Glossary

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Here you will find a list with explanations of the technical terms and abbreviations related to the topic of medical cannabis. With the help of the mouse-over function, you will get a preview of the meaning of underlined words within the page texts. If you click on these, you will be taken to the glossary.

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Introduction

01

Areas of application of medical cannabis: clinical efficacy in a wide range of indications and symptoms

Medical cannabis shows a variety of therapeutically beneficial effects: Potential applications include symptoms such as painful muscle spasms, chronic or neuropathic pain, chemotherapy-induced nausea and vomiting, and loss of appetite in HIV/AIDS, for example. Diseases such as epilepsy, Tourette syndrome, ADHD, depression, anxiety and sleep disorders, psychosis and glaucoma have also become the focus of treatment with medical cannabis or THC and CBD. Due to the comprehensive therapeutic spectrum and potential for use of cannabis and cannabis-based medicines, there is still a great need for research.

Therapeutic spectrum of medical cannabis: advances in current research and continuous increase in knowledge

There is ample evidence in the literature for the efficacy and therapeutic spectrum of medical cannabis or cannabis formulas. The primarily evidence-based use of medical cannabis has been continuously confirmed by already completed and additional new controlled clinical studies.

An analysis of the accompanying surveys from 2019 provides information on the areas of use for which cannabis-based drugs have mainly been prescribed in Germany in recent years (see figure). 1

The German accompanying survey offers the opportunity to generate a continuous gain in knowledge from the collected data. The requirement of the Federal Institute for Drugs and Medical Devices (BfArM) (§36 para. 6 sentence 4 SGB V) that participation in a non-interventional study was mandatory until 31 March 2022 enabled the Federal Joint Committee (G-BA) to define indications and performance guidelines for cannabis therapy. 2

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Figure 1. Indications for use of cannabis-based medicines that justify prescription (data from companion survey 2019)3

Benefits of cannabis-based therapy

03

Benefits of cannabis-based therapy: symptom treatment with a broad therapeutic spectrum

As has been impressively shown, the use of cannabis both in the form of the cannabis flowers and the full-spectrum extracts and cannabinoids means an expansion of the therapeutic spectrum. Cannabis-based medicines can be used in numerous indications - especially when the established medication does not bring about sufficient symptom improvement or leads to intolerable side effects.3-5

Established indications for cannabis-based medications include chemotherapy-induced nausea and vomiting (CINV), loss of appetite and cachexia in cancer or HIV/AIDS, chronic or neuropathic pain, and spasticity in multiple sclerosis.3 Most commonly – i.e. in 72% of prescriptions – medical cannabisis prescribed for pain relief.6

Although cannabis-based therapy can alleviate symptoms of a disease, it has no curative effects, i.e. it cannot heal a disease. However, thanks to the analgesic, antiemetic and appetite-stimulating effect of medical cannabis, chronically and severely ill patients experience a significant improvement in their quality of life.

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Therapy with medical cannabis: patient-dependent effect profile

Medical cannabis is currently prescribed mainly for chronic pain, chronic inflammatory diseases and neurological and psychiatric diseases. Cannabis-based therapy is focused on the symptoms of the individual patients and is based on the broad therapeutic spectrum of the contained cannabinoids and terpenes. The manner of action can differ in the individual patients.3,4,7

Selection of medical cannabis by physicians

04

Selection of medical cannabis by physicians: individually suitable cannabis strains

Figure 2. Selection criteria for cannabis-based medications

According to the legally prescribed use of common forms of therapy, the treating physicians can propose a cannabis-based medication to the affected patients as a stress-reducing alternative and supplement to conventional therapeutic preparations. During selection, the treating physicians not only focus on the symptoms or disease of the individual patients, but also consider the patients' previous experience with these substances. They individually decide which medication is suitable for which patients.

