Inhalation of liquids: A clinical review
Martinez claims that the liquid inhalation method is more than just a regulatory requirement. It also addresses real clinical requirements that are not always met by flower.
“Liquid Inhalation permits consistent and controlled dosage,” explained he. For patients, this means that they can expect a rapid onset of effect with repeatable doses and effects. Patients can look forward to a consistent experience when they use the medication. This is essential for managing symptoms.
Consistency is essential for prescribers working within the conservative frameworks of hospitals.
“It’s a lot easier to say ‘use X milligrams via this inhaler, up to Y times a day’ and know what that means, versus trying to estimate doses from inhaling flower, where technique and individual variation can lead to different results.
Some patients, like those with chronic lung disease or severe asthma, may find that vaporising liquid formulations are more gentle on their lungs. Additionally, some conditions require very fine titration of dosage – neuropathic pain, severe spasticity – and a device can help dial that in more systematically.”
Martinez, however, was cautious not to declare liquid inhalation superior. “This isn’t about declaring liquid formats ‘better’ across the board or trying to replace flower entirely. “Cannabis flower is still clinically useful for many patients”, he stated.
The natural flower form is preferred by many people because it contains a broader range of cannabinoids. “We believe the future of medicinal cannabis will not be about a single format, but about providing multiple clinically-appropriate options in a regulated environment.”
Cost barriers
The higher regulatory standards raises questions regarding affordability, and creates a risk that only patients with sufficient resources can have access to pharmaceutical grade devices.
While Martinez cited cost as a ‘legitimate concern’, as the market matures he believes ‘competition and scale’ will bring costs down.
Martinez directly acknowledged this concern. The cost is an issue that deserves attention. A higher regulatory standard and manufacturing standard can increase the price initially, especially when reimbursement is not available.”
Although the HAS has yet to decide the exact details, it is likely that the HAS will cover a large portion of patient costs. This includes both the device and the doses.
With France offering both a middle-ground on the question of health care, and likely cost relief for its patient population, Jeanroy states that he is confident ‘France is going to be the model, not Germany, in the development of the medical cannabis framework in Europe at the national and the supranational level.’
As such, he believes a general shift away from flower will ‘definitely be a trend in Europe’ in the coming months.
Martinez offered a similar prediction, noting that he expects ‘diversification rather than convergence’, with already established markets continuing to support flower, ‘while newer frameworks will lean into standardised preparations and device-based delivery.’
He concluded that “the demand will always remain; the question, however, is to what extent we can meet this through safe and regulated channels.” By the end of next year we will see that more people are relying on legal services than they were before.