Presentation (CTI)

OBJECTIVES: Chronic pain is a substantial public health burden across Europe, affecting quality of life and healthcare utilisation. Medical cannabis has emerged as a potential treatment option; however, access and reimbursement remain inconsistent. This study evaluates whether medical cannabis improves outcomes in chronic pain in Europe and whether evidence has translated into favourable legislative frameworks.
METHODS: Research comprised a structured review of literature, health technology assessments, and real-world registry data examining medical cannabis policy and chronic pain outcomes across Europe. Germany, Italy and the UK were selected to represent regulatory and reimbursement environments. Outcomes assessed included patient-reported pain scores, quality of life, opioid utilisation, healthcare resource use, and health equity indicators, including socioeconomic and geographic access disparities.
RESULTS: Country-level evidence suggests medical cannabis is associated with improvements in chronic pain outcomes; however, translation into equitable access varies by reimbursement model. In Germany, the German Pain e-Registry (2022) reported that 46.5% of patients achieved ≥50% pain reduction, alongside improvements in quality of life (31.4%) and sleep (35.3%). These outcomes have supported a favourable reimbursement environment, with statutory (GKV) coverage now supporting >370,000 medical cannabis patients. In the UK, 2022 registry data highlighted significant improvements in pain and EQ-5D-5L at 1 and 3 months; however, access remains limited in the public sector and is largely private, with <5,000 NHS prescriptions versus ~60,000 private patients. In Italy, a 2024 pilot study reported a significant pain reduction (NRS 8 to 4; p<0.001) and quality of life improved with cannabis; however, regionally devolved SSN reimbursement creates geographic disparities in medical cannabis coverage.
CONCLUSIONS: Medical cannabis demonstrates clinical benefits in chronic pain; however, these outcomes do not translate into equitable access. Differences in reimbursement frameworks drive socioeconomic and geographic disparities, indicating that inclusive and consistent reimbursement, rather than legalisation is the key determinant of equitable access.