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Erschienen in: Der Schmerz 1/2016

01.02.2016 | Schwerpunkt

Medical use of cannabis products

Lessons to be learned from Israel and Canada

verfasst von: J. Ablin, P. A. Ste-Marie, M. Schäfer, PD Dr. W. Häuser, M.-A. Fitzcharles

Erschienen in: Der Schmerz | Ausgabe 1/2016

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Abstract

Introduction

The German government intends to reduce the barriers for the medical use of cannabis products. A discussion on the indications and contraindications of the medical use of cannabis and on the changes of the regulatory framework has already begun in Germany. It is useful to draw from the experiences of other countries with a more liberal medical use of cannabis.

Methods

The Israeli and Canadian experience is outlined by physicians who have been charged with expertise on the medical use of cannabis by their jurisdiction.

Results

In Israel, only the plant-based cannabinoid nabiximol (mixture of tetrahydrocannabinol/cannabidiol) can be prescribed for spasticity/chronic pain in multiple sclerosis and for cancer pain. The costs of nabiximole are reimbursed by some, but not by all health maintenance organizations. The medical use of marijuana is permitted; however, it is strictly regulated by the government. Selected companies are allowed to produce marijuana for medical use, and only certain physicians are licensed to prescribe marijuana as a therapeutic drug for specific indications such as chronic neuropathic, and cancer pain, inflammatory bowel diseases, or posttraumatic stress disorder if conventional treatments have failed. The costs of marijuana are not reimbursed by health insurance companies.
In Canada, synthetic cannabinoids and the plant-based (nabiximol) are licensed for neuropathic and cancer pain, HIV-related anorexia and chemotherapy-associate nausea. The costs of these synthetic cannabinoids are covered by health insurance companies. The medical use of marijuana as a treatment option is allowed for individual patients suffering from any medical condition when authorized by a medical practitioner or nurse. Licensed producers are the only source for patients to newly access medical cannabis, although those with previous permission to grow may continue cultivation at the present time. The costs of marijuana are not reimbursed by health insurance companies.
There are multiple contraindications for the medical use of cannabis products in both countries.

