Cannabis and cannabinoids as medicines
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.
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.
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.
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.
|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|
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 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
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.
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 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 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 .
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.
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.
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).
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.
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.
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.
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.
- Kenneth Finn: Cannabis in Medicine . Springer Nature, 2020, ISBN 978-3-030-45968-0 .
- Eva Hoch, Miriam Schneider, Chris Maria Friemel (eds.): Cannabis: Potential and Risk - A Scientific Inventory . Springer, Heidelberg 2019, ISBN 978-3-662-57291-7 , doi : 10.1007 / 978-3-662-57291-7 (478 pages, bundesgesundheitsministerium.de [PDF]). , Short report, 8 pages, PDF
- European Monitoring Center for Drugs and Drug Addiction (Ed.): Medical use of cannabis and cannabinoids: questions and answers for policymaking , Luxembourg 2018. ISBN 978-92-9497-362-7 .
- World Health Organization , Expert Committee on Drug Dependence (Ed.): Critical Review of Cannabis and cannabis resin (PDF) , Delta-9-tetrahydrocannabinol (PDF) , Extracts and tinctures of cannabis (PDF) , Isomers of THC (PDF) . Department of Essential Medicines and Health Products, 2018. (English Abstract: WHO endorses decisions of Expert Committee on cannabis and other substances ).
- National Academies of Sciences, Engineering, and Medicine (Ed.): The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research . National Academies Press, Washington, DC 2017, ISBN 978-0-309-45304-2 , doi : 10.17226 / 24625 (English).
- Didier M. Lambert (Ed.): Cannabinoids in Nature and Medicine . Helvetica Chimica Acta, Zurich 2009, ISBN 978-3-906390-56-7 .
- Michael A. Everywhere: Cannabis as medicine. 21 questions and answers about handling cannabis in practice . In: Pain Medicine . tape 34 (1) , 2018, pp. 24-35 , doi : 10.1007 / s00940-018-0699-4 .
- Information on "Medical Marijuhana" from the US National Center for Complementary and Integrative Health - A facility of the US Department of Health
- Peter Cremer-Schaeffer: Cannabis as Medicine. First findings from the accompanying survey. Edited by the Federal Institute for Drugs and Medical Devices. (May 9, 2019).
- ^ 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 .
- ↑ Germany: Amendment to Annex III of the BtMG from March 2017. Austria: Suchtgiftverordnung , ris.bka.gv.at.
- ↑ Medical cannabis: The most important changes In: Deutsches Arzteblatt 2017; 114 (8), accessed 08/2017
- ↑ Transcription ( Memento of December 3, 2013 in the Internet Archive ), Papyros Ebers, Leipzig 1875.
- ↑ 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]).
- ^ 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 .
- ^ Mathias Broeckers: Cannabis . AT Verlag, Aarau 2002, ISBN 978-3-85502-872-6 , p. 139 .
- ^ 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.
- ↑ Rainer-B. People: Therapy with Cannabis and Co. in: Pharmazeutische Zeitung , issue 05/2009 of January 29, 2009.
- ↑ antiquecannabisbook.com: Ads for Bromidia
- ↑ F. Grothenhermen, K. Müller-Vahl K: The therapeutic potential of cannabis and cannabinoids . In: Deutsches Ärzteblatt 109 (29-30) . 2012, p. 495-501 .
- ↑ European Monitoring Center for Drugs and Drug Addiction : Drug Profile Cannabis .
- ↑ 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 .
- ↑ WHO: ECDD Recommendations Cannabis , January 22, 2019
- ↑ ebb healing plant rehabilitated? In: New Germany . January 20, 1998, accessed March 2017.
- ^ The La Guardia Committee Report: The Marihuana Problem in the City of New York. 1944.
- ↑ Harry J. Anslinger, Will Oursler: Hemp Around Their Necks. 1961.
- ↑ Cannabinoids as antioxidants and neuroprotectants .
