Specialist Physicians Sound the Alarm over TLV's Decision That Could Force Patients Back to Opioids

Patients receiving effective pain treatment risk losing access for financial reasons. In Aurea Care’s appeal, specialist physicians warn of deteriorating health, new adverse effects and a return to opioids. Pharmaceutical manufacturer APL had already warned before the decision that patients receiving appropriately prescribed treatment would also be affected.

Aurea Care has supplemented its appeal against TLV’s decision to exclude extemporaneously prepared oral medicines containing dronabinol and cannabidiol from Sweden’s pharmaceutical reimbursement scheme from 1 December 2026.

The clinic is asking the Administrative Court in Stockholm to overturn the decision and grant an interim stay. Patient safety is at the heart of the appeal: what happens when medically justified treatment can still be prescribed, but patients can no longer afford to collect their medicines?

Specialist physicians challenge blanket treatment switching

Opinions from two specialist physicians explain why Sativex and Epidyolex cannot simply replace individually tailored treatment with dronabinol and cannabidiol.

Separate extemporaneous preparations allow the dose of each substance to be adjusted independently. This matters when a patient’s need for pain relief and sensitivity, particularly to THC, require different doses and ratios of the two substances.

Sativex contains THC and CBD in a fixed ratio. Switching may therefore mean that a patient receives too much of one substance or too little of the other. Epidyolex contains cannabidiol alone and cannot, by itself, replace treatment in which dronabinol is a medically justified component.

The route of administration and excipients also differ. Sativex is an oromucosal spray containing ethanol and propylene glycol, among other ingredients, whereas the extemporaneous preparations concerned are oral oil solutions. These differences may affect tolerability and the practical feasibility of treatment.

The specialists’ objection is therefore specific: the same or related active substances do not automatically provide the same clinical treatment.

Interruption may increase pain and medication risks

For patients whose treatment is stable, interruption may lead to increased pain, poorer sleep, reduced functioning and a lower quality of life.

Those who have reduced or discontinued opioids or sedating medicines may need to resume them. The specialist evidence describes risks associated with returning to opioids, including sedation, falls, the development of tolerance, dependence and overdose.

Switching products also often requires renewed dose titration and closer follow-up. During the transition, symptom control may deteriorate while dizziness, sedation or cognitive impairment emerges. The consequences may be particularly serious for older and frail patients.

The opinions describe potential risks in individual patients. They emphasise that effective treatment needs to be assessed in terms of documented benefit, adverse effects and individual needs before it is changed.

APL warned that appropriately treated patients would be affected

In its consultation response of 16 June 2025, APL supported measures to prevent circumvention of reimbursement decisions. However, it also warned that a blanket exclusion would affect patients prescribed extemporaneous medicines on legitimate medical grounds. APL called for a specific procedure for these patients and stressed the importance of avoiding treatment interruptions.

Aurea Care raises a corresponding objection. According to the clinic, TLV has not examined its patient records or individual clinical assessments. Dispensing statistics do not explain why a physician considered another medicine unsuitable.

The decision therefore also affects medically justified treatment, without any wrongdoing having been established in the individual patient cases.

Lawyers demand consideration of patients’ actual circumstances

In a separate appeal on behalf of five patients, Setterwalls law firm argues for the patients’ right to have the decision reviewed. The lawyers emphasise that continued prescribing does not protect those who cannot afford their medicines.

They request an interim stay because deterioration during the court proceedings may be difficult or impossible to reverse. Alternatively, they ask for implementation to be postponed until 1 October 2027.

Aurea Care continues its services and its work for patients

In response to claims currently circulating on social media about Aurea Care’s imminent closure, the clinic is delivering a clear message: it will not close as a result of TLV’s decision. Its services will continue, as will its work to protect patients’ access to medically justified, reimbursed treatment with cannabis-based medicines.

False rumours of closure create unnecessary anxiety and undermine serious discussion about patients’ care and future treatment.

At the time of review, Aurea Care has 278 ratings on TimeCenter, including 235 with four or five stars, and an average score of 4.3 out of 5. The clinic’s website also features patient interviews about experiences of care and treatment. Reviews and patient accounts offer insight into individual experiences, while clinical effectiveness and safety need to be assessed through clinical follow-up and research.

Support patients’ right to effective treatment

The patient association Cannabispatienter has also appealed the decision. Membership is entirely free and open to patients, relatives and anyone else wishing to support safe and equitable care.

Patients, loved ones and other supporters are also encouraged to sign the petition for continued reimbursement. Links to membership, the petition, reviews and patient accounts are provided below.

Sources and further reading

This article draws on Aurea Care’s appeal and supplementary submission in case 20288-26, the specialist opinions in Appendices 5 and 6, APL’s consultation response of 16 June 2025, and the law firm’s supplementary submission of 30 September 2026 in case 19974-26. The reporting linked below provides public summaries of these documents.