The Netherlands has run a prescriber-and-pharmacy medical cannabis programme continuously since 2003, one of the longest-running pharmacy-dispensed programmes anywhere. What its clinicians describe is not a set of protocols but a set of habits: prescribe only where the evidence holds, start low, and treat the pharmacy counter as a second clinical checkpoint rather than a till.
Source and status. This article summarises the accounts of a Leiden pain specialist and a Hague pharmacist interviewed in Martin Woodbridge, A primer to medicinal cannabis (an introductory text, Bedrocan International, 2018). The book was funded by the Dutch medicinal cannabis producer Bedrocan International, which holds its copyright. Readers should weigh that conflict of interest. The practitioners’ roles are given as they were described in 2018 and may have changed since. This is contextual reference from another jurisdiction for healthcare professionals, regulators and operators. It is not a clinical guideline, not a protocol, and not medical advice. Two clinicians in one country make a case study, not evidence.
Thailand, as of October 2026. Cannabis flower is a controlled herb under the Notification of the Ministry of Public Health Re: Controlled Herbs (Cannabis) B.E. 2568 (issued 26 June 2025). It may be dispensed only against a prescription on form PT 33 from an authorised practitioner. Each prescription covers no more than 30 days and is single use (no refills), and sold flower must come from a GACP-certified cultivation site. Online sale or advertising of flower is prohibited, and recreational use is not permitted. Two Ministerial Regulations B.E. 2569 tightened licensing in April 2026 but did not change the PT 33 rules. The Cannabis Control Act is still a draft: the Cabinet approved it on 22 September 2026 and sent it to the House. In a Thai setting, every clinical decision described below belongs to the prescribing practitioner working under that framework.
1. The Counselling Sequence
The pharmacist’s framing is the part most worth transplanting: the pharmacist’s role is as important as the prescriber’s. That role covers supporting the prescriber with medication review, discussing benefits and risks with the patient, reducing misuse and harm, and collecting feedback on safety, efficacy and adverse reactions.
Her sequence works as a reusable structure in any jurisdiction:
- Ask first what the patient already knows about medical cannabis. Start from their model, not from a script.
- Explain how it works, how to use it, the dosing regimen, possible side effects, and safe storage.
- Confirm the patient understands possible interactions with their other medicines, and the contraindications.
- At the next contact, ask about their experience, focusing on efficacy and side effects.
Step one is the step most often skipped. Her advice to pharmacists new to the field explains why it matters: get trained or read widely, because patients generally know a great deal and also carry misinformation. A clinician who does not first find out which is which is arguing with the wrong thing.
On timing, her pharmacy’s practice was to allow one to two weeks before judging whether the medicine was working. THC pharmacokinetics vary widely between people, products and routes, so treat this as one pharmacy’s house rule, not a measured constant.
2. Misuse Monitoring From Dispensing Records
The pharmacist described misuse as infrequent. Her pharmacy picked it up by monitoring the quantity dispensed and the frequency of dispensing. Where misuse appeared, the pharmacist agreed an approach with the patient. If that failed, the pharmacy consulted the prescriber for a solution. She treated pharmacovigilance, meaning collecting and evaluating reports of adverse effects from healthcare providers and patients, as a core pharmacist function, alongside giving truthful information about benefits and risks.
The prescriber described the other side. When Dutch health insurers reimbursed medical cannabis broadly, some patients arrived with vague indications. Some saw a prescription as a cheap route to a drug they were already using. They could press hard and react sharply when misuse was raised. His answer was consistency rather than gatekeeping by instinct: prescribe only for indications with sufficient evidence, and discuss misuse openly when it becomes apparent.
This is a workable, low-technology control. It needs only that dispensing records exist and that somebody reads them. Under PT 33’s 30-day, single-use prescriptions, and after the PT 33 enforcement drive reported in June 2026, it is the most directly useful habit here for Thai dispensaries.
3. The Prescriber’s Account
In 2018 the pain specialist worked in anaesthesiology and pain medicine in Leiden. He saw mainly two groups: advanced cancer patients with loss of appetite, nausea and vomiting, already on multiple medicines; and patients with central neuropathic pain after more common drugs had failed.
Start where the evidence is solid. His advice to new prescribers was to stay with indications where the evidence is strong, in a defined adult population, and build experience where the expected effect is known. In his view, people already using cannabis recreationally are not the group to start with, because they can press for prescriptions on questionable indications. That is about where competence gets built, not a judgement of patients.
Advantages, and their limits. He named an analgesic effect in neuropathic pain and, depending on the preparation, antiemetic and appetite-stimulating effects. He also named a calming effect from some varieties, and no known organ-damaging side effects in adults apart from the potential mental-health risk, comparing this with NSAIDs used inadequately. That last point needs a counterweight. Cannabinoid hyperemesis syndrome, cardiovascular events (which he himself links to smoking, below) and dependence are all documented adverse effects. See our article on contraindications and cautions. Everything on his list is symptom management. None of it concerns disease modification.
Practices he said improve outcomes:
- Start low, in a quiet and comfortable setting. For cannabis-naive patients, psychological reactions are the real concern, and the setting is part of the prescription.
- Vaporised flower over the oral route for analgesia in the Dutch setting, for dose accuracy, faster onset and no combustion products.