- ↑ R. Mechoulam, Y. Shvo, I. Hashish: The structure of cannabidiol . In: Tetrahedron 19 (12) . 1963, p. 2073-2078 .
- ↑ 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 .
- ^ R. Mechoulam, L. Hanus: Cannabidiol: An overview of some chemical and pharmacological aspects. I. Chemical aspects. Chem Phys Lipids; 121: 35-43 . 2002.
- ↑ T. Dingermann, K. Hiller, G. Schneider, I. Zündorf: Schneider drug drugs. 5th edition. Elsevier, 2004. Page 207. ISBN 3-8274-1481-4 .
- ↑ S. Chandra, H. Lata, MA ElSohly, LA Walker, D. Potter: Cannabis cultivation: methodological issues for obtaining medical-grade product . In: Epilepsy Behav . No. 70 , 2017, p. 302-312 , doi : 10.1016 / j.yebeh.2016.11.029 .
- ↑ a b c Michael A. Everywhere: Cannabis as medicine. 21 questions and answers about handling cannabis in practice. In: Pain Medicine. Volume 34 (1), 2018, pp. 24-35, doi: 10.1007 / s00940-018-0699-4 .
- ↑ Clinical Studies and Case Reports , cannabis-med.org, accessed March 17, 2018
- ^ Mary E. Lynch, Paula Cesar-Rittenberg, Andrea G. Hohmann: A Double-Blind, Placebo-Controlled, Crossover Pilot Trial With Extension Using an Oral Mucosal Cannabinoid Extract for Treatment of Chemotherapy-Induced Neuropathic Pain . In: Journal of Pain and Symptom Management (47) . 2014, p. 166-173 , doi : 10.1016 / j.jpainsymman.2013.02.018 .
- ↑ G. Bar-Sela, A. Avisar, R. Batash, M. Schaffer: Is the clinical use of cannabis by oncology patients advisable? In: Current medicinal chemistry. Volume 21, Number 17, June 2014, pp. 1923-1930. PMID 24606496 (Review).
- ↑ a b c d W. Hauser, MA Fitzcharles, L. Radbruch, F. Petzke: Cannabinoids in pain management and palliative medicine - an overview of systematic reviews and prospective observational studies . In: Deutsches Ärzteblatt Int. (114) . 2017, p. 627–634 , doi : 10.3238 / arztebl.2017.0627 ( researchgate.net [accessed March 17, 2018]).
- ↑ Saving opioids through cannabis? June 5, 2019, accessed June 12, 2019 .
- ↑ ▷ Replace strong pain relievers with cannabis? | Information from experts. August 31, 2017, accessed June 12, 2019 (German).
- ↑ Everywhere (2018), p. 27
- ↑ a b Epilepsy: US approval for cannabidiol solution . Pharmaceutical newspaper of June 26, 2018.
- ↑ DG Boychuk, G. Goddard, G. Mauro, MF Orellana: The effectiveness of cannabinoids in the management of chronic nonmalignant neuropathic pain: a systematic review. In: Journal of oral & facial pain and headache. Volume 29, number 1, 2015, pp. 7-14. PMID 25635955 (Review).
- ↑ M. Mücke, T. Phillips, L. Radbruch, F. Petzke, W. Hauser: Cannabis-based medicines for chronic neuropathic pain in adults. In: The Cochrane database of systematic reviews. [Electronic publication before printing] March 2018, doi: 10.1002 / 14651858.CD012182.pub2 , PMID 29513392 (review).
- ↑ National Academies of Sciences, Engineering, and Medicine (Ed.): The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research . National Academies Press, Washington, DC 2017, ISBN 978-0-309-45304-2 , pp. 94 , doi : 10.17226 / 24625 (English).
- ↑ a b c Eva Hoch, Miriam Schneider, Chris Maria Friemel (Ed.): Cannabis: Potential and Risks. A scientific analysis (CaPRis) . Springer, Heidelberg September 30, 2017, p. 5 f . ( bundesgesundheitsministerium.de [PDF] short report).
