patients with chronic and debilitating conditions, who are often unable to work and may rely on social assistance. Most study participants said they would prefer to obtain cannabis through the formal healthcare system, citing the regulated quality, safety, and transparency of pharmacy-supplied products. However, high out-of-pocket costs drive many toward unregulated or illegal sources, where prices may be lower but product quality and safety are not guaranteed.

2. Limited availability of prescribing physicians and restrictive medical guidelines

Participants generally felt that there were not enough physicians in the Netherlands who prescribe cannabis. While a few reported positive experiences with physicians who were open to prescribing it, most had had negative encounters or assumed that their physician would reject their request for prescribed cannabis.

Several participants shared frustrating experiences in which physicians cited medical guidelines or recommendations as reasons for not prescribing cannabis. The recommendation from the Dutch Society of General Practitioners (NHG), which advises against prescribing cannabis outside of palliative care, was explicitly mentioned. Participants noted that physicians often viewed cannabis as a treatment of last resort rather than a viable treatment option. A few participants reported that their physicians were in principle willing to prescribed cannabis but felt constrained by guidelines and recommendations.

3. Lack of accurate and accessible information

Access to prescribed cannabis is further hindered by limited medical expertise. Although any doctor in the Netherlands is legally permitted to prescribe medicinal cannabis when standard treatments are insufficiently effective or cause too many side effects, this option is rarely used in practice. “This is largely due to a lack of knowledge,” said Strada. “Medicinal cannabis is not a standard part of medical training, and there are too few opportunities for continued education.” In addition, persistent stigma surrounding cannabis discourages patients from discussing it with their doctors for fear of being judged.

Reliable and accessible information about medicinal cannabis via official authorities is also scarce. As a result, people typically search for information on online forums and social media, where misinformation is widespread.

4. Poor fit between services and patient needs

At present, five cannabis strains are available by prescription in the Netherlands. Study participants reported that this limited selection does not adequately meet patients’ diverse needs. Each person’s body reacts differently to cannabis, meaning a strain that works for one person may not be equally effective for another. Furthermore, variation in the plant itself can also influence its effectiveness. Patients, therefore, called for a broader range of products, which would increase the likelihood of finding a product that works for their specific symptoms.

5. Stigma

Interview data indicated that the acceptability of prescribed cannabis as a therapeutic option was shaped by sociocultural factors, with stigma emerging as a key barrier to access. Participants described that stigma was driven by negative associations with cannabis as a recreational drug and a potential substance of abuse.

Participants reported both experienced and perceived stigma from physicians, friends, family, and society at large. Many described being labelled as ‘drug users’ or believing that others saw them this way. Some recalled encounters in which physicians or social contacts were dismissive or judgmental of their medicinal cannabis use, because they believed it was motivated by a desire to get high rather than a therapeutic need.

Improving accessibility

Despite medicinal cannabis being legally available in the Netherlands for more than twenty years, access through conventional healthcare remains severely restricted. The Trimbos Institute concludes that substantial policy changes are needed to improve availability and better align care with patient needs. Improving access would not only reduce reliance on unregulated sources but also more effectively safeguard public health.