.svg)
Introduction
01
Cannabis as medicine: Use as a remedy for centuries
The use of cannabis as a medicine goes back many centuries. For example, Chinese doctors already used it in early dynasties to treat concentration disorders and fever. Since the end of the 19th century, medicinal cannabis has been used in Europe to treat pain and sleep disorders, but also asthma, depression and loss of appetite, as well as to relieve cramps.1
Medical cannabis
02
What is medical cannabis and what effect does it have?
Cannabis is the Latin name for hemp. The fibers of this plant, for example, can be used to make ropes or textiles and the seeds can be used to produce oil. Hemp seeds are available as foods such as hemp oil, protein powder, etc. The dried flowers and leaves as well as cannabis extracts and cannabis-based finished dosage forms are today of increasing importance for the treatment of diseases in medicine. However, please note the following: Hashish and marijuana are still illegal drugs in Germany.
The manifold medicinal effects of cannabis are mainly based on the ingredients tetrahydrocannabinol (THC) and cannabidiol (CBD). In addition, cannabis contains a large number of other active substances such as terpenes.2,3 While THC has a pain-relieving and relaxing effect, CBD can be used as an anxiety reliever and anti-inflammatory.4,5
Effects of medical cannabis strains
03
What are the legal requirements for prescribing medical cannabis?
Since 2017, the prescription of medical cannabis has been permitted in Germany. Cannabis flowers and cannabis flower extracts may be prescribed by physicians as medicines and the statutory health insurance companies cover the costs in certain cases and after approval of the application for reimbursement. Strict rules apply, i.e. the following requirements must be met:6,7
- A serious illness is present.
- Other recognized medical treatments are not available or, according to the physicians, are not possible.
- With the use of medical cannabis, there is a prospect of a noticeable positive effect on the course of the disease or on severe discomfort.
The treating physicians assess whether these requirements are met. Before the first prescription, patients must apply for authorization from their health insurance company and only after approval by the health insurance company the physicians issue what is called a narcotic prescription. Privately insured patients are not entitled to reimbursement by the private health insurance companies (PKV), and thus they must bear the costs of the drug themselves – but a request for cost coverage by the PKV can make sense.
Find out more
Types of medical cannabis
04
What types of medical cannabis are available?
In Germany, various dosage forms of medical cannabis are approved: dried cannabis flowers, plant extracts, dronabinol and cannabidiol formulas as well as finished dosage forms.8 Thus, physicians have the option of prescribing different types of medical cannabis:
- The active ingredients nabiximols, nabilone and cannabidiol are available in the form of oral spray, capsules or solution.
- The active ingredient dronabinol is available as a so-called compounded drug, i.e. the drug – usually oily drops for oral ingestion – is prepared individually for the patients in the pharmacy.
- Additionally, medical cannabis is available as a compounded drug in the form of dried flowers or as a plant extract.
There are two options for the medical use of cannabis: either cannabis or cannabinoid-containing medications are inhaled or orally ingested. A combination therapy consisting of inhalation and oral intake is also possible.4
Find out more
What side effects can medical cannabis have?
Fatigue and difficulty concentrating are observed as the most common side effects of medical cannabis. In addition, the following short-term impairments may occur: dry mouth, nausea, sleep disorders, euphoria, vomiting, orientation disorders, drowsiness, confusion, balance disorders and hallucinations.9 Acute side effects can be mainly psychological, such as euphoria and anxiety, but can also manifest physically as heart and circulatory disorders including tachycardia, drop in blood pressure, and dizziness.5
Please note
If any of these side effects occur, please contact your treating physicians.
References
Status: 2021
Frankhauser M. Cannabis in der westlichen Medizin. In: Grotenhermen F (ed). Cannabis und Cannabinoide. Pharmakologie, Toxikologie und therapeutisches Potential. 2nd edition. Göttingen: Hans Huber 2004:57-71.
Freeman TP et al. Medicinal use of cannabis based products and cannabinoids. BMJ 2019;365:l1141 doi: 10.1136/bmj.l1141.
Russo EB. Taming THC: potential cannabis synergy and phytocannabinoid-terpenoid entourage effects. British Journal of Pharmacology2011;163:1344–1364. https://bpspubs.onlinelibrary.wiley.com/doi/pdf/10.1111/j.1476-5381.2011.01238.x (last visited on 21 July 2021)
Grotenhermen F,Häußermann K. Cannabis. Verordnungshilfe für Ärzte. Wissenschaftliche Verlagsgesellschaft Stuttgart 2019.
Müller-Vahl K, Grotenhermen F. Cannabis und Cannabinoide in der Medizin. Medizinisch Wissenschaftliche Verlagsgesellschaft Berlin 2020.
BfArM: Änderungen in der Betäubungsmittelgesetzgebung: Änderungen 2017. https://www.bfarm.de/DE/Bundesopiumstelle/Betaeubungsmittel/_artikel.html (last visited on 05 July 2021).
Sozialgesetzbuch, Fünftes Buch(SGB V) Gesetzliche Krankenversicherung § 31 Absatz 6SGB. https://www.sozialgesetzbuch-sgb.de/sgbv/31.html (last visited on 04 Aug 2021).
HochE, Friemel CM, Schneider M. Cannabis: Potenzial und Risiko. Hoch E, Friemel CM,Schneider M. Cannabis: Potenzial und Risiko. Cannabis, Cannabinoide und das Endocannabinoidsystem 2019. https://link.springer.com/chapter/10.1007%2F978-3-662-57291-7_1 (last visited on 04 Aug 2021).
Whiting PF et al. Cannabinoids for Medical Use - A Systematic Review and Meta-analysis. In: JAMA 2015;313(24):2456-2473.doi:10.1001/jama.2015.6358