- ↑ National Academies of Sciences, Engineering, and Medicine (Ed.): The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research . National Academies Press, Washington, DC 2017, ISBN 978-0-309-45304-2 , pp. 93 , doi : 10.17226 / 24625 (English).
- ↑ S. Singla, R. Sachdeva, JL Mehta: Cannabinoids and atherosclerotic coronary heart disease . In: Clinical cardiology . tape 35 , no. 6 , June 2012, p. 329-335 , doi : 10.1002 / clc.21962 , PMID 22278660 . (Review).
- ↑ S. Steffens, P. Pacher: Targeting cannabinoid receptor CB (2) in cardiovascular disorders: promises and controversies . In: British journal of pharmacology . tape 167 , no. 2 , September 2012, p. 313–323 , doi : 10.1111 / j.1476-5381.2012.02042.x , PMID 22612332 , PMC 3481040 (free full text). (Review).
- ^ A b Stephen Sidney: Marijuana Use and Type 2 Diabetes Mellitus: a Review . In: Current diabetes reports. tape 16 , no. 11 . Springer Science + Business Media, New York 2016, p. 117 , doi : 10.1007 / s11892-016-0795-6 , PMID 27747490 (English, review).
- ↑ National Academies of Sciences, Engineering, and Medicine (Ed.): The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research . National Academies Press, Washington, DC 2017, ISBN 978-0-309-45304-2 , pp. 174 , doi : 10.17226 / 24625 (English).
- ↑ National Academies of Sciences, Engineering, and Medicine (Ed.): The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research . National Academies Press, Washington, DC 2017, ISBN 978-0-309-45304-2 , pp. 99, 101 , doi : 10.17226 / 24625 (English).
- ↑ Eva Hoch, Miriam Schneider, Chris Maria Friemel (Ed.): Cannabis: Potential and Risks. A scientific analysis (CaPRis) . Springer, Heidelberg September 30, 2017, p. 6 ( bundesgesundheitsministerium.de [PDF] short report).
- ↑ E. Perucca: Cannabinoids in the Treatment of Epilepsy: Hard Evidence at Last? In: Journal of epilepsy research . tape 7 , no. 2 , December 2017, p. 61-76 , doi : 10.14581 / jer.17012 , PMID 29344464 , PMC 5767492 (free full text). (Review).
- ↑ T. Passie, HM Emrich, M. Karst, SD Brandt, JH Halpern: Mitigation of post-traumatic stress symptoms by Cannabis resin: a review of the clinical and neurobiological evidence. In: Drug testing and analysis. Volume 4, number 7-8, 2012 Jul-Aug, pp. 649-659, doi: 10.1002 / dta.1377 . PMID 22736575 (Review).
- ↑ Kevin Betthauser, Jeffrey Pilz, Laura E. Vollmer: Use and effects of cannabinoids in military veterans with posttraumatic stress disorder . In: American Journal of Health-System Pharmacy . tape 72 , no. 15 , August 1, 2015, ISSN 1079-2082 , p. 1279-1284 , doi : 10.2146 / ajhp140523 , PMID 26195653 ( ajhp.org [accessed March 10, 2018]).
- ↑ maps.org (PDF file)
- ^ National Institute on Drug Abuse: Independently Funded Human Studies Approved to Receive Marijuana - 1999 to present. In: drugabuse.gov. March 16, 2016, accessed May 2, 2016 .
- ↑ MAPS - Marijuana PTSD Study (US). In: maps.org. October 13, 2015, accessed May 2, 2016 .
- ^ Victor Novack, Gal Meiri, Naama Saban, Raphael Mechoulam, Lihi Bar-Lev Schleider: Real life Experience of Medical Cannabis Treatment in Autism: Analysis of Safety and Efficacy . In: Scientific Reports . tape 9 , no. 1 , January 17, 2019, ISSN 2045-2322 , p. 200 , doi : 10.1038 / s41598-018-37570-y ( nature.com [accessed March 10, 2019]).
