Medical Cannabis

Phytocannabinoids from medicinal hemp act on the endocannabinoid system of the human body, which is involved in the regulation of a diversity of physiological functions, while displaying a very favourable safety profile. Many patients use cannabis as a replacement for prescription drugs that have a more unfavourable safety profile. Medicinal cannabis follows strict pharmaceutical quality standards regarding active ingredient content, stability and purity and may be prescribed by any medical doctor since March 2017 in Germany, with the costs covered by the statutory health insurance funds.

The legalisation of cannabis for medicinal purposes has been the subject of controversial discussions for many decades, even though the therapeutic use of cannabis has already demonstrated positive effects in several countries. As an example, the consumption, abuse, as well as mortality due to (accidental) overdose of prescription drugs (e.g. opioids) has verifiably decreased in US states where medicinal cannabis is legally available.1

A 2017 cross-sectional study with 2774 cannabis consumers that was published in the Journal of Pain Research revealed that 46% of those surveyed used cannabis as a replacement for prescription drugs. While these figures only illustrate self-reported data, certain tendencies are observable: the most frequently substituted classes of drugs were narcotics/opiates (35.8%), anxiolytics/benzodiazepines (13.6%) and antidepressants (12.7%).2

The number of prescription drug substitution with cannabis on a small diagram.
Fig.1: Number of reported prescription drug substitutions with cannabis, by drug category (adapted from Coroon et al., 2017)

The plant cannabinoids contained in cannabis, particularly THC and CBD, modulate the body’s own endocannabinoid system (ECS), which is involved in the regulation of a wide variety of physiological functions (nervous system, immune system, cardiovascular system, gastrointestinal system, muscles, bones, skin). This also explains the broad therapeutic potential of the plant3. Following a 1961 UN Convention, cannabis has been categorised as an illegal drug, on a par with heroin or cocaine, which has hindered research regarding its medicinal properties and controlled clinical application in recent decades. Although cannabis has been used as a medicinal plant for thousands of years4, which in itself should be considered a testimony to its efficacy and safety, numerous doctors and pharmacists oppose cannabis as a medicine with disproportionate scepticism.

According to the World Health Organization (WHO), in 2015 an estimated 183 million adults consumed cannabis world-wide; it is thus the most commonly consumed illegal substance – it was not possible to erase 10,000 years of co-evolution of humanity and this cultivated plant within a few decades. The WHO subsequently responded and reevaluated the risk of (recreational) cannabis consumption in 2018: marihuana is now considered a “relatively safe drug” which, in contrast to heroin, cocaine but also legal substances such as alcohol, nicotine and various medicines, has never led to fatal overdoses. At most, they deliver a warning regarding possible acute side effects, including an impaired short-term memory formation, reduced motor control as well as potential risks for the cognitive development of adolescents.5

In any case, medicinal cannabis and its preparations, in contrast to cannabis from the black market or home-grown cannabis, follow strict quality standards in terms of active ingredient content and stability, and guarantee the absence of pesticides, moulds and thinners. This makes research and specific application of cannabis-based medication possible in the first place. Furthermore, the supervision of cannabis therapy by a medical doctor serves to minimise potential harm, which is not the case in an attempted self-therapy with cannabis (e.g. interaction with other medication, individual assessment of risks and benefits, intervention options in the event of undesired side effects…).

Previously, the BfArM (Federal Institute for Phamaceutical Drugs in Germany) had granted certificates of exemption for the treatment with cannabis according to § 3 (2) of the BtMG (German Narcotics Act) for the following diagnoses7:

Source: German Bundestag (27/03/2017): Antwort der Bundesregierung auf Anfrage der LINKEN (Answer from the Federal Government to a request from the leftist party Die Linke)
With the inception of the German “Cannabis Law” in March 2017, cannabis flowers and cannabis preparations at pharmaceutical quality are now marketable and may be prescribed by any medical doctor – excluding dentists and veterinarians. The legislator rules that the statutory health insurance funds must bear the treatment costs – as long as the legal prerequisites have been fulfilled. Only in justified exceptional cases shall rejecting the coverage of costs be possible.

[1] Bradford AC, Bradford WD. Medical marijuana laws reduce prescription medication use in Medicare part D. Heal Aff. 2016;35:1230-1236.

[2] Corroon J, Mischley L, Sexton M. Cannabis as a substitute for prescription drugs – a cross-sectional study. J Pain Res. 2017;Volume 10:989-998. doi:10.2147/JPR.S134330

[3] Cannabis: Verordnungshilfe für Ärzte von Franjo Grotenhermen; Klaus Häußermann – ISBN 10: 3804737595 – ISBN 13: 9783804737594

[4] Russo E. Hemp for Headache. J Cannabis Ther. 2001;1(2):21-92. doi:10.1300/J175v01n02_04

[5] http://www.who.int/medicines/access/controlled-substances/Section3.CannabitPlant.Toxicology.pdf

[6] https://www.bundesgesundheitsministerium.de/ministerium/meldungen/2017/januar/cannabis-als-medizin.html

[7] German Bundestag (27/03/2017): Antwort der Bundesregierung auf Anfrage der LINKEN (Answer from the Federal Government to a request from the leftist party Die Linke)