Conclusions

The use of standardized, synthetic, and plant-based cannabis products should be allowed in Germany for defined medical conditions when high-level evidence of efficacy and safety exists. The costs should be reimbursed by the health insurance companies. Contraindications for the medical use of cannabis should be defined. Growing marijuana by patients for their medical use should not be allowed.
Literatur
1.
Zurück zum Zitat Arzneimittelkommission der deutschen Ärzteschaft, Fachausschuss der Bundesärztekammer. Stellungnahme der Bundesärztekammer, der Kassenärztlichen Bundesvereinigung und der Arzneimittelkommission der deutschen Ärzteschaft zu den Anträgen der Fraktion Bündnis 90/Die Grünen “Medizinische Verwendung von Cannabis erleichtern” vom 27.11.2007 und der Fraktion Die Linke “Cannabis zur medizinischen Behandlung freigeben” vom 25.06.2008. www.​akdae.​de/​Stellungnahmen/​Weitere/​20081001.​pdf. Accessed 02 Apr 2015 Arzneimittelkommission der deutschen Ärzteschaft, Fachausschuss der Bundesärztekammer. Stellungnahme der Bundesärztekammer, der Kassenärztlichen Bundesvereinigung und der Arzneimittelkommission der deutschen Ärzteschaft zu den Anträgen der Fraktion Bündnis 90/Die Grünen “Medizinische Verwendung von Cannabis erleichtern” vom 27.11.2007 und der Fraktion Die Linke “Cannabis zur medizinischen Behandlung freigeben” vom 25.06.2008. www.​akdae.​de/​Stellungnahmen/​Weitere/​20081001.​pdf. Accessed 02 Apr 2015
2.
Zurück zum Zitat Asbridge M, Hayden JA, Cartwright JL (2012) Acute cannabis consumption and motor vehicle collision risk: systematic review of observational studies and meta-analysis. BMJ 344:e536 PubMedCentralCrossRefPubMed Asbridge M, Hayden JA, Cartwright JL (2012) Acute cannabis consumption and motor vehicle collision risk: systematic review of observational studies and meta-analysis. BMJ 344:e536 PubMedCentralCrossRefPubMed
5.
Zurück zum Zitat Deutscher Bundestag. Antwort der Bundesregierung auf die schriftliche Frage 76 des Abgeordneten Frank Tempel, Die Linke, Bundesdrucksache 18/3672. Schriftliche Fragen mit den in der Zeit vom 22. Dezember 2014 bis 2. Januar 2015 eingegangenen Antworten der Bundesregierung. Accessed 2 May 2015 Deutscher Bundestag. Antwort der Bundesregierung auf die schriftliche Frage 76 des Abgeordneten Frank Tempel, Die Linke, Bundesdrucksache 18/3672. Schriftliche Fragen mit den in der Zeit vom 22. Dezember 2014 bis 2. Januar 2015 eingegangenen Antworten der Bundesregierung. Accessed 2 May 2015
7.
Zurück zum Zitat D’Souza DC, Ranganathan M (2015) Medical marijuana: is the cart before the horse? JAMA 313:2431–2432 CrossRefPubMed D’Souza DC, Ranganathan M (2015) Medical marijuana: is the cart before the horse? JAMA 313:2431–2432 CrossRefPubMed
9.
Zurück zum Zitat Fitzcharles MA, Ste-Marie PA, Ablin JN, Shir Y (2014) Comparison of Canadian and Israeli rheumatologists’ understanding of cannabinoid use as a therapy for rheumatic diseases. Ann Rheum Dis 73(Suppl 2):1177 CrossRef Fitzcharles MA, Ste-Marie PA, Ablin JN, Shir Y (2014) Comparison of Canadian and Israeli rheumatologists’ understanding of cannabinoid use as a therapy for rheumatic diseases. Ann Rheum Dis 73(Suppl 2):1177 CrossRef
10.
Zurück zum Zitat Fitzcharles MA, Jamal S (2015) Expanding medical marijuana access in Canada: considerations for the rheumatologist. J Rheumatol 42:143–145 CrossRefPubMed Fitzcharles MA, Jamal S (2015) Expanding medical marijuana access in Canada: considerations for the rheumatologist. J Rheumatol 42:143–145 CrossRefPubMed
11.
Zurück zum Zitat Fitzcharles M, Baerwald C, Ablin J, Häuser W (2016) Efficacy, tolerability and safety of cannabinoids in chronic pain associated with rheumatic diseases (fibromyalgia syndrome, low back pain, osteoarthritis, rheumatoid arthritis): a systematic review of randomized controlled trials. Schmerz 29 Doi 10.1007/s00482-015-0084-3 Fitzcharles M, Baerwald C, Ablin J, Häuser W (2016) Efficacy, tolerability and safety of cannabinoids in chronic pain associated with rheumatic diseases (fibromyalgia syndrome, low back pain, osteoarthritis, rheumatoid arthritis): a systematic review of randomized controlled trials. Schmerz 29 Doi 10.1007/s00482-015-0084-3
13.
Zurück zum Zitat Health Canada (ed) (2013) Information for health care professionals—cannabis and the cannabinoids. Health Canada, Controlled Substances and Tobacco Directorate, Ottawa Health Canada (ed) (2013) Information for health care professionals—cannabis and the cannabinoids. Health Canada, Controlled Substances and Tobacco Directorate, Ottawa
15.
Zurück zum Zitat Kalant H (2001) Medicinal use of cannabis: history and current status. Pain Res Manag 6:80–91 PubMed Kalant H (2001) Medicinal use of cannabis: history and current status. Pain Res Manag 6:80–91 PubMed
16.
