Frequently
asked questions

• Deutscher Bundestag. (2017, März 27). Drucksache 18/11701: Cannabismedizin und Straßenverkehr. https://dip21.bundestag.de/dip21/btd/18/117/1811701.pdf (last visited on 01 Aug 2021)

• Ärzteblatt. Cannabispatienten dürfen Auto fahren https://www.aerzteblatt.de/nachrichten/74004/Cannabispatienten-duerfen-Auto-fahren (last visited on 01 Aug 2021)

• Laub L. Cannabismedikation und Medikamentenprivileg des § 24 a StVG. DPolG – Deutsche Polizeigewerkschaft Polizeispiegel 2017; 51(7/8). https://www.dpolg.de/fileadmin/user_upload/www_dpolg_de/pdf/polizeispiegel/polizeispiegel_17_08.pdf (last visited on 06 Aug 2021).

In principle, the same requirements for driving ability and the same legal situation apply as for the use of opioids in pain therapy.7 When driving motor vehicles, an alcohol limit of 0.0 per mille applies to cannabis patients. The consumption of alcohol and other psychoactive substances before driving has resulted in a withdrawal of the driving license of cannabis patients. In the event of a violation, there is a risk of criminal liability in accordance with § 316 of the Criminal Code (StGB).

Reference: Deutscher Bundestag. (2017, März 27). Drucksache 18/11701: Cannabismedizin und Straßenverkehr. https://dip21.bundestag.de/dip21/btd/18/117/1811701.pdf (last visited on 01 Aug 2021

German law does not specify where or in what environment a cannabis-based medicine may be inhaled or ingested. However, it is clear to everyone that outsiders do not know whether or not cannabis is being used for legal, medical reasons. Therefore, it is advisable to refrain from using it in public spaces.

Generally, patients do not have to identify themselves as such to the police, but carrying medical cannabis can be problematic during checks. Currently, there is no official, legally recognized "cannabis ID". Therefore, patients who are being treated with medical cannabis should always carry a copy of their current narcotic prescription for medical cannabis with them – and this always in the packaging dispensed by the pharmacy.

In general, all medicines – including medical cannabis should always be stored in a “child-safe” manner, namely in a special place inaccessible to children. Cannabis flowers should be stored in a cool, dry place up to 25°C and protected against light. Certain cannabis medicines should be stored in the refrigerator and should not be accessible to children and other people there.

Reference:
BfArM: Bundesopiumstelle. Hinweise für Patient:innen https://www.bfarm.de/DE/Bundesopiumstelle/Cannabis-als-Medizin/Hinweise-fuer-Patienten/_node.html (last visited on 06 Aug 2021)‍

Basically, there are two possible applications for the medical use of cannabis: either cannabis or cannabinoid-containing medicines are inhaled or ingested. In individual cases, a combination of inhalation and ingestion can also be useful. Crushed dried cannabis flowers are suitable for inhalation. The use of a medical vaporiser is recommended - also for a better dosage of medicinal cannabis. The ingestion of cannabis extracts dissolved in oil is also a reliable medical form of application. Likewise, an effect can be achieved with cannabis flowers processed in pastries or dissolved in tea, but the dosage is less reliable.

Patients can obtain a dosing spoon from the pharmacy for the correct inhalation dose. One lightly filled dosing spoon corresponds to about 100 mg (0.1 g) of flowers. Another option is the use of single-dose packs of crushed and sifted flowers according to a prescription. The physician must issue a corresponding prescription for this purpose.

If the dose of cannabis is too high, an unpleasant feeling of intoxication usually occurs, but nausea and dizziness may also develop. If such side effects occur as a result of a dose that is too high, they will subside as soon as the effect of the medical cannabis subsides. Before the next application, the treating physician should be consulted regarding whether and how the dose can be appropriately reduced. However, if the side effects persist or intensify, you should immediately seek (emergency) medical assistance.

If a dose is missed, the usual dose can be taken at the earliest possible time without unfavorable consequences. However, under no circumstances should the dose be doubled or increased to "make up" for the missed dose.

Physicians will in each patient check whether there are any contraindications for the use of medical cannabis. Contraindications include severe personality disorders, psychosis, cardiovascular diseases, pregnancy and breastfeeding. Due to the absence of available data, the treatment of children and adolescents (before puberty) is considered very carefully. Especially in elderly patients, severe central nervous system and cardiovascular side effects may occur and be a contraindication.

Within the Schengen area, all medically prescribed narcotics can be taken along when traveling. All that is required is a medical certificate which must be confirmed by the supreme state health authority. The certificate is valid for one month. Regarding the provisions outside the Schengen area, you should inform yourself about the respective national legal situation and include transit countries as well as transit airports. The Schengen area includes the following European countries: Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Sweden, Switzerland, Slovakia, Slovenia, and Spain.‍

Whether and how much medical cannabis abis may be carried depends on the destination. Within the Schengen area, patients may carry medical cannabis abis as a travel requirement for up to 30 days - in the quantity prescribed for the period. In addition, a "certificate for carrying narcotics in the context of medical treatment" according to Article 75 of the Schengen Implementation Agreement is required. This certificate must be filled out by the attending physician and certified by the highest state health authority. A separate certificate is required for each preparation.

For journeys outside the Schengen area, there are unfortunately no uniform international regulations regarding the carrying of narcotics. In this case, it is essential to check the respective entry and exit regulations of the destination country before travelling. Attention: in some countries drastic penalties could be imposed for the possession of cannabis! It is strongly recommended to contact the diplomatic representation of the country of travel, if necessary, also to inquire about the possibility of a local prescription. When travelling by air, it is advisable to keep the medicinal cannabis in your hand luggage, together with all the supplies needed for its use. The same applies to the necessary papers such as a copy of the prescription and the certificate to carry your medicine. It is even better to keep the medical cannabis, aids and documents in a separate bag.

