Can medical assistants prescribe medical marijuana

FAQ list on the use of cannabis in medicine

The law does not specify the indications permitted for a prescription. Regarding the requirements for a prescription in the event of a serious illness see questions 1 and 2.

Development of a G-BA guideline based on the results of the accompanying survey by the BfArM

Since there are not yet sufficient research results on the benefits and effects of a treatment with cannabis-containing drugs for many clinical pictures, the BfArM carries out a non-interventional scientific survey of the treatments approved by the health insurance companies over a period of 60 months (Section 36 (6) sentence 4 SGB V).

With the help of the data obtained from the accompanying survey, the BfArM will prepare a study report on the basis of which the Federal Joint Committee (G-BA) will then regulate the details of the granting of benefits in a guideline within six months (Section 36, Paragraph 6, Clause 8, SGB V ). This will therefore only be the case in 2022.

State of scientific knowledge on relevant indication areas

The CaPRiS study [1] (2017), for which more than 2,000 studies were evaluated, came to the following conclusion with regard to the effectiveness, tolerability and safety of cannabis medicinal products:

"In the area of ​​medicinal use of herbal, synthetic and semi-synthetic cannabinoids, a benefit in the indication" nausea and vomiting or appetite stimulation "was found in people with chemotherapeutically treated cancer and HIV / AIDS. In" chronic pain "there is predominantly evidence of mild Pain reduction and various improvements in secondary measures compared to placebo. Cannabis drugs were generally administered in combination with analgesics. The data currently tend not to suggest a substantial reduction in symptoms. In the case of "spasticity in multiple sclerosis and paraplegia" there are also "subjective" , but not enough objectifiable indications for an improvement of the symptoms. Inconsistent results, mostly inadequate studies, are available in the area of ​​gastrointestinal, neuroinflammatory, neurological and psychological diseases. [...] "

Cannabis: Potential and Risk. Results of a scientific analysis, Heidelberg

According to research by the Drugs Commission of the German Medical Association (AkdÄ), acceptable scientific findings for cannabis drugs are currently only available for the accompanying treatment of spasticity, nausea and vomiting with cytostatics and chronic pain. A possible effectiveness is also discussed in the literature for loss of appetite and weight loss in HIV-AIDS, schizophrenia, Parkinson's disease, Tourette's syndrome, epilepsy, headaches and inflammatory bowel diseases.

http://www.akdae.de/Stellunghaben/Weiter/20160114.pdf

One of Whiting et al. [2] The meta-analysis carried out on 79 studies on the topic produced moderate evidence for the use of cannabinoids for the treatment of chronic pain and spasticity. There was less evidence for the treatment of nausea and vomiting in the context of chemotherapy, weight loss in HIV infection, sleep disorders and the treatment of Tourette's syndrome.

A detailed review [3] by the US National Academies of Sciences, Engineering, and Medicine shows that there is good evidence for the therapeutic effectiveness of cannabinoids in the following indications: the treatment of chronic pain in adults, of spasticity in multiple sclerosis and for the antiemetic therapy of nausea and vomiting using cytostatics. There is moderate or little evidence, inter alia. for the treatment of sleep disorders in certain situations, weight loss in HIV / AIDS and symptoms of Tourette's syndrome.

The previous exemptions for treatment with cannabis according to Section 3 (2) BtMG (see question 15) was granted by the BfArM primarily for the following indications:

  • Pain (approx. 57%)
  • ADHD (approx. 14%)
  • Spasticity (of various origins) (approx. 10%)
  • Depression (approx. 7%)
  • Loss of appetite / cachexia (approx. 5%)
  • Tourette syndrome (approx. 4%)
  • Intestinal diseases (approx. 3%)
  • Epilepsy (approx. 2%)
  • Other psychiatry (approx. 2%)

Source:

German Bundestag (March 27, 2017): Answer of the Federal Government to the small question from LINKEN, Drucksache 18/11701, Cannabismedizin und Straßenverkehr, p. 3

Further possible indications are mentioned by Müller-Vahl and Grotenhermen in their article "Medical Cannabis - The Most Important Changes" (DÄBl. Vol. 114 Issue 8 February 24, 2017, A354).

With regard to the indications, it should be noted that containing cannabinoids Medicines only have a symptomatic effect and so far no scientific knowledge is available for them with regard to a therapeutic benefit for the treatment of the respective primary disease.

Contraindications to consider:

For the cannabinoid-containing finished medicinal products that have been approved to date, the following contraindications are mentioned in the technical information:

Sativex®[4]:

  • is contraindicated in patients with an allergy to cannabis extracts or other ingredients of the drug (ethanol, propylene glycol and peppermint oil), a known or suspected medical history or family history of schizophrenia or another psychotic illness, a history of a severe personality disorder or other significant psychiatric disorder Exceptions to depression due to MS and breastfeeding.
  • Caution should also be exercised in children or adolescents under 18 years of age, pregnant women, the elderly, patients with severe liver or kidney dysfunction, patients with epilepsy or regular seizures, patients with severe heart disease such as angina pectoris and in patients who have previously used drugs or addictive substances.

Canemes®[5]:

  • is contraindicated in patients with known hypersensitivity to cannabinoids, in children or adolescents under 18 years of age, in patients with severe liver dysfunction, in mental illnesses including manic-depressive disorders and depression and in breastfeeding women.
  • Caution is also advised in patients with impaired kidney function, with substance abuse or drug abuse including alcohol abuse or alcohol dependence, in the elderly, and in patients with hypertension and heart disease.

Müller-Vahl and Grotenhermen (2017) [6] point out the following possible contraindications:

“Cannabis should not be prescribed in the presence of a severe personality disorder, psychosis and severe cardiovascular diseases as well as pregnant women and nursing mothers. In the absence of data, treatment in children and adolescents (before puberty) should be carefully considered. Greater central nervous and cardiovascular side effects can occur, particularly in older patients.


[1] Hoch, E., Friemel, C.M., Schneider, M. (Eds.). Cannabis: Potential and Risk. Results of a scientