The Transvaal pharmacy in The Hague, the seat of Dutch government, is the only place in the Netherlands where patients can buy whole plant cannabis oil of guaranteed quality. Pharmacist Armin Ramcharan distills the oil from three different varieties of cannabis grown by Bedrocan, a medical cannabis producer. Patients from as far afield as Italy travel to The Hague to buy it.
Hash oil is considered a hard drug under Dutch law, in the same category as heroin or cocaine. This is why Bedrocan, the country’s only legal medical cannabis grower, cannot produce oil. The company’s license is limited to cultivating cannabis flower.
As in most European countries, all sorts of cannabis oil are available via internet in the Netherlands. Most of it is CBD oil produced by extracting the non-intoxicating cannabinoid from industrial hemp. Even the national chain De Tuinen has been selling CBD oil in its 127 stores. Whole plant oil, which contains THC, in general is produced illegally by an unknown number of small producers.
Pharmacies offer an alternative. By law they’re allowed to produce any kind of medicine whatsoever, provided it’s for patients who don’t respond well to available medications. The Transvaal pharmacy in The Hague has been making its own morphine infusion bags for years, explains Armin Ramcharan, who runs the cannabis oil project.
“These are sterile preparations that we need to make in a sterile environment. We’re very good at it and give lectures about it,” Ramcharan said. That strong reputation caught regulators’ eyes. “At one of these talks about palliative medication, the Dutch Office of Medicinal Cannabis had a talk about cannabis use in the palliative phase. That’s the stage where someone only has a very short time to live and is in a lot of pain. When they heard what we can do here, they asked us to develop a cannabis oil for children with epilepsy.”
“These are all patients who are not really treatable with regular medication.”Armin Ramcharan, Transvaal pharmacy
The request marked the beginning of a lengthy quest to find the best way to produce oil and a reliable way to test it. Ramcharan spent a full year on getting things right, cooperating with the universities of Leiden and Groningen. The pharmacy didn’t get any funding, he said. “We do it ourselves, mostly because we like it,” Ramcharan said. “There’s a bit of passion and then it’s no problem. We like to develop new things, find out how we can make the product really well and help patients with it. That’s our vision.”
The oil is made with extremely pure ethanol and heated in an oven to turn the cannabinoid acids into active cannabinoids. Peanut oil is used to dilute the extract and to soften the bitter taste. At the moment, the oil is almost exclusively prescribed to patients who do not respond to regular medication. “It’s the last resort, that’s how you should see it,” said Ramcharan. “It’s not a first-choice drug. Not yet, because there’s not enough evidence yet. GW Pharmaceuticals in Britain has started clinical trials. I’m quite happy they did, because this research, these results are very important. Because they simply show: you cannot avoid this, it has really been proven in research. It’s not a myth.”
In order to do clinical research, both the product and the analysis must be good, Ramcharan stressed. “You need to know exactly what is in it. A lot of people sell oil now, but nobody really knows what’s in it. The origin of the plant is very important, too; the plant material must continuously have the same quality. Only then can it be registered, and that’s the hard part. That’s very difficult for cannabis.”
What’s missing is what’s called a monograph, a thorough study of a single topic that contains standard rules and limits. “Once a monograph is established in the European directives, things become much easier,” explained Ramcharan. “But preparing one takes a lot of research and time. If it’s in place, you can make oil and then analyze it on the basis of the monograph. That’s how it works with all medicines.”
Ramcharan has never used cannabis himself and said he was quite skeptical at first. “But I was thrilled when we received the first results,” he said, estimating that 60 percent to 70 percent of patients respond well to the oil. He has just submitted an article to the Dutch Pharmaceutical Weekly about the results seen in 27 epilepsy patients. “Fifty percent of them responded, and if they responded, there was a 50 percent seizure reduction. That’s a lot. And these are all patients who are not really treatable with regular medication. So that’s very special.”
A new research project will start this month. Ramcharan will buy samples of all the different cannabis oils he can find and analyze them in the Transvaal pharmacy lab and at least one other independent lab. “We want to find out what’s happening in the market, and we will present the results to the Office of Medicinal Cannabis. I am very curious about the results.”