- Never smoking. He linked smoked cannabis to myocardial infarction and stroke, through cardiovascular stimulation in susceptible hearts plus carboxyhaemoglobin from smoke.
- Know what you are prescribing. Flower from legally regulated producers assures the patient that the active-ingredient content is controlled and that the product is free of contamination. Our article on what GMP actually means for medical cannabis covers that machinery.
Thailand note on routes. Thailand prohibits e-cigarettes and vaping devices, and their import, sale and possession can be prosecuted. Do not assume a vaporiser is a lawful route there. In Thailand, the lawful routes are those set out in the PT 33 prescription and in the registration of the product dispensed.
Two first consultations. He was rarely the one to raise cannabis with an older, cannabis-naive patient at a first visit. If that patient was otherwise suitable and other treatments had given inadequate relief, he mentioned it as an option and left the patient and family time to think before the next appointment. An experienced patient actively seeking cannabis, sometimes overstating the failure of other therapies, discussed it fully at the first visit. The central question there was eligibility.
4. Dosing and Safety: Principles, Not Numbers
The pharmacy’s dosing advice was written for Dutch standardised products as of 2018. We do not reproduce its figures: without the product’s THC/CBD concentration they mean nothing clinically, and they cannot be carried over to another formulation. The principle is what transfers. Start low, titrate slowly, and dose by the specific product prescribed.
For inhalation, the pharmacy told patients to wait between inhalations and to stop at the first psychoactive effects, which signal too high a dose. It also warned that switching variety, especially from a lower-potency one, means recalculating the dose.
She named schizophrenia, cardiac arrhythmia and other cardiac disease as contraindications. She saw the greatest risks as intoxication, psychotic symptoms (especially in psychiatric patients), worsening depression and prescribing for older patients, and noted that long-term effects in children are unknown. The prescriber’s main interaction concern was other CNS depressants, opioids among them, which can markedly amplify sedation in older patients. The pharmacist also flagged CYP450-mediated interactions. These topics are covered in detail in our articles on contraindications and on drug interactions.
5. What Patients Report
The same book summarises qualitative interviews by the Ghent University researcher Frédérique Bawin with self-described medicinal cannabis users in Flanders, Belgium. Her full results appear in her doctoral dissertation, Self-reported medicinal cannabis use in Flanders: a study of user profiles and patterns of use (Ghent University, 2020). The book also cites a 2016 Dutch patient questionnaire. That was a university student project, not a peer-reviewed study, and we could not trace it, so we do not repeat its figures.
Symptom suppression, not cure. Patients described cannabis as suppressing symptoms without removing them. They generally did not regard it as a cure, and some reported partial or no success for particular symptoms. For pain in particular, the pain did not go away; it became bearable. Higher doses relieved more pain but brought more side effects. Some patients said conventional painkillers worked better and chose cannabis anyway for its side-effect profile.
The patient–doctor gap. As the book reports this research, many patients sourced cannabis themselves and did not discuss it with their GP. They chose product, dose and route without supervision. They did not prefer it that way: they wanted medical supervision and found few doctors with relevant experience. When they did get medical input, it was often a prescription plus very general advice. The book calls this an inversion of the doctor–patient relationship, in which the patient becomes the one supplying information. That is exactly the gap the counselling sequence in section 1 is designed to close.
6. What Transfers, and What Does Not
| Element | Transfers to a Thai setting? |
|---|---|
| Prescribe only for indications with adequate evidence | Yes, jurisdiction-independent |
| Start low, titrate slowly, product-specific; quiet setting for naive patients | Yes |
| Allow time before judging effect, not day 2 | Yes, as a principle; timing varies by patient and product |
| Avoid smoking | Yes, as a clinical principle |
| Vaporisation | No. Vaping devices are prohibited in Thailand; use only the routes in the PT 33 prescription and product registration |
| Pharmacist as a second clinical checkpoint | Yes in principle; depends on how the local dispensing channel is structured |
| Monitor quantity and frequency to detect misuse | Yes; needs only dispensing records |
| Ask what the patient already knows, first | Yes, and it costs nothing |
| Dutch drop counts and volumes | No. Product- and formulation-specific |
7. The Caveats, Stated Plainly
This is two practitioners in one country, recorded in 2018, in a book funded by and copyright to Bedrocan International. The source itself says its case studies are context-specific and are not a basis for prescriber and pharmacist decisions. The clinical data it reflects was current to June 2018, and the field has moved since. Treat it as an account of how a mature programme conducts itself, useful for designing a service. It is not a substitute for guidance from the authority that regulates you.
8. The Question for Thailand
Where the formal channel is hard to reach, patients do not stop. They self-source, unsupervised, from material of unknown content. That is a patient-safety problem. In our view, which is an opinion and not a finding, the number of practitioners trained and confident enough to use the PT 33 channel properly may now limit it as much as the rules do, even as the rules tighten.
For clinicians and pharmacists in Thailand and the region: which part of this is hardest to reproduce where you work: the training, the product consistency, the time for proper counselling, or the record-keeping? And if you are a patient: did your prescriber give you specific guidance, or general advice?
Asiannabis Community: general information for professional reference, not medical advice or a clinical guideline. In Thailand, cannabis flower is supplied only on prescription by an authorised practitioner using form PT 33.