No, it is not permitted to grow cannabis yourself – not even for medical reasons. Medical cannabis falls under the Narcotics Act (BtMG) during treatment, thus quality assurance and medical control must be guaranteed. Supplying medical cannabis of confirmed quality can only be guaranteed by certified producers of cannabis medicines.

In Germany, all doctors, except dentists and veterinarians, are allowed to prescribe medical cannabis. If the treating doctor refuses to prescribe cannabis, this can have several reasons: For example, there may be other treatment methods that are effective, or there may be no scientific evidence for a positive effect of cannabis on the disease to be treated. Interactions with other necessary medicines or contraindications (pregnancy, health risks such as kidney and heart diseases, etc.) can also be reasons for refusal. If doctors refuse to prescribe cannabis on principle, this must be respected by the patients.

Medical cannabis is dosed in such a way that a state of intoxication is usually avoidable. The initial dose is low and is slowly increased (titration), so that the patient gets used to the treatment and is not impaired in either thinking or acting. However, if a state of intoxication occurs, the correct dosage should be checked by the treating physician and adjusted accordingly.

Smoking or vaporizing cannabis flowers are possible forms of application. In inhalation, the use of a vaporizer facilitates the most accurate dosing of medical cannabis. There are also other possible application options: Dosage forms such as capsules, drops or solutions are also available for oral or sublingual use. Together with the treating physicians, the patients decide which dosage form appears to be suitable as an initial treatment. It is often necessary to test different forms of application in order to find the individual dosage option.

Only a few valid research results are available concerning the long-term treatment with medical cannabis. The Federal Ministry of Health (BMG) in a scientific report, "Cannabis: Potential and Risks. A Scientific Analysis (CaPRis)" from 2015, has prepared an assessment of the side effects of cannabis medications.

The cannabis plant owes its diverse active properties primarily to the cannabinoids delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). However, cannabis contains a large number of active substances in addition to THC and CBD: More than 550 substances could be isolated in the meantime and at least 144 of them were classified as cannabinoids. For the medical use of cannabis, THC and CBD are considered to be the main active substances.

The different cannabis strains are classified as "THC or CBD-rich" as well as "THC/CBD-balanced", i.e. they are characterized by a predominant THC or CBD content or the content of THC and CBD is balanced.

The effect of cannabis-containing medicines depends mainly on the composition of the cannabinoids delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) contained in them. THC mainly acts against nausea and vomiting and relaxes and calms. CBD has mainly anti-anxiety, anti-inflammatory and antispasmodic effects.

Reference:
Grotenhermen F, Häußermann K. Cannabis. Prescription guide for physicians. Wissenschaftliche Verlagsgesellschaft Stuttgart 2019.

In case of side effects and interactions, please contact the treating physician immediately. Their instructions must be followed without fail!
Side effects of a therapy with medical cannabis occur rarely and are usually mild to moderate. Side effects resulting from excessive dosage include: SyncopeVariations in blood pressure, fluctuations in pulse rate, fluctuations in blood glucose levels, fluctuations in respiratory rate. Some affected individuals may also experience transient psychotic attacks, anxiety, delusions or hallucinations. In most cases, reducing the dose can achieve the desired effect while reducing side effects.

Reference:
Product Monograph THC STRAIN 1. 2021
Product Monograph CBD STRAIN. 2021
Product monograph CBD - THC BALANCE STRAIN. 2021

In case of side effects and interactions, please contact the treating physician immediately. Their instructions are to be considered absolutely!

Dizziness; may significantly increase the risk of falls in the elderly, vomiting, exacerbation of multiple sclerosis, urinary tract infections, anxiety in first-time users, psychotic effect (higher doses).
Neurological symptoms: decreased coordination, muscle weakness, sedation, drowsiness, impaired concentration, changes in psychomotor activity, slurred speech, slowed responsivenessCognitive impairmentDecreased attention activation (alertness) and increased risk of accidents during complex tasks.
General effects: Dry mouth, headache, cough, sore throatTachycardiaApplication during pregnancy may result in decreased birth weight.

Reference:
Product Monograph THC STRAIN 1. 2021
Product Monograph CBD STRAIN. 2021
Product Monograph CBD - THC BALANCE STRAIN. 2021
Medical Grade Cannabis. Clinical Guide IMCA Israeli Medical Cannabis Agency 2017; https://www.docdroid.net/E2wicok/20180105142901-watermark-watermark-pdf (last visited 07/12/2022).

In the event of side effects and interactions, consult the treating physician immediately. Their instructions must be followed without fail!

Dependence
Increased risk of chronic bronchitis and impaired lung function (mainly when used as a cigarette)
Psychotic symptoms and disorders are more likely to be observed in patients with a corresponding personal or family history:inside with appropriate personal or family history
Decrease in levels of luteinizing hormone (LH) and follicle stimulating hormone (FSH), prolactin (PRL) and growth hormone (STH)
Gastrointestinal tract disorders and electrolyte disturbances, especially in patient:inside with renal insufficiency to be considered
Application of more than 10 years may lead to permanent impairment of cognitive abilities

Reference:
Product Monograph THC STRAIN 1. 2021
Product Monograph CBD STRAIN. 2021
Product Monograph CBD - THC BALANCE STRAIN. 2021
Medical Grade Cannabis. Clinical Guide IMCA Israeli Medical Cannabis Agency 2017; https://www.docdroid.net/E2wicok/20180105142901-watermark-watermark-pdf (last visited Jul. 12, 2022).