In current clinical studies, the following have been used with good results:

  • THC extract containing 3% THC in Crohn’s disease and ulcerative colitis8
  • CBD-dominant extract with 30% CBD and 1% THC in dementia, Crohn’s disease, autism, spasticity/dystonia and epilepsy9
  • CBD/THC-balanced extract containing 5% CBD and 5% THC for pain, PTSD, Parkinson's disease, multiple sclerosis and chemotherapy-associated symptoms10

Please note

For the selection of the appropriate medication, it is generally necessary to consider the following questions:

  • Which symptoms should be alleviated?
  • Which cannabinoid properties are required?
  • Which cannabinoid properties are suitable for the patients to be treated?

Figure 3. Possible expanded indications based on research results and treatment experiences4,7

Advances in cannabis-based therapy: outlook for expanded indications

Since the law does not prescribe indications for treatment with cannabis nor has it specified restrictions on certain areas of application, new expanded indications are constantly being developed. Decisive for this are continuously evidence-based updated research findings and treatment experiences.

Thus, further potential therapeutic approaches are based on increasing scientific findings in the following indications: Spasticity, Tourette's syndrome, Epilepsy, Attention deficit hyperactivity disorder (ADHD), Migraine, Cluster headache, Anorexia, Post-traumatic stress disorder (PTSD), Sleep and anxiety disorders, Depression, Schizophrenic psychosis, Obsessive-compulsive and addictive disorders, Neurodegenerative and neurological diseases (Alzheimer's disease, Parkinson's disease, Huntington's disease, Amyotrophic lateral sclerosis (ALS), Dystonia, Tremor, Restless legs syndrome), Chronic inflammatory bowel diseases (Ulcerative colitis and Crohn's disease, Irritable bowel syndrome, Glaucoma and Hyperhidrosis.4,7

Current studies on medical cannabis

Studies are being conducted worldwide on medical cannabis, as shown in the following overview (Table 1).8-11

Table 1. Current studies on medical cannabis8-11

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References

Status: 2021

  1. BfArM: Cremer-Schaeffer P. Cannabis als Medizin. Erste Erkenntnisse aus der Begleiterhebung. 2019 https://www.bfarm.de/SharedDocs/Downloads/DE/Bundesopiumstelle/Cannabis/Vortrag_Cannabis_Begleiterhebung.pdf?__blob=publicationFile (last visited on 17 Feb 2022).

  2. BfArM: Bundesamt für Justiz. Verordnung über die Begleiterhebung nach § 31 Absatz 6 des Fünften Buches Sozialgesetzbuch. https://www.gesetze-im-internet.de/canbv/__3.html (last visited on 15 July 2021).

  3. Grotenhermen F, Häußermann K. Cannabis. Verordnungshilfe für Ärzte. Wissenschaftliche Verlagsgesellschaft Stuttgart 2019.

  4. Müller-Vahl K, Grotenhermen F. Cannabis und Cannabinoide in der Medizin. Medizinisch Wissenschaftliche Verlagsgesellschaft Berlin 2020.

  5. Sozialgesetzbuch, Fünftes Buch (SGB V) Gesetzliche Krankenversicherung § 31 Absatz 6 SGB. https://www.sozialgesetzbuch-sgb.de/sgbv/31.html (last visited on 17 Feb 2022).

  6. DAP Report. Medizinische Cannabisblüten. https://www.deutschesapothekenportal.de/rezept-retax/medizinisches-cannabis/ (last visited on 17 Feb 2022).

  7. Russo E, Guy WG. A tale of two cannabinoids: The therapeutic rationale for tetrahydrocannabinol and cannabidiol.  Medical Hypotheses 2006;66:234–246.

  8. Product monograph: THC STRAIN 1. 2021

  9. Product monograph: CBD STRAIN. 2021

  10. Product monograph: CBD -THC BALANCE STRAIN. 2021

  11. Häußermann K, Grotenhermen F, Milz E.  Cannabis. Verordnungshilfe für die Apotheke. Deutscher Apotheker Verlag Stuttgart 2018.