- ^ SE Hadland, JR Knight, SK Harris: Medical marijuana: review of the science and implications for developmental-behavioral pediatric practice . In: Journal of developmental and behavioral pediatrics . tape 36 , no. 2 , 2015, p. 115–123 , doi : 10.1097 / DBP.0000000000000129 , PMID 25650954 , PMC 4318349 (free full text). (Review).
- ↑ AR de Mello Schier, NP de Oliveira Ribeiro, DS Coutinho, S. Machado, O. Arias-Carrión, JA Crippa, AW Zuardi, AE Nardi, AC Silva: Antidepressant-like and anxiolytic-like effects of cannabidiol: a chemical compound of Cannabis sativa . In: CNS & neurological disorders drug targets . tape 13 , no. 6 , 2014, p. 953-960 , PMID 24923339 . (Review).
- ^ AC Campos, FA Moreira, FV Gomes, EA Del Bel, FS Guimarães: Multiple mechanisms involved in the large-spectrum therapeutic potential of cannabidiol in psychiatric disorders . In: Philosophical transactions of the Royal Society of London. Series B, Biological sciences . tape 367 , no. 1607 , December 2012, p. 3364–3378 , doi : 10.1098 / rstb.2011.0389 , PMID 23108553 , PMC 3481531 (free full text). (Review).
- ↑ Louisa Degenhardt: "Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta-analysis" doi: 10.1016 / S2215-0366 (19) 30401-8 . Lancet Psychiatry journal, October 28, 2019
- ^ N. Black, E. Stockings, G. Campbell, LT Tran, D. Zagic, WD Hall, M. Farrell, L. Degenhardt .: Cannabinoids for the treatment of mental disorders and symptoms of mental disorders: a systematic review and meta -analysis. In: Lancet Psychiatry . tape 6 , no. 12 , 2019, pp. 995-1010 , PMID 31672337 . (Review), PDF .
- ↑ Sativex: Report for the public by the British approval authority MHRA (English; PDF; 490 kB)
- ↑ Percentages quoted from: Kathrin Gießelmann: Cannabis Medicines. Pain comes first. In: Deutsches Ärzteblatt. Volume 116, No. 21, (May) 2019, p. B 868 f.
- ↑ Peter Cremer-Schaeffer: Cannabis as medicine. First findings from the accompanying survey. Edited by the Federal Institute for Drugs and Medical Devices. (May 9, 2019).
- ↑ Franjo Grotenhermen , Klaus Häußermann: Cannabis. Prescription aid for doctors. 2nd Edition. Scientific publishing company, Stuttgart 2017.
- ↑ German Pharmacy Portal The BtM prescription in detail
- ↑ MDS guidelines / basics of the MDK assessment (cannabis) according to § 31 paragraph 6 SGB V as of January 28, 2020, ( direct link PDF )
- ↑ BfArM - Instructions for patients. Retrieved April 17, 2018 .
- ^ Franjo Grotenhermen: Harm Reduction Associated with Inhalation and Oral Administration of Cannabis and THC . In: Journal of Cannabis Therapeutics (1) . 2001, p. 133–152 , doi : 10.1300 / J175v01n03_09 .
- ↑ Dale H. Gieringer: Cannabis “Vaporization” . In: Journal of Cannabis Therapeutics (1) . S. 153–170 , doi : 10.1300 / J175v01n03_10 .
- ↑ L. Zuurman, C. Roy et al. a .: Effect of intrapulmonary tetrahydrocannabinol administration in humans . In: Journal of Psychopharmacology (22) . 2008, p. 707-716 , doi : 10.1177 / 0269881108089581 .
- ↑ Standardized recipes (NRF / SR) . 5th edition. Govi, Eschborn 2011, ISBN 978-3-7741-1139-4 .
- ↑ D. Bussick, C. Eckert-Lill: What can pharmacies have in store ? Pharmaceutical newspaper, edition 08/2017.
- ↑ Frederike K. Engels, Floris A. de Jong a. a .: Medicinal cannabis in oncology. In: European Journal of Cancer . 43, 2007, pp. 2638-2644, doi: 10.1016 / j.ejca.2007.09.010 .
