Objectives On 1 January 2018, the Medicinal Cannabis Pilot Programme was introduced in Denmark. The Programme runs for 4 years. Medicinal Cannabis are not authorized medicines, and since knowledge about the effects and adverse reaction including a risk of addiction of the products is insufficient in many areas, only medicinal cannabis products accepted by The Danish Medicines Agency may lawfully be prescribed by all kind of doctors during the Programme. To support doctors, The Danish Medicines Agency has prepared guidelines, regarding relevant indications etc. Concerns have been raised regarding risk of overuse and concerns regarding how to handle these new products, including who is responsible for the treatment when patients change sector (admission to or discharge from hospital or at outpatient clinics at hospitals). To minimize these concerns in the Capital region, it was decided to describe how to use these products and to follow the consumption.

Methods To agree on how to handle these new products when patients change sector (admission to or discharge from hospital or at outpatient clinics at hospitals), the regional Drug Committee for hospitals and general practices in the Capital region of Denmark in cooperation with relevant clinicians in the region wrote a guideline focusing on what to do on admission, at discharge and in the ambulatory setting regarding these products. Furthermore, the regional Drug Committee followed and still follows the consumption of medicinal cannabis at hospitals and in the primary care setting in the Capital Region of Denmark during the Programme.

Results In 2018, the consumption of the currently 6 products (three herbal teas and three oral suspensions) in hospitals in our region was concentrated on few ambulatories with an expense of about 350.000 DDK (53.000 USD). No adverse incidents have been reported to the regional safety incident reporting system. The regional Drug Committee have not been involved in any primary-secondary care interface problems regarding these products.

In 2018 patients had been prescribed medicinal cannabis in our region - primarily from anesthesiologists in primary care - with a cost of these products of about 3.7 mio. DDK (557.000 USD).

In 2018, 21 ‘Adverse Drug Reaction’ reports from medicinal cannabis were reported to The Danish Medicines Agency from all 5 regions, with neurologic symptoms, predominantly dizziness and gastrointestinal symptoms, predominantly nausea and vomiting as the most frequently reported adverse reactions.

On 31. December 2018, 1211 patients from all 5 regions of Denmark (primarily from anesthesiologist in primary care) had been prescribed medicinal cannabis

Conclusions Regionally, there does not seem to be an overuse of the prescription medicinal cannabis. The regional Drug Committee continues to follow the consumption until the Programme ends, and the consumption in hospitals and in primary care sector is analyzed and discussed with relevant clinicians at hospitals and in general practice to continuously prevent inappropriate use.