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Medical cannabis in Switzerland: what the law change of 1 August 2022 actually changed

canmed association
LawFOPHSwissmedic

Since 1 August 2022, cannabis for medical purposes has been regulated in Switzerland like any ordinary controlled substance. The Federal Office of Public Health (FOPH) exemption permit for prescribing, which previously delayed every single therapy, has been dropped. This article summarises what that means in practice, along the lines of the official Swiss sources.

Before: an FOPH exemption permit for every therapy

Until the end of July 2022, cannabis was listed in Schedule D (prohibited substances) of Swiss narcotics law. Any physician who wanted to treat a patient therapeutically with cannabis had to obtain a case-by-case exemption permit from the FOPH. That delayed therapy and added administrative cost.

What changed on 1 August 2022

With the revision of the Narcotics Act (NarcA), cannabis was moved from Schedule D to Schedule A of the Schedule of Controlled Substances (NarcSchO). For prescribing, the same rules now apply as for any other narcotic-containing medicinal product, such as morphine. Swissmedic puts it this way: “Since 1 August 2022, the prohibition on cannabis for medical purposes has been lifted.”

In concrete terms:

  • Prescribing without an FOPH exemption. Physicians may prescribe cannabis medicines on a narcotics prescription, a special form for prescribing controlled substances.
  • Export permitted. Export of cannabis for medical purposes is now permitted, where previously only limited export was possible.
  • Controls remain. Swissmedic continues to issue cultivation permits and oversee the supply chain, with the goal of “making diversion more difficult and ensuring adequate theft protection”.

Who can prescribe

Any physician with the right to prescribe controlled substances may now prescribe cannabis medicines. The FOPH puts it this way: “Cannabis medicines are prescribed by physicians by means of a narcotics prescription.” No additional FOPH authorisation is required.

In practice, experience with cannabis medicine, suitable indications and careful patient counselling remain decisive, especially because many cannabis medicines are dispensed as magistral preparations (exempt from authorisation, compounded by the pharmacy).

Indications named by the FOPH

The FOPH lists three main areas of medical use:

  • chronic pain conditions, for example neuropathic or cancer-related pain
  • spasticity and cramps in multiple sclerosis or other neurological diseases
  • nausea and loss of appetite during chemotherapy

This list is not exhaustive; it describes the areas where cannabis medicines are most frequently used.

Reporting obligation: the MeCanna system

With liberalisation, the FOPH introduced a digital reporting system: MeCanna. Prescribing physicians are required to enter data about the therapy. “This concerns in particular medical information regarding the therapy and its course,” the FOPH states. Captured items include indication, dosage form, dosing, effects and side effects.

Reports are filed at the start of therapy, then again after one and two years, or upon discontinuation. Data collection is limited until 2029 and is meant to improve the evidence base on effectiveness.

What health insurance pays

On this point the law change altered little. The FOPH writes: “The catalogue of services of mandatory health insurance (OKP) currently contains no cannabis medicines.” Reimbursement is possible only in exceptional cases, under Art. 71a ff. of the Health Insurance Ordinance (KVV) (case-by-case coverage), when there is no therapeutic alternative and substantial therapeutic benefit is demonstrated.

In practice, the coverage guarantee still runs via the insurer’s medical adviser, and a significant share of patients pay for the therapy in whole or in part out of pocket.

What has not changed

  • Cannabis remains a controlled substance. Prescribing, supply and dispensing are strictly documented.
  • Street cannabis remains illegal. Liberalisation applies exclusively to medical use on prescription.
  • Quality requirements remain high. Pharmaceutical cannabis flowers and extracts are subject to medicinal-product requirements, including testing for pesticides, heavy metals, microbiology and aflatoxins.

What patients can concretely do

  1. Talk to a physician experienced in cannabis medicine. Our directory helps locate such practices in Switzerland.
  2. Document previous therapies so that the indication and any coverage request are well founded.
  3. Set realistic expectations: cannabis is a complementary therapy option, not a replacement for established standard treatments.

This article summarises the official legal situation and information from the FOPH and Swissmedic. It does not replace medical advice.

Sources

  1. Medical use of cannabis · Federal Office of Public Health FOPH
  2. FAQ cannabis medicines · Federal Office of Public Health FOPH
  3. Reporting system for cannabis medicines (MeCanna) · Federal Office of Public Health FOPH
  4. Cannabis for medical purposes, Swissmedic Visible Nov 2022 · Swissmedic
  5. Information sheet, cannabis for medical purposes · Swissmedic