- ↑ Product portfolio of the Dutch Bureau voor Medicinale Cannabis ( Memento of the original from October 29, 2010 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. (Dutch)
- ↑ Questions about hemp , AGES, accessed on March 22, 2017.
- ↑ Werner Reisinger: Cannabis - Gutes Kraut, Bad Kraut , Wiener Zeitung, August 12, 2016.
- ^ Health Canada: Fact Sheet Sativex , August 2007.
- ↑ FDA Orphan Drug Designations , accessed March 21, 2018.
- ^ Register of designated Orphan Medicinal Products (alphabetical) , accessed on March 27, 2018.
- ↑ O. Devinsky, JH Cross, L. Laux et al .: Trial of cannabidiol for drug-resistant seizures in the Dravet syndrome. In: New England Journal of Medicine . tape 376 , 2017, p. 2011-2020 .
- ^ EA Thiele, ED Marsh, JA French, M. Mazurkiewicz-Beldzinska, SR Benbadis, C. Joshi, PD Lyons, A. Taylor, C. Roberts, K. Sommerville: Cannabidiol in patients with seizures associated with Lennox-Gastaut syndrome ( GWPCARE4): A randomized, double-blind, placebo-controlled phase 3 trial . In: The Lancet . tape 391 , no. 10125 , March 17, 2018, p. 1085-1096 , doi : 10.1016 / S0140-6736 (18) 30136-3 .
- ↑ Cannabidiol: A Panacea? In: arznei-telegram . December 13, 2019, accessed January 31, 2020 .
- ↑ Database of medicinal products authorized in the UK: electronic Medicines Compendium (eMC) ( Memento of the original from December 6, 2013 in the Internet Archive ) Info: The archive link has been inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice.
- ↑ Amendment to Annex III of the BtMG from May 2011.
- ↑ a b Act amending narcotics law and other regulations of March 6, 2017 ( Federal Law Gazette I p. 403 ).
- ↑ Amendment to Annex III of the BtMG from March 2017.
- ↑ Amendment to Annex II of the BtMG from March 2017.
- ↑ Appendix I of the BtMG
- ↑ Information for patients: Application for an exception permit in accordance with Section 3 (2) BtMG for the acquisition of cannabis for use in medically supervised and accompanied self-therapy (as of March 2013) , bfarm.de (PDF file)
- ^ Judgment of the Federal Administrative Court Az. 3C April 17 , May 19, 2005.
- ↑ Change in the law on narcotics: cannabis for the seriously ill on prescription. Federal Government, May 4, 2016, accessed December 27, 2016 .
- ↑ Götz Hausding: Bundestag approves cannabis medicines for seriously ill patients . In: German Bundestag . ( bundestag.de [accessed on May 12, 2017]).
- ↑ AFP: Germany: Far less medical cannabis imported into Germany than allowed . In: The time . May 9, 2019, ISSN 0044-2070 ( zeit.de [accessed June 12, 2019]).
- ↑ Cannabis Agency , BfArM website accessed March 22, 2017.
- ↑ a b Lenne Quentin: Medical cannabis imports stall: patients without substance . In: The daily newspaper: taz . February 15, 2019, ISSN 0931-9085 ( taz.de [accessed June 12, 2019]).
- ^ Deutsche Welle (www.dw.com): Challenge to Canadian cannabis producers | DW | 03/30/2019. Accessed June 12, 2019 (German).
- ↑ Götz Hausding: German Bundestag - Bundestag permits cannabis drugs for seriously ill patients .
- ↑ Seriously ill: Bundestag permits cannabis on prescription . 19th January 2017.
- ↑ Accompanying survey: First results presented. May 9, 2019, accessed on June 12, 2019 (German).
- ↑ BfArM grants first surcharges for cannabis for medical purposes: Cultivation of 7200 kg of cannabis now on the way, BfARM press release of April 17, 2019.
