In a move that raised few eyebrows in the Netherlands and caused other countries around the world to turn their curiosity and interest towards the liberal European nation, the Dutch government legalized the medical use of cannabis on Monday, paving the way for doctors to prescribe the narcotic as a painkiller for those who are seriously ill.

The decision to permit cannabis for the relief of symptoms related to the treatment of terminal cancer, AIDS and HIV, and for patients with multiple sclerosis or Tourette's syndrome, is the latest in a list of pioneering social reforms in the Netherlands.

However, whereas the Dutch decisions to legalize euthanasia and sell cannabis for recreational use in licensed coffee shops caused controversy in the international arena, the move to permit cannabis for medical purposes has attracted the attention of other countries that have been considering similar initiatives -- especially in Europe.

All eyes on Holland

The Dutch Health Ministry says it has already fielded calls for progress reports from officials in Germany, Britain, Belgium and Luxembourg. Britain announced plans to begin testing cannabis for medical purposes earlier this year with the possibility of the government making it legal for doctors to prescribe their patients starting in 2004 if tests prove conclusive.

Germany already legally provides patients with oral pills and liquids, such as the pharmaceutically manufactured products Marinol and Nabilone, which contain tetrahydrocannabinol (THC), one of the active compounds found in cannabis.

According to Dr. Franjo Grotenherman from the International Association for Cannabis as Medicine (IACM), the German government agreed in 1999 to work on creating a formula for a cannabis extract that could be used as a medical treatment. The government passed the responsibility for developing the formula to the German Pharmaceutical Association, which announced two months ago that their work was complete.

“But now the winds have changed,” Dr. Grotenherman told Deutsche Welle. “At the time of the agreement on the formula, we had a Green Party minister in Health, now the minister is from the SPD and is a little more sceptical.” Dr. Grotenherman added that the process had now slowed down even after the Bundestag voted in support of developing cannabis for medical use in 2001. The Dutch move may now grease the wheels, he hoped.

A report in 2002 by the Vienna-based International Narcotics Control Board (INCB) suggested that decisions by Italy, Luxembourg, Portugal and Spain to decriminalize the drug could also open up possibilities for developing cannabis for medical use.

US, Canada and Australia monitoring

Elsewhere in the world, the Duitch experience will be carefully monitored Parts of the United States, Australia and Canada that began to sell and distribute marijuana for medical use in July were all considering following suit and prescribing the drug through medical sources. Federal law has made it difficult for American states to implement medical marijuana laws. In California, where the drug could be legally used for medical purposes, federal prosecutors used national laws to convict professionals involved in prescribing or supplying cannabis.

The Dutch decision came after extensive tests on the medical benefits of the drug that began in 1996. There has yet to be any concrete evidence of physiological change from using the drug in its medical form, but research shows certain alleviating effects in patients. "There is no scientific proof that it works," said a health ministry spokesman, "but repeated use indicates that an effect does exist."

Claims of effectiveness

Cannabis is claimed to be effective in reducing nausea and vomiting in patients undergoing chemotherapy and radiotherapy, of reducing tension in glaucoma patients and in improving the appetite of those suffering from HIV and AIDS. It is also said to be effective in treating multiple sclerosis and certain nervous disorders. Experts at the Dutch Health Ministry have recommended that the drug only be taken via an inhaler or mixed with tea and not smoked.

Based on these findings, the Dutch government has given permission for two cultivators -- the Stichting Institute of Medical Marijuana (SIMM) and the firm Bedrocan -- to supply pharmacists with strictly regulated dosages of cannabis. The cannabis provided by the two companies is rigorously tested for impurities by the Bureau for Medicinal Cannabis, which also organizes its distribution.

Available now

The government-contracted suppliers began transporting the drug to several hundred pharmacies across the country on Monday, where it will be available to patients, in five gram (0.18 oz) pots or packets. The drug will be sold for between €40 and €50 ($43.80-$54.80) per bag, and patients will be expected to pay for their cannabis themselves. There are no plans as yet to provide the drug as a subsidized health benefit.

The Dutch Health Ministry expects the drug to be initially available to between 4,000 and 7,000 patients, rising to 15,000 within a year. Government estimates put the number of people who are already regularly taking cannabis for medical reasons at around 7,000, with many either buying it in coffee shops or receiving it illegally from doctors and chemists, according to Health Ministry estimates.

"It was ridiculous that people were using this drug while no doctor was permitted to prescribe it, despite the fact that scientific studies showed benefits," a Dutch Health Ministry official said.

Less expensive relief on the street

Cannabis is available in licensed coffee shops in the Netherlands at almost half the price of the government regulated drug, although the strength and quality of the product from illegal channels cannot be guaranteed. Time will tell if the government scheme replaces the street option for patients searching for relief -- something other countries will be watching with interest.