Refill patterns, dispensing adherence and potential waste in medical cannabis: a retrospective observational study at an Italian Regional Centre
This retrospective observational study at an Italian regional center reveals that while a majority of medical cannabis dispensations showed no estimated waste, significant economic loss persists due to structural factors like standardized preparation volumes and limited validity periods rather than solely patient non-adherence.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In Italy, medical cannabis is a carefully regulated treatment used when standard medicines fail to manage difficult conditions like severe chronic pain, muscle stiffness from multiple sclerosis, or nausea from cancer therapy. Unlike pills made in a factory, these treatments are often mixed by hand in hospital pharmacies to fit the specific needs of each patient. Because the strength and amount of medicine must be tailored to the individual, doctors often start with a very small dose and increase it slowly over time. Once a patient takes their bottle home, however, the healthcare system loses track of how much is actually used. The medicine cannot be returned to the pharmacy if it is not finished, and if a patient stops taking it or changes their dose, the remaining liquid is discarded. This creates a puzzle for hospitals: they must provide enough medicine to keep patients safe, but they also want to avoid wasting expensive resources that might sit unused in a medicine cabinet.
Researchers at a regional center in the Marche region of Italy decided to look closely at this puzzle. They examined records from every medical cannabis dispensation made at their facility throughout the year 2025. Their goal was not to spy on patients, but to understand the patterns of how often people returned to pick up more medicine. By comparing the date a patient was supposed to return based on their prescribed daily dose against the actual date they came back, the team could see if patients were picking up refills early, late, or right on time. They used this timing to estimate how much medicine might have been left over and wasted at the end of each treatment cycle. They also calculated the financial cost of this potential waste, looking at how much money the regional health service might be losing on medicine that was dispensed but never used.
The study analyzed 1,233 dispensations involving 372 patients. Most of these patients were women, and the vast majority were being treated for chronic pain. When the researchers looked at the timing of refills, they found that nearly half of the patients picked up their next bottle more than ten days before they theoretically needed to. About a quarter came back more than ten days late, while the rest arrived right on schedule or had irregular patterns that suggested they had stopped treatment. Surprisingly, the team found that the patients who were most consistent and arrived exactly when expected were actually the ones generating the highest amount of potential waste. On average, these "adherent" patients had nearly twenty milliliters of extra medicine left over per bottle, which translated to a higher average cost per visit than those who were late or early.
The type of medicine also played a major role in how much was wasted. While some custom-made, personalized bottles resulted in very little excess, standard formulas created more significant leftovers. One specific type of preparation, known as FM2, was responsible for the largest share of the total financial waste, amounting to nearly six thousand euros, simply because it was prescribed so frequently. Another type, Bedrocan, had the highest average waste per single bottle, but because it was prescribed less often, its total impact on the budget was lower. In total, the researchers estimated that the potential waste across the entire year was just over ten thousand euros. They noted that in about two-thirds of all cases, there was no estimated waste at all, but the remaining cases involved substantial amounts of unused liquid.
The findings suggest that the problem of waste is not caused by patients forgetting to take their medicine or failing to follow instructions. Instead, the issue appears to be built into the way the treatment is delivered. Because the medicine is often compounded in fixed volumes that do not perfectly match a patient's low or changing daily dose, a bottle might contain more liquid than the patient can use before it expires. Even when a patient follows the schedule perfectly, they may still end up with a bottle that is too big for their current needs. The researchers conclude that reducing this waste will not come from trying to change patient behavior, but from adjusting the system itself. By better matching the volume of medicine to the actual daily dose and improving communication between doctors and pharmacists, hospitals could provide the same level of care while significantly reducing the amount of medicine that goes unused.
Drowning in papers in your field?
Get daily digests of the most novel papers matching your research keywords — with technical summaries, in your language.