Zurück zum Zitat Koppel BS, Brust JC, Fife T, Bronstein J, Youssof S, Gronseth G, Gloss D (2014) Systematic review: efficacy and safety of medical marijuana in selected neurologic disorders: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 82:1556–1563 PubMedCentralCrossRefPubMed Koppel BS, Brust JC, Fife T, Bronstein J, Youssof S, Gronseth G, Gloss D (2014) Systematic review: efficacy and safety of medical marijuana in selected neurologic disorders: report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology 82:1556–1563 PubMedCentralCrossRefPubMed
17.
Zurück zum Zitat Mann RE, Stoduto G, Ialomiteanu A, Asbridge M, Smart RG, Wickens CM (2010) Self-reported collision risk associated with cannabis use and driving after cannabis use among Ontario adults. Traffic Inj Prev 11:115–122 CrossRefPubMed Mann RE, Stoduto G, Ialomiteanu A, Asbridge M, Smart RG, Wickens CM (2010) Self-reported collision risk associated with cannabis use and driving after cannabis use among Ontario adults. Traffic Inj Prev 11:115–122 CrossRefPubMed
20.
Zurück zum Zitat Mechoulam R, Gaoni Y (1965) A total synthesis of DL-delta-1-tetrahydrocannabinol, the active constituent of hashish. J Am Chem Soc 20(87):3273–3275 CrossRef Mechoulam R, Gaoni Y (1965) A total synthesis of DL-delta-1-tetrahydrocannabinol, the active constituent of hashish. J Am Chem Soc 20(87):3273–3275 CrossRef
21.
Zurück zum Zitat Mechoulam R (2014) Looking ahead after 50 years of research on cannabinoids. Cannabinoids 5:1–15 Mechoulam R (2014) Looking ahead after 50 years of research on cannabinoids. Cannabinoids 5:1–15
24.
Zurück zum Zitat Mücke M, Carter D, Radbruch L, Häuser W (2016) Wirksamkeit, Verträglichkeit und Sicherheit von Cannabinoiden in der Palliativmedizin. Eine systematische Übersicht von randomisierten kontrollierten Studien. Schmerz DOI: 10.1007/s00482-015-0085-2 Mücke M, Carter D, Radbruch L, Häuser W (2016) Wirksamkeit, Verträglichkeit und Sicherheit von Cannabinoiden in der Palliativmedizin. Eine systematische Übersicht von randomisierten kontrollierten Studien. Schmerz DOI: 10.1007/s00482-015-0085-2
25.
Zurück zum Zitat Paglia-Boak A, Adlaf EM, Mann RE, Rehm J Drug use among Ontario students : 1977 to 2009 OSDUHS Highlights Toronto, ON, Canada: Centre for Addiction and Mental Health; 2011 Contract No.: Document Number| Paglia-Boak A, Adlaf EM, Mann RE, Rehm J Drug use among Ontario students : 1977 to 2009 OSDUHS Highlights Toronto, ON, Canada: Centre for Addiction and Mental Health; 2011 Contract No.: Document Number|
26.
Zurück zum Zitat Petzke F, Häuser W, Krumova EK (2016) Efficacy, tolerability and safety of cannabinoids for chronic neuropathic pain—a systematic review of systematic reviews. Schmerz DOI: 10.1007/s00482-015-0089-y Petzke F, Häuser W, Krumova EK (2016) Efficacy, tolerability and safety of cannabinoids for chronic neuropathic pain—a systematic review of systematic reviews. Schmerz DOI: 10.1007/s00482-015-0089-y
27.
Zurück zum Zitat Pertwee RG (2012) Targeting the endocannabinoid system with cannabinoid receptor agonists: pharmacological strategies and therapeutic possibilities. Philos Trans R Soc Lond B Biol Sci 367:3353–3363 PubMedCentralCrossRefPubMed Pertwee RG (2012) Targeting the endocannabinoid system with cannabinoid receptor agonists: pharmacological strategies and therapeutic possibilities. Philos Trans R Soc Lond B Biol Sci 367:3353–3363 PubMedCentralCrossRefPubMed
29.
Zurück zum Zitat Tafelski S, Häuser W, Schäfer M (2016) Efficacy, tolerability and safety of cannabinoids for chemotherapy-induced nausea and vomiting—a systematic review of systematic reviews. Schmerz DOI: 10.1007/s00482-015-0092-3 Tafelski S, Häuser W, Schäfer M (2016) Efficacy, tolerability and safety of cannabinoids for chemotherapy-induced nausea and vomiting—a systematic review of systematic reviews. Schmerz DOI: 10.1007/s00482-015-0092-3
32.
Zurück zum Zitat Volz S, Häuser W, Sigmund B (2016) Wirksamkeit, Verträglichkeit und Sicherheit von Cannabinoiden in der Gastroenterologie – Chronisch entzündliche Darmerkrankungen, Reizdarmsyndrom und chronische Pankreatitis: Eine systematische Übersichtsarbeit. Schmerz DOI: 10.1007/s00482-015-0087-0 Volz S, Häuser W, Sigmund B (2016) Wirksamkeit, Verträglichkeit und Sicherheit von Cannabinoiden in der Gastroenterologie – Chronisch entzündliche Darmerkrankungen, Reizdarmsyndrom und chronische Pankreatitis: Eine systematische Übersichtsarbeit. Schmerz DOI: 10.1007/s00482-015-0087-0
Metadaten
Titel
Medical use of cannabis products
Lessons to be learned from Israel and Canada
verfasst von
J. Ablin
P. A. Ste-Marie
M. Schäfer
PD Dr. W. Häuser
M.-A. Fitzcharles
Publikationsdatum
01.02.2016
Verlag
Springer Berlin Heidelberg
Erschienen in
Der Schmerz / Ausgabe 1/2016
Print ISSN: 0932-433X
Elektronische ISSN: 1432-2129
DOI
https://doi.org/10.1007/s00482-015-0083-4

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