- ↑ BfArM - Press - Award procedure successfully concluded: BfArM awards the remaining four surcharges for the cultivation of cannabis for medical purposes. Retrieved June 12, 2019 .
- ↑ Federal Administrative Court press release No. 26/2016 in the case of BVerwG 3 C 10.14: Growing cannabis for therapeutic purposes is exceptionally permitted. April 4, 2016, accessed December 27, 2016 .
- ↑ Narcotics Ordinance , ris.bka.gv.at
- ↑ Therapy with cannabinoids ( Memento of the original from June 3, 2014 in the Internet Archive ) Info: The archive link was inserted automatically and has not yet been checked. Please check the original and archive link according to the instructions and then remove this notice. , Hänseler AG, accessed October 5, 2011.
- ↑ Rebekka Haefeli: Now comes cannabis light. A huge disappointment for stoners, the great hope for planters: low-THC cannabis. The trade in the herb could develop into a billion dollar business . Observer, Zurich, July 7, 2017, pp. 36–40.
- ↑ a b Uso medico della cannabis . Ministero della salute (Ministry of Health in Italy), December 15, 2016.
- ↑ The arduous route to cannabis on prescription . World, January 10, 2014.
- ↑ Décret n ° 2013-473 du 5 juin 2013 modifiant en ce qui concerne les spécialités pharmaceutiques les dispositions de l'article R. 5132-86 du code de la santé publique relatives à l'interdiction d'opérations portant sur le cannabis ou ses dérivés (Decree No. 2013-473 of June 5, 2013 amending the provisions of article R. 5132-86 of the Code on the prohibition of the trade in cannabis or its derivatives in relation to pharmaceutical specialties), accessed on August 5, 2018.
- ↑ a b Compte rendu de séance - Comité technique des Centers d'Evaluation et d'Information sur la Pharmacodépendance (report of the meeting of the technical committee of the drug addiction evaluation and information centers), of March 18, 2018 (PDF).
- ^ Medical Use of Marijuana , Health Canada
- ^ Medical marijuana goes on sale in Dutch pharmacies , Independent, September 1, 2003.
- ↑ Israeli government approves guidelines for medical marijuana , Haaretz, August 7, 2011.
- ↑ Another European country just legalized marijuana . In: The Independent . July 3, 2017 ( independent.co.uk [accessed March 6, 2018]).
- ↑ Tiroler Tageszeitung Online: Poland's lower house for the approval of marijuana for medical purposes | Tiroler Tageszeitung online - news from now! In: Tiroler Tageszeitung Online . ( tt.com [accessed March 4, 2020]).
- ↑ Denmark: four-year trial period for medical marijuana on prescription decided - Highway - Das Cannabismagazin. Retrieved March 6, 2018 .
- ↑ Paraguay: Law to Legalize Medical Marijuana - Highway - The Cannabis Magazine. Retrieved March 6, 2018 .
- ↑ Peru Legalizes Medical Marijuana - Highway - The Cannabis Magazine. Retrieved March 6, 2018 .
- ↑ Lesotho Just Granted Africa's First Legal Marijuana License . In: OkayAfrica . September 13, 2017 ( okayafrica.com [accessed July 12, 2018]).
- ↑ Puerto Rico conditionally legalizes marijuana. Retrieved March 6, 2018 .
- ↑ Chambre des Députés du Grand-Duché de Luxembourg: Rôle des affaires. Chambre des Députés du Grand-Duché de Luxembourg, 2018, accessed on July 12, 2018 (French).
- ↑ Zimbabwe legalizes marijuana for medicinal, scientific uses | The Star . In: thestar.com . ( thestar.com [accessed July 12, 2018]).
- ↑ South Korea: Huge sales market for the cannabis industry. December 3, 2018, accessed April 13, 2019 .
- ↑ Thailand approves medicinal cannabis . December 25, 2018 ( bbc.com [accessed April 13, 2019]).
- ^ State Medical Marijuana Laws. Retrieved July 29, 2020 .