Hemp can not only be driven on, hemp can also help sick. As early as 2700 BC BC, people in today's China used the flowers of the cannabis plant as a remedy, for example against rheumatism or malaria. At the turn of the 19th to the 20th century, the plant in Europe enjoyed great popularity, among other things, for pain treatment. Interest in her as medicine has been growing significantly again for several years.
Chronic pain, spasticity in multiple sclerosis or rheumatic complaints - all this should be alleviated with the help of hemp. Likewise, components of the plant can help people with epilepsy or loss of appetite, such as cancer patients after chemotherapy or people with HIV. While there are currently discussions in Germany about legalizing cannabis as a recreational drug, politicians, researchers and doctors are still debating to what extent marijuana is suitable as a medicine.
Proponents say that cannabis as medicine has made people with persistent problems possible and effective therapy. Critics argue that the advantages are exaggerated, risks and damage are ignored. Well: Both sides have valid points.
So it's a good thing that there is more and more research on therapeutic options that provides orientation and explains what is known about medical weed and what is not. A fundamental finding of this research: Grass can not heal, but at most alleviate symptoms of a disease.
Only a few indications have the effectiveness been reasonably well established.
The hemp plant contains more than 500 different connections, over 100 of which are cannabinoids. On the one hand, DELTA 9 tetrahydrocannabinol (THC), especially for people with pain, is medically interesting. On the other hand, cannabidiol (CBD), which, unlike THC, does not intoxicate. It is described in several studies as helpful in fear and sleep disorders as well as childish epilepsy.
Since 2017, doctors in Germany have been officially allowed to issue prescriptions for dried cannabis flowers and their extracts as well as drugs with the active ingredients dronabinol (semi-synthetic THC) and nabilone (synthetic THC) to seriously ill people – despite the lack of approval. As a rule, the costs are covered by the health insurance companies. Before this change in the law, this was only possible with an exemption from the Federal Institute for Drugs and Medical Devices (BfArM). The patients usually had to bear the costs themselves. Now access is much easier. However, cannabis on prescription is only an option if current treatments do not help or are not tolerated (see »How do I get a prescription for cannabis?«).
The evidence for the effectiveness of medical cannabis based on randomized clinical trials has not developed much further since 2017, anesthesiologist Frank Petzke said at an online press conference for the German Pain Congress 2021. "There is no reliable proof of efficacy for almost all indications, especially for cannabis flowers and extracts," explained the head of pain medicine from the University Medical Center Göttingen.
How do I get a recipe for cannabis?
Since March 10, 2017, doctors have been able to prescribe cannabis in the form of dried flowers and extracts as well as medicines with the active ingredients dronabinol and nabilon. Before the first regulation, the prescribing contract doctor must submit an application for assumption of costs at the responsible health insurance company: It is important to demonstrate the severity of the disease and the restrictions in everyday life. The decisive factor is that the quality of life is severely impaired in the long run. It is at the discretion of the treating doctor whether an attempt with cannabis is possible. In addition, all other therapies must have failed and there must be a reasonable view that the cannabis could help.
The health insurance company must have decided on the assumption of costs no later than three weeks after receipt. This period may be extended to five weeks if the cashier wishes to obtain an expert opinion. The situation is different for patients in outpatient palliative care: they must receive an answer within three days. If the health insurance company does not meet the deadline, the application is considered approved. Anyone who has procured the medicine himself after the deadline has expired can demand reimbursement of the costs incurred.
If the health insurance company has approved the application, the doctor can issue a recipe. With the exception of CBD, cannabisarz patterns are prescribed on a narcotics recipe. Doctors are allowed to prescribe cannabis even if the health insurance does not cover the costs. But here the patient has to pay the remedy himself.
Only three funds are approved as medicines: the drug Nabiximols consists in equal parts of THC and CBD. The latter takes up part of the undesirable psychological side effects of THC. It is used as an antispasmodic oral spray with multiple sclerosis under the name Sativex. Nabilon helps in capsule form under the trade name Canemes against chemotherapeutic nausea and vomiting. Epidyolex has been on the market since 2019 and contains CBD. It is approved in patients with very rare epilepsy called Lennox-Gast car and Dravet syndrome.
If you want to be prescribed medical cannabis for chronic pain, you should therefore be aware of one thing: It is an individual healing attempt for which there is no clinically proven proof of efficacy so far.
Pain patients use cannabis most often.
In order to obtain more knowledge here, doctors who prescribed cannabis medicinal products had to report anonymized data since 2017: about the respective disease, the dosage, the effect and the side effects. The BfArM recently published the final report on the accompaniment. It includes the data of a total of 21,000 treatments with cannabis products and is intended to serve as a basis for decision -making whether the health insurance companies will also cover the costs for further cannab a therapies. Hemp was most frequently prescribed as a remedy for chronic pain, followed by spasticity and anorexia.
However, the effect on pain is only reasonably well documented in one case: neuropathic pain, i.e. chronic nerve pain caused by diabetes, a stroke or spinal cord injuries, for example. They differ from pain signals that are transmitted by damaged tissue – for example due to a cut injury – via healthy nerves. For many other types of pain, such as acute or cancer-related pain, cannabinoids seem to have little effect.
The Cochrane Collaboration, an international research network, known for its systematic overview work, summed up in 2018: There are indications that cannabis relieves neuropathic pain better and improves sleep quality more than a placebo. However, scientific evidence of good quality is missing in order to make a safe statement. In addition, side effects may revoke the positive effects of the cannabinoids. Also in a current guideline of the Working Group of Scientific Medical Societies. V. (AWMF) For the therapy of neuropathic pain, the use of cannabinoids is not recommended.
Cannabinoids function in this way.
If cannabinoids get into the human body, dock to the receptors of the endocannabinoid system. Type CB1 receptors are mainly on nerve cells in the brain, CB2 receptors mainly on cells of the immune system and in the digestive tract. They also exist in the skin, the bone and the lungs. The best known cannabinoids are Delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). The drug is based on the former. THC binds to CB1 receptors in the brain, which are available in large numbers in the limbic system, i.e. in brain regions that are involved in the processing of emotions. In addition, THC and CBD influence the distribution of messenger substances such as serotonin, noradrenaline and glutamate that participate in stress and attachment.
Nevertheless, cannabinoids could be helpful, for example because they make pain more bearable. This in turn ensures less stress and better sleep, which makes everyday life much more worth living. Evidence of this was recently provided by a study by cannabis researcher Joshua Aviram and his colleagues at the Technion-Israel Institute of Technology in Haifa, Israel. In 2021, the group surveyed more than 1,000 chronic pain patients monthly for half a year about their condition. During this period, the participants took medical cannabis in the form of marijuana or as an extract in addition to the conventional painkillers. Although this did not lead to a reduction in pain intensity, two other effects occurred with an increasing amount of THC: subjective quality of life increased and patients needed less painkillers.
Anaesthetist Marc Seibolt also confirms this impression: "For chronic pain patients who cannot be helped in any other way, cannabis is a blessing in many cases." Seibolt is the chief physician of the Day Clinic of the Algesiologikum, Center for Pain Medicine and Mental Health, in Munich. In the outpatient clinic there, he cared for hundreds of people who were given dronabilon for their pain. "The patients sleep better due to the THC, it raises the mood and counteracts depression. As a result, the pain is less present for them, they can endure it better, " says the specialist, who works as a consulting expert for several pharmaceutical companies that manufacture or distribute cannabis products – including the Sanity Group and the Demecan company.
The fact is: The signal paths to which cannabinoids influence are involved in a variety of cognitive and emotional processes (see "How do cannabinoids work?"). Depression can be found in the density of the cannabinoid receptors in various brain areas. In principle, it is plausible that hemp consumption can influence these processes and thus alleviate symptoms. In depressive women, a reduced mirror of endocannabinoids was detected. The lower the concentration in the brain, the longer the mood, as the cell biologist Matthew Hill 2008 showed. In addition, a high number of CB1 receptors in the frontal-Limbic area in the brain suggests that cannabinoids could preferably influence the affective quality of pain, i.e. their evaluation.
Not suitable for people at risk of psychosis, in addition, cannabis damages the lungs
The psychologist Nicola Black and her colleagues from the University of New South Wales in Sydney published a meta -analysis of 84 studies on the use of pharmaceutical cannabis in mental illnesses. According to the authors, there is vague indications of a fear -resolving effect of THC. However, the following applies here: The dose makes the poison. Small quantities of the psychoactive cannabinoid are probably calming, but large ones can even cause fear and panic.
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Self -medication with cannabis is strongly discouraged. Since legalization for medical use or as a luxury food in various countries worldwide, there have been increasingly professional cultivation. But in Europe, many products are circulating with dangerous synthetic cannabinoids. The risk of dependency is greater, panic attacks, dizziness, heartbeat, psychoses are possible consequences of the frenzy. If you want to alleviate your pain or other symptoms with cannabis, you should definitely use hemp on a prescription and have a doctor.
Research suggests that people at increased risk of psychosis should stay away from cannabis. The drug can trigger a psychotic episode; This is probably due to the active ingredient THC. Patients with heart disease and pregnant women are also discouraged. There is also initial evidence that THC could inhibit the proliferation of cells of the immune system and thus potentially impair immunotherapy in cancer patients. All these factors should be considered when considering the use of therapeutic cannabis.
Marc Seibolt advises those patients who still want to try medical hemp: if you have never been treated with cannabis before, you should start with a monopreparation such as dronabinol or an extract of THC and CBD. Unlike flowers, they do not vary in their composition and effectiveness, so they can be better controlled. "It is also essential to start with a low dosage and then increase it slowly," adds the anaesthesiologist. In the case of capsules and oils taken orally, the concentration in the blood also increases gradually and in significantly lower amounts; in contrast to the cannabis flowers, there are no psychoactive effects. This also reduces the risk of psychological dependence.
The Federal Medical Association and the Association of Statutory Health Insurance Physicians also advise against smoking medical marijuana, the dried cannabis flowers. Professor Stefan Andreas sees that. The pneumologist is the chief physician of the Lung specialist clinic Immenhausen of the Pneumological Teaching Clinic of the University Medical Center Göttingen and a member of the German Society for Pneumology and ventilation medicine (DGP). "Inhaling cannabis, the lungs and the cardiovascular system can be damaged." Lung overblowing can occur; Recently it has also been known that a diffusion disorder is possible if hemp is smoked over a longer period of time. The respiratory body then no longer brings enough oxygen out of the air into the blood. This is the result of Robert Hancox from the University of Otago, New Zealand, and his colleagues in 2022 in a large -scale cohort study. The researchers had repeatedly examined more than 1037 young cannabis smokers for more than 20 years for their lung function.
Stefan Andreas also advises against the vaporization that is often recommended as more recommended, i.e. the evaporation of the dried cannabis flowers. "There are no long-term examinations that clearly prove that the e-cigarette is less harmful than the classic joint." This is also a problem for pleasure purposes in view of the planned legalization: »What we absolutely need in advance are reliable studies data the harmful consequences of cannabis. "
In the final report of the BfArM, it says in the end: »We do not see the results of the cannabis flowers without worry. The comparatively small age, the high proportion of men, which refers to THC with a high dose with the lack of knowledge from scientific publications on effectiveness and security in the event of such doses, raises the question of demarcation between actually therapeutic effects and experienced increase in well -being with a high risk of dependency. «
The Federal Joint Committee (G-BA) is now evaluating the results of the BfArM study in order to determine when cannabis therapy makes sense. Regulations for the outpatient care of patients with cannabis are expected to be announced by the end of September 2022.
glossary
Cannabis: plant genus from the hemp family; the male plant is mainly used for fiber production, the female one contains the psychoactive substance THC and CBD
CBD, cannabidiol: Not psychoactive, should have an antiepileptic and anxiety -solving effect, among other things
Dronabinol: consists of THC and can be produced as a prescription drug (mixed by the pharmacist), including for nausea and vomiting in cancer and for weight loss in HIV
Endocannabinoids: Substances occurring in the human body that resemble chemically THC and CBD
Epidyolex: medicinal product made from CBD, approved for very rare forms of epilepsy
Hashisch: The dried and pressed blossom resin of the female plant
Marijuana: dried leaves or flowers of the female hemp plant
Nabilon (canemes): medicines with synthetic THC, approved against nausea and vomiting in the event of cancer and loss of appetite at HIV
Nabiximols (sativex): ready -made medicine with THC and CBD, approved against muscle cramps in multiple sclerosis
THC, tetrahydrocannabinol: psychoactive main active ingredient of cannabis
