Cannabis and cannabinoids as medicines

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Cannabis sativa L., from Koehler's medicinal plants
Medical marijuana from the USA
Man with California Medical Marijuana Identification Card

Cannabis ( drug obtained from leaves or flowers of the hemp plant genus ) can be used as a medicine . For use also come cannabis-like substances ( cannabinoids ), isolated or (partially) be produced synthetically.

In many cultures, marijuana (dried leaves and inflorescences as a whole) and hashish (the resin of the flower hairs of the female plant) are used in traditional medicine, but are also consumed as stimulants and intoxicants . From the large number of active ingredients contained in the plant (in addition to cannabinoids , especially terpenes ), Δ 9 -tetrahydrocannabinol (THC) and cannabidiol (CBD) have been recognized as pharmacologically particularly effective components and researched separately. In addition to marijuana, standardized extracts and synthetic THC analogues are used in therapy .

In Austria, cannabis (i.e. the plants and parts of plants belonging to the cannabis genus) is only a drug that can be marketed and prescribed if it is present in preparations that are approved as finished medicinal products. In Germany, cannabis flowers and extracts have also been approved as medicinal products since March 10, 2017, if they come from cultivation for medical purposes under state control or approved imports.

history

Illustration from the Vienna Dioscorides ; 512 AD
Cannabis extract; Early 20th century

Cannabis has been used as a medicine in various cultures for millennia. In the 16th century BC Ebers papyrus , which originated in the 4th century BC, mentions a plant identified as cannabis as part of a remedy "for the toenail". The recipe - using ocher - suggests application as an envelope.

The classical Chinese book of Shennong of the medicinal plants from the 2nd or 3rd century AD, attributed to the mythical Emperor Shennong (around 2800 BC), mentions the resin of the cannabis flower as a remedy for beriberi , constipation, gynecological diseases, Gout , Malaria , Rheumatism, and Absenteeism.

The cannabis plant was also known in ancient medicine; a picture can be found, for example, in the " Wiener Dioskurides " compiled in 512 AD , an edition of the main work Περὶ ὕλης ἰατρικῆς ( Latin De materia medica , About the remedies') by the Greek doctor Pedanios Dioscurides , who wrote in the 1st century AD. lived. The Greek doctor Galenus of Pergamon assigned the hemp plant a warming and drying effect as part of the ancient humoral pathology .

Ancient medicine was adopted and further developed by Islamic doctors . Arab physicians such as at-Tabarī and al-Antaki described the properties of the plant in the 9th century on the basis of the ancient authors. In Islamic medicine, the pressed seeds were mainly used, less often the leaves. In the 10th century Ishak ben Sulaymān described the use of hemp seed oil to treat ear diseases; Ibn-al Baitār (around 1190-1248) used hemp seeds as a medicine against worm infestation . Yuhanna ibn Masawaih (around 777–857) and Avicenna (around 980–1037) used the sap of the leaves for skin diseases. Ibn-al Baitār and al-Qazwīnī (1203–1283) also knew the analgesic properties and used cannabis to treat nerve and eye pain. Dosage details were not given in the Arabic textbooks; the oil or juice of the leaves was instilled into the painful orifices.

Cannabis found its way into monastery medicine from the 11th century and was used for various ailments and as a substitute for opium. The abbess Hildegard von Bingen (1098–1179) recommended hemp as a remedy for nausea and stomach pain. Cannabis found its way into modern medicine through the report published in 1839 by the Irish doctor William Brooke O'Shaughnessy (1809-1889), who, as part of his medical work during his stationing in Calcutta, India, had an analgesic, antispasmodic and muscle-relaxing effect after using cannabis indica (Indian hemp). Based on his observations and studies, O'Shaughnessy recommended the use of cannabis for rheumatism , cholera and tetanus .

A popular cannabis-finished product of the 19th century was the soporific Bromidia in the US, an elixir of cannabis and henbane extracts in combination with potassium bromide ( "potassium bromide") and chloral hydrate . Ethanolic extracts from cannabis herb ( Extractum Cannabis, Tinctura Cannabis ) were particularly widespread . Since the beginning of the 20th century, cannabis-containing drugs have been gradually replaced by synthetic drugs, the benefits of which have been proven in modern clinical studies, because of their fluctuating effects, difficult dosages and the risk of paradoxical effects.

