Cannabis-based medicines divide Finnish experts over effectiveness and necessity

Finnish medical experts remain deeply divided over the use of cannabis-derived medicines, with disagreements over their effectiveness, risks, and even whether the topic warrants discussion, according to an investigation by national broadcaster Yle.

While such treatments are prescribed sparingly in Finland—fewer than 200 prescriptions annually, including special permits—some specialists argue the country’s cautious approach is overly restrictive and rooted in outdated attitudes.

Limited approval, narrow applications

The Finnish Medicines Agency (Fimea) currently authorises only two cannabis-based medicines for sale. One, Sativex, is approved for muscle stiffness in multiple sclerosis (MS) patients but requires a neurologist’s prescription. The other, a purified CBD oil called Epidyolex, treats rare forms of epilepsy under specialist supervision.

Fimea’s chief physician, Maria Paile-Hyvärinen, notes that annual Sativex usage suggests “a few dozen” MS patients receive it, with numbers declining. In contrast, Epidyolex use is rising, with over 100 patients treated last year.

Special permits for unlicensed cannabis preparations—such as dried flowers—number under 100 annually. Paile-Hyvärinen emphasises that these lack regulatory approval for safety or efficacy, placing greater responsibility on prescribing physicians to weigh risks and benefits.

Scepticism from pain specialists

At Helsinki University Hospital’s (HUS) Pain Clinic, chief physician Katri Hamunen dismisses cannabis as a meaningful pain treatment. “Despite the hype, its medical significance for pain management is minimal,” she states, citing weak evidence even for neuropathic pain—the most studied application. Hamunen attributes global interest in medical cannabis to political and economic factors, particularly in countries like Canada and Israel where commercial incentives drive its promotion.

Joni Eriksson, deputy chief physician at Turku University Hospital’s Pain Clinic, concurs. “Based on current high-quality research, the harms of cannabis and cannabinoids outweigh the benefits for pain treatment,” he says. While Turku does not routinely prescribe cannabis-based medicines, Eriksson notes that the clinic monitors experiences from countries with broader usage, such as Denmark, and remains open to adjusting practices if new evidence emerges.

Calls for more research

Experts agree that rigorous, comparable studies are needed. Samuel Kohtala, a neuropharmacology docent at the University of Helsinki, highlights challenges in interpreting existing research due to inconsistent methodologies. Markus Storvik, a pharmacology docent at the University of Eastern Finland, adds that most ongoing studies—primarily funded by foundations—focus on pain relief but notes Finland’s stance remains “excessively cautious, partly due to outdated attitudes.”

In Pirkanmaa, regional chief physician Sirpa Rainesalo reports that Sativex has been used sporadically for MS-related stiffness in adults, but cost and lack of reimbursement limit long-term use. “We haven’t identified any patients on it continuously,” she says.

Patient experiences, particularly among those with severe neuropathic pain, often clash with clinical assessments. Some report significant relief from symptoms like phantom limb pain, underscoring the complexity of balancing anecdotal benefits against scientific consensus.