In 1925 cannabis was banned worldwide by the Second International Opium Conference of the League of Nations in Geneva. The justification for the ban was that at that time there was no evidence of medical benefits, along with severe psychotropic side effects and psychological dependence. In 1961 the standard agreement on narcotics was concluded, which still forms the basis of international drug control today. Since the classification of cannabis in Annex IV (highest health risk, equivalent to heroin) results in a conflict that cannot be resolved otherwise due to increasing medical indications, the WHO expert group (ECDD) issued a recommendation to the UN at the beginning of 2019 that cannabis etc. To delete derivatives from this group and, if necessary, only to list them in Annex I. Only in the former GDR did the Leipziger Arzneimittelwerke manufacture the finished herbal medicinal product Plantival until 1990 , which contained cannabis sativa as an ingredient .

In 1944, the La Guardia Report of the La Guardia Committee was published in the USA , an expert group set up by the then New York Mayor Fiorello LaGuardia , which failed to confirm many of the negative sociological, psychological and medical effects ascribed to cannabis use. As a result, the head of the then drug control authority, the Federal Bureau of Narcotics (FBN), Harry J. Anslinger , threatened to severely punish further research into cannabis.

Modern cannabis research began with the isolation of the main psychotropic ingredient Δ 9 - THC in 1964 by Raphael Mechoulam . Another milestone in cannabis research was the discovery of the endocannabinoid system with its receptors and endogenous ligands from the late 1980s, which forms the basis for today's understanding of how cannabinoids work. The United States Department of Health and Human Services registered patent US6630507 B1 "Cannabinoids as antioxidants and neuroprotectants" on April 21, 1999 as the original agent.

In Germany, the “International Working Group on Cannabis as Medicine”, or IACM for short (former name: “Working Group on Cannabis as Medicine”, AMC) has been campaigning for the medical use of cannabis since 1997.

Pharmacologically active ingredients

So far, a total of 113 different cannabinoids have been identified, the details of which are mostly still unknown. The currently most frequently discussed cannabinoids, which are presumably mainly responsible for the therapeutic effects, are cannabidiol (CBD, discovered in 1940, first chemically synthesized in 1963) and Δ 9 -tetrahydrocannabinol (THC, discovered in 1964). Other naturally occurring cannabinoids are cannabigerol (CBG), cannabinol (CBN), cannabichromene (CBC) and cannabidivarin .

In general, C. indica products have a higher CBD to THC ratio than C. sativa products . Various strains have been bred that either have a higher content of psychoactive THC or non-psychoactive CBD.

The following table shows the state of knowledge on the pharmacological effects of individual cannabinoids. It should be noted that information obtained from in-vitro studies and animal models cannot necessarily be transferred directly to humans.

Effects of individual cannabinoids proven in (pre) clinical studies
THC CBD CBG CBN CBC THC-V CBD-A CBG-A CGC-A CBC-A THC-A
Pain reliever Yes check.svg Yes check.svg Yes check.svg Yes check.svg
Anticonvulsant Yes check.svg Yes check.svg Yes check.svg
Promotes sleep Yes check.svg
Anxiety-relieving Yes check.svg
Appetizing Yes check.svg Yes check.svg
Appetite suppressant Yes check.svg
Lowering blood sugar Yes check.svg Yes check.svg
Antibacterial Yes check.svg Yes check.svg Yes check.svg Yes check.svg
Anti-emetic Yes check.svg Yes check.svg
fungicide Yes check.svg Yes check.svg
Reduces the growth of tumor cells Yes check.svg Yes check.svg Yes check.svg Yes check.svg Yes check.svg
With arteriosclerosis Yes check.svg
Against psoriasis Yes check.svg
Antipsychotic Yes check.svg
For muscle cramps Yes check.svg Yes check.svg Yes check.svg Yes check.svg Yes check.svg
Promotes bone growth Yes check.svg Yes check.svg Yes check.svg Yes check.svg Yes check.svg
Anti-inflammatory Yes check.svg Yes check.svg Yes check.svg Yes check.svg Yes check.svg Yes check.svg Yes check.svg
Relaxes the stomach and intestines Yes check.svg
Immunomodulating Yes check.svg
Neuroprotective Yes check.svg
THC : Δ 9 -tetrahydrocannabinol; CBD : cannabidiol; CBG : cannabigerol; CBN : cannabinol; CBC : cannabichromene; THC-V : tetrahydrocannabinol-V; CBD-A : cannabidiol-A; CBG-A : cannabigerol-A; CGC-A : cannabigerol-A; CBC-A : cannabichromene-A; THC-A : Tetrahydrocannabinol-A.

For the medical use of cannabis, it is important that the spectrum of activity of the two main active ingredients CBD and THC can complement one another. Both intensify their pain-relieving effect. The antiemetic, appetite-stimulating and muscle-relaxing effect of THC is complemented by the anticonvulsant, neuroprotective and anti-anxiety effect of CBD. Both can be prescribed by a doctor individually or in combination.

Therapeutic meaning

Indications

An effectiveness in the therapy of chronic neuropathic pain is considered empirically proven according to the principles of evidence-based medicine . According to these rules, the effectiveness against tumor pain and muscle spasticity caused by multiple sclerosis is less well documented . Nabilone is used for chemotherapy- induced nausea and vomiting , other cannabis preparations in this indication as part of a healing attempt . One by tumor or AIDS caused disease infection cachexia can be alleviated by the appetite-enhancing effects.

In palliative medicine , the continuation of cannabis therapy after proven successful symptom control in neuropathic pain, spasticity in multiple sclerosis or after neurotraumas is established.

Pain sufferers can reduce or stop taking opioids by taking pharmaceutical cannabis.

Overview of globally approved cannabis-based drugs (2018)
indication Active ingredients Admission
Spasticity in multiple sclerosis Nabiximols Germany and 18 other EU countries
Neuropathic pain Israel, Canada, New Zealand
Additional therapy for tumor pain that is difficult to treat Canada
Nausea and vomiting with chemotherapy Nabilone Germany, USA
Anorexia with Weight Loss in HIV / AIDS United States
Nausea and vomiting with chemotherapy Dronabinol United States
Anorexia with Weight Loss in HIV / AIDS
Lennox-Gastaut syndrome Cannabidiol United States
Dravet syndrome

Use in the context of healing attempts

Cannabis is used, for example, in the context of therapeutic trials for therapy-refractory loss of appetite , as a coanalgesic for chronic pain syndrome , and for seizures that cannot be treated with conventional therapy , especially in children.

There is an anti-nausea and vomiting benefit of certain herbal, synthetic, and semi-synthetic cannabinoids in chemotherapy-treated cancer or in HIV / AIDS. Numerous older scientific studies are to be regarded as inadequate due to their design or their poor methodological quality. In particular - with the exception of one study - there are no comparisons with modern drugs against nausea and vomiting such as 5-HT3 , NK1 receptor antagonists or neuroleptics, so that the effectiveness cannot be precisely assessed. Studies comparing cannabis drugs (dronabinol, nabilone, levonantradol, nabiximols) with conventional drugs or placebo provide indications of a better effect against nausea and vomiting. In palliative treatment of cancer and HIV / AIDS patients, individual studies found a slight - but not significant compared to placebo - improvement in nausea and vomiting and an increase in appetite with dronabinol or cannabis cigarettes. Compared to placebo, side effects are significantly more common with treatment with cannabis drugs. They are mostly temporary and not serious. Serious side effects and study discontinuations due to drug intolerance occur when investigating all clinical applications of cannabis.

Despite a multitude of anecdotal reports on the effectiveness of cannabis against nausea and vomiting during chemotherapy, there are no good quality randomized studies on this. There are no studies on the effectiveness of cannabidiol or cannabis enriched with cannabidiol in nausea and vomiting caused by chemotherapy. This information is often requested by patients who want to avoid the psychoactive effects of THC-based products.

Notes on further areas of application

  • Experiments on animal models indicate that the modification of the endocannabinoid system by cannabis could positively influence the development of arteriosclerosis, provided cannabis is not inhaled but taken in a different preparation.
  • As far as we know today, there is no connection between cannabis use and body mass index or obesity, metabolic syndrome , or prediabetes. The likelihood that marijuana users will develop diabetes is slightly lower or equal to that of non-users. The meaningfulness of the studies on cannabis and diabetes that have been published to date is low, as the data were obtained from cross-sectional studies . A biological marker that would enable a dose-response relationship between cannabis and the long-term effect on metabolism is not established. Possible disruptive factors were not excluded .
  • The currently available data from individual case series can neither prove nor disprove the effectiveness of cannabinoids in the treatment of epilepsy . Cannabidiol can alleviate the symptoms of therapy-resistant forms of epilepsy, but the study results are inconsistent. The proof of the therapeutic effect is made more difficult by the fact that in epilepsy, CBD is rarely given alone, but mostly in combination with other anti- epileptic drugs whose plasma concentration is increased by CBD.
  • Cannabinoids can relieve symptoms of post-traumatic stress disorder . Cannabis use is widespread among US war veterans with post-traumatic stress disorder; a number of these reported improvement in symptoms such as anxiety and nightmares. Research into the use of cannabis by soldiers has been carried out in the USA with public funds since 2014. In April 2016, the DEA released the research facilities at Johns Hopkins University and in Arizona.

In addition, an application is being discussed for sleep disorders , anxiety disorders , autism , ADHD , bipolar disorder , depression , arthritis, and autoimmune diseases such as Crohn's disease and ulcerative colitis .

A meta-analysis from 2019 evaluated 80 studies on the treatment of depression, anxiety, post-traumatic stress disorder, Tourette's syndrome , ADHD and psychosis with cannabis preparations. A total of 3,000 people were included. Only half of the studies corresponded to the methodological "gold standard" of a randomized controlled study . The analysis showed no positive effect in any area, except - supported by very weak evidence ("very low quality evidence") - a sparse ("scarce") benefit of cannabis for patients with symptoms of anxiety that are related to other diseases (non-cancerous Pain, multiple sclerosis ).

Side effects

Side effects of cannabis therapy include dizziness (12.5%), tiredness (16.3%), drowsiness (7%), nausea (7.4%), increased pulse ("racing heart", tachycardia ), drop in blood pressure, dry mouth, headache , red eyes, breathing problems, mental disorders and a number of other undesirable effects occur, which also depend on the route of administration, the dose and duration of therapy as well as a variety of other factors. The use of cannabis and cannabinoids has been linked to central nervous and psychiatric side effects.

Medicinal cannabis and cannabinoid preparations

Cannabis flowers and cannabis extracts with standardized active ingredient contents as well as synthetic cannabinoids can be medically indicated for various clinical pictures, although the ability to prescribe is regulated differently at national level. In Germany, doctors of all disciplines - without any special additional qualifications - can prescribe dronabinol (both as a finished drug and as a prescription drug), nabilone and the cannabis-based sublingual spray Sativex, also off-label (outside of the approved indications) as part of an individual therapeutic attempt if the doctor and Promise the patient a benefit from it. Since March 10, 2017, German doctors have also been able to prescribe cannabis flowers and cannabis extracts with a BtM prescription for their patients. The assumption of costs by health insurance companies was also made mandatory, but is only possible after prior application and approval in a few indications. In most cases, the health insurers pass this test to the community med. Service MDK , which decides individually based on the revised evaluation criteria in terms of form and indication. An essential criterion is the presence of a "serious illness".

The Federal Institute for Drugs and Medical Devices advises cannabis patients against smoking cannabis flowers, but recommends other forms of consumption.

Herbal cannabis preparations contain, in addition to the main active ingredients, a number of naturally occurring cannabinoids , so that their profile of action can differ from the isolated individual substances. Further products based on cannabis extracts that are standardized to a fixed content of THC and possibly also other cannabinoids are under development (capsules for oral administration, sublingual tablets ). Hemp oil and essential hemp oil are used less medicinally today . The antiemetic and psychoactive THC structural analogue levonantradol or nabitan are not used medicinally .

Oral, rectal or transdermal administration as well as the inhalation of the vaporized (directly vaporized) cannabis are alternatives to smoking, especially since vaporization, unlike smoking, does not produce any cancer-causing combustion products. A randomized, double-blind and placebo-controlled study on twelve healthy male volunteers who inhaled vaporized pure THC (instead of cannabis) showed that THC could be detected in blood plasma after inhalation, with the plasma concentration fluctuating only slightly between the individual persons.

The New Formulation Form (NRF) used in Germany contains standardized recipes for the following medicinally used herbal cannabis products:

  • Oily cannabis oleoresin solution
  • Cannabis flowers for inhalation after vaporization
  • Cannabis flowers for making tea

The NRF lists the following recipes with biogenic or synthetic individual substances:

  • Oily dronabinol drops
  • Dronabinol capsules
  • Ethanolic dronabinol solution for inhalation
  • Oily cannabidiol solution

Medicinal cannabis flowers

Bediol, cannabis flos from the Netherlands
Bedrocan, cannabis flos from the Netherlands

In Germany, since March 10, 2017, patients have been able to get medical cannabis flowers (lat. "Cannabis flos" ) on prescription, whereby the costs can be covered by the health insurance companies. The cultivation of cannabis for medical purposes is made possible under state supervision (cannabis agency) (see → Cannabis as a medicinal product, Germany ). Until deliveries from German cultivation are available, demand will be covered by imports. As of February 2017, medical cannabis flowers were available for import in 14 varieties with different nominal THC and CBD contents, which came from the Netherlands and Canada. The THC levels range from less than 1 to approx. 22%, the CBD levels from below 0.05 to approx. 10.2%.

In the Netherlands, cannabis flowers are grown under state supervision, the trade is subordinate to the Bureau voor Medicinale Cannabis (BMC). Five varieties are available on prescription for human and veterinary medicine: Bedrocan (THC approx. 22%; CBD <1%), Bedrobinol (THC approx. 13.5%; CBD <1%), Bediol (THC approx. 6.3 %; CBD approx. 8%), Bedica (THC approx. 14%; CBD <1%; ground flowers) and Bedrolite (THC <1%; CBD approx. 9%). The retail price is € 34.50 excluding 6% VAT for 5 grams of flowers (as of December 2015).

In Austria, the Agency for Health and Food Safety (AGES) is authorized by the Narcotics Act to cultivate cannabis for the purpose of obtaining active ingredients for the manufacture of pharmaceuticals, in order to sell them to traders with a manufacturing license or trading license for drugs and poisons. One customer is the German company Bionorica , which extracts cannabinoids from them.

Nabiximols

The mouth spray with the trade name Sativex (active ingredient: Nabiximols, a full cannabis extract with adjusted levels of THC and CBD) is approved in Germany and other EU countries as well as in Canada and Israel.

Uses include the treatment of neuropathic pain and spasm in multiple sclerosis, and the treatment of pain, nausea and vomiting associated with cancer and AIDS diseases. In Canada, approval includes the concomitant treatment of neuropathic pain in multiple sclerosis and the treatment of pain in cancer patients for whom opioid therapy is unsuccessful.

Dronabinol

Dronabinol is a semi-synthetically manufactured substance that is marketable and prescribable in Germany within the meaning of the Narcotics Act . Dronabinol is structurally identical to tetrahydrocannabinol (THC) - more precisely the psychoactive isomer (-) - Δ 9 -trans-tetrahydrocannabinol - so that both terms are sometimes used synonymously . Dronabinol is not approved in Germany; For individual therapy, however, dronabinol can be prescribed as a prescription drug or obtained from there in the form of the finished drug approved in the USA as a single import in accordance with Section 73 AMG. In the USA, a ready-to-use drug containing dronabinol is approved for the treatment of loss of appetite ( anorexia ) in AIDS patients and for the treatment of nausea and vomiting caused by cytotoxic drugs in cancer therapy.

Cannabidiol

Cannabidiol was granted orphan drug status by both the FDA and the EC for the treatment of special forms of epilepsy in children, such as Lennox-Gastaut (2014), Dravet syndrome (2017) and West syndrome (2017), so a simplified procedure can be claimed for an application for drug approval . In 2017, a placebo-controlled, randomized, double-blind study was published in 120 children and young adults with Dravet syndrome, which was able to demonstrate a significant decrease in the frequency of seizures. In March 2018, the results of a randomized, placebo-controlled study on 171 patients with Lennox-Gastaut syndrome were published, which showed a statistically significant reduction in the number of monthly seizures with cannabidiol. Based on this data, the manufacturing company received approval for Epidiolex in the USA in 2018 and in Europe in 2019 .

Nabilone

The fully synthetic THC derivative nabilone, like dronabinol, is marketable and prescribable in Germany as a narcotic, but has not been on the market as a finished drug since 1991. There are still preparations in Canada and Great Britain, for example. They are indicated for the treatment of loss of appetite and emaciation ( cachexia ) in AIDS patients and for the treatment of nausea and vomiting during chemotherapy and radiation therapy as part of cancer therapy.

Legal position

The global legal situation of medical cannabis · As of April 2020
  • legal (prescription only)
  • legal for recreational use too

    • Germany

    In Germany, cannabis ( "plants and parts of plants belonging to the cannabis genus" ) has been a marketable and prescription drug since 2011 - provided that it is contained "in preparations that are approved as finished medicinal products" or, since March 2017, from state-controlled drugs Cultivation or up to the establishment of this comes from imports.

    In other forms, until March 2017, cannabis was only marketable for the production of pharmaceuticals and only with an exemption under Section 3 (2) BtMG for the acquisition of cannabis flowers from the pharmacy for use as part of medically supervised self-therapy for therapeutic use. In 2007, such an exemption was granted for the first time for a patient suffering from multiple sclerosis , since according to the law, such a permit is “only possible in exceptional cases for scientific or other purposes in the public interest”. This was preceded by the legitimation by the judgment of the Federal Administrative Court in 2005, which saw the provision of the necessary medical care for the population as a purpose in the public interest within the meaning of Section 3 (2) BtMG.

    On May 4, 2016, the federal government passed a draft law that is intended to enable patients to be supplied with natural cannabis and to be reimbursed by health insurers, and which was passed unanimously by the Bundestag on January 19, 2017. According to the announcement published on March 9, 2017, needy, chronically seriously ill people can get cannabis on prescription, whereby the costs may be covered by the health insurance companies. Doctors should independently decide whether cannabis therapy makes sense, even if there are other treatment options in individual cases. "So the patients do not have to be 'exhausted', as it was initially said, before they are entitled to a cannabis prescription." The doctor may give a patient up to 100 grams of cannabis in the form of dried flowers or up to 1 gram - based on the Δ 9 -THC content - prescribe as an extract of standardized pharmaceutical quality (amendment of §§ 1 and 2 BtMVV ). In order to ensure the supply, the cultivation of cannabis for medical purposes in Germany is made possible and the import of up to 42.8 tons of cannabis is allowed. For this purpose, a state cannabis agency was set up, which coordinates and controls the cultivation and distribution and is located at the BfArM. Exemptions from the Federal Opium Agency at the BfArM for the purchase of medicinal hemp products will therefore no longer be required. Growing yourself remains prohibited. The care of German patients therefore depends on imports. In 2018, 3.1 tons of pharmaceutical cannabis were imported. The reference countries were Canada and the Netherlands. However, since the legalization of cannabis as a stimulant in Canada in October 2018 there have been supply bottlenecks in Germany, since Canadian companies have primarily been supplying the domestic market since then. Due to the bottlenecks, German dealers are cooperating with partners in other European countries such as Macedonia in order to guarantee security of supply in the future.

    With the change in law that came into force on March 10, 2017, an anonymous accompanying study by the Federal Institute for Drugs and Medical Devices (BfArM) began, the first results of which were presented in May 2019. At almost 70 percent, pain is by far the most common diagnosis for prescribing pharmaceutical cannabis.

    In April 2019, the BfArM announced that it had awarded contracts for the cultivation of cannabis for medical purposes. This means that the cultivation of pharmaceutical quality cannabis in Germany can be implemented under the narcotics and drug law requirements. Three Canadian companies or subsidiaries have been awarded the contract to produce a total of 10.4 tons of pharmaceutical cannabis over the next three years.

    In April 2016, the Federal Administrative Court had, as an exception, allowed a terminally ill man to grow cannabis for self-therapy. With the ruling, the Federal Administrative Court obliged the Federal Institute for Drugs and Medical Devices to grant an exceptional permit for the cultivation of cannabis, because the narcotic is necessary for medical care and no equally effective and affordable alternative therapy is available. This does not affect the authority of the BfArM to add ancillary provisions to the permit.

    Austria

    In Austria, preparations made from cannabis are permitted in accordance with Section 14 no. 3 Narcotics Ordinance not prescribable. The only exceptions are approved finished medicinal products (medicinal specialties).

    Switzerland

    In Switzerland , the doctor must apply for a patient-specific special permit from the Federal Office of Public Health (FOPH) for therapy with dronabinol . Since dronabinol is not a compulsory health insurance service, the assumption of costs must be clarified in advance and on a case-by-case basis; with some health insurances you need additional insurance. Since 2011, cannabis cultivation with a THC content of up to 1% has been permitted in Switzerland, mainly because of the natural fluctuations in hemp plants; previously the limit was 0.3%, but it could not be adhered to on a regular basis. Since then, industrial hemp cultivation for medical purposes has increased in Switzerland.

    Italy

    Since 2006, doctors in Italy have been able to prescribe prescription drugs containing dronabinol. The dried and ground inflorescences of medical cannabis - approved by the national cannabis authority - can also be prescribed for ingestion as a decoction or for inhalation with a special vaporizer. Furthermore, the cannabis extract-based drug Sativex , which was approved in April 2013 for the treatment of painful spasms in multiple sclerosis, has been available for prescription since 2013 .

    Until 2016, cannabis flowers for medical use were imported into Italy from the Netherlands, which are grown there under the responsibility of the Medical Cannabis Office of the Dutch Ministry of Health, Social Affairs and Sport. In 2016, the Italian army started growing medicinal cannabis in its own country on behalf of the Ministry of Health ( Ministero della salute ). The cultivation takes place in a pharmaceutical company of the Italian army in Florence . The strain known as Cannabis FM-2 contains 5 to 8% THC and 7.5 to 12% CBD. Cannabis can be prescribed in Italy for chronic pain, multiple sclerosis, spinal cord injuries; for nausea and vomiting caused by chemotherapy, radiation therapy, HIV therapy; as an appetite stimulator in cachexia, anorexia, loss of appetite in cancer patients or patients with AIDS and anorexia nervosa; to treat glaucoma; to reduce involuntary body and face movements in Tourette's syndrome when conventional or standard therapies are ineffective.

    France

    The cannabis extract Sativex has been approved in France since 2014 . This was preceded by a decree that came into force in June 2013, which enabled the French medicines authority Agence nationale de sécurité du médicament et des produits de santé (ANSM) to issue a marketing authorization and paved the way for the sale of medicinal products containing cannabis.

    On request and under the responsibility of the prescribing physician, the ANSM can authorize individual patients to use the dronabinol-containing preparation Marinol for a limited period (Autorisations temporaires d'utilisation nominative, ATUn) . It can then be imported from a third country in which there is an approval (e.g. Canada, USA). Between 2006 and 2013, 167 patients were treated with dronabinol.

    International

    In addition to Germany, Austria and Switzerland, Belgium, the Netherlands, Spain, Italy, Finland, Portugal, the Czech Republic, Israel, Uruguay, Canada, Great Britain, New Zealand, Greece, Poland, Denmark, Paraguay, Peru, Lesotho, Puerto Rico, Luxembourg, Zimbabwe, South Korea and Thailand are among the countries in which cannabis or its active ingredients can be used legally for medicinal purposes.

    In the US, 33 (out of 50) states, four of the five US territories and the District of Columbia allow the medicinal use of cannabis and cannabis products.

    See also

    Portal: Hemp  - Overview of Wikipedia content on the topic of hemp

    literature

    Web links

    Commons : Cannabis as a medicine  - collection of pictures, videos and audio files

    Individual evidence

    1. ^ A b Cannabinoids in medicine: A review of their therapeutic potential . In: Journal of Ethnopharmacology . tape 105 , no. 1-2 , April 21, 2006, ISSN  0378-8741 , p. 1–25 , doi : 10.1016 / j.jep.2006.02.001 .
    2. ↑ Germany: Amendment to Annex III of the BtMG from March 2017. Austria: Suchtgiftverordnung , ris.bka.gv.at.
    3. ↑ Medical cannabis: The most important changes In: Deutsches Arzteblatt 2017; 114 (8), accessed 08/2017
    4. ↑ Transcription ( Memento of December 3, 2013 in the Internet Archive ), Papyros Ebers, Leipzig 1875.
    5. ↑ Indalecio Lozano: The therapeutic use of Cannabis sativa (L.) in Arabic medicine . In: Journal of Cannabis Therapeutics . tape 1 , 2001, p. 63–70 ( cannabis-med.org [PDF; accessed March 17, 2018]).
    6. ^ EB Russo: History of cannabis as medicine . In: GW Guy, BA Whittle, P. Robson (Eds.): Medicinal uses of cannabis and cannabinoids . Pharmaceutical Press, London 2004, ISBN 978-0-85711-017-6 , pp. 1-16 .
    7. ^ Mathias Broeckers: Cannabis . AT Verlag, Aarau 2002, ISBN 978-3-85502-872-6 , p. 139 .
    8. ^ WB O'Shaughnessy (1839) Case of Tetanus, Cured by a Preparation of Hemp (the Cannabis indica.), Transactions of the Medical and Physical Society of Bengal ( Memento of July 21, 2011 in the Internet Archive ) 8, 1838-1840 , Pp. 462-469.
    9. ↑ Rainer-B. People: Therapy with Cannabis and Co. in: Pharmazeutische Zeitung , issue 05/2009 of January 29, 2009.
    10. ↑ antiquecannabisbook.com: Ads for Bromidia
    11. ↑ F. Grothenhermen, K. Müller-Vahl K: The therapeutic potential of cannabis and cannabinoids . In: Deutsches Ärzteblatt 109 (29-30) . 2012, p. 495-501 .
    12. ↑ European Monitoring Center for Drugs and Drug Addiction : Drug Profile Cannabis .
    13. ↑ S. Pisanti, M. Bifulco: Modern history of medical cannabis: from wide-spread use to prohibitionism and back . In: Trends in Pharmacological Sciences 38 (3) . 2017, p. 195–198 , doi : 10.1016 / j.tips.2016.12.002 .
    14. ↑ WHO: ECDD Recommendations Cannabis , January 22, 2019
    15. ↑ ebb healing plant rehabilitated? In: New Germany . January 20, 1998, accessed March 2017.
    16. ^ The La Guardia Committee Report: The Marihuana Problem in the City of New York. 1944.
    17. ↑ Harry J. Anslinger, Will Oursler: Hemp Around Their Necks. 1961.
    18. ↑ Cannabinoids as antioxidants and neuroprotectants .
    19. ↑ R. Mechoulam, Y. Shvo, I. Hashish: The structure of cannabidiol . In: Tetrahedron 19 (12) . 1963, p. 2073-2078 .
    20. ↑ Y. Gaoni, R. Mechoulam: Isolation, structure and partial synthesis of the active constituent of hashish . In: Journal of the American Chemical Society (86) . 1964, p. 1646-1647 .
    21. ^ R. Mechoulam, L. Hanus: Cannabidiol: An overview of some chemical and pharmacological aspects. I. Chemical aspects. Chem Phys Lipids; 121: 35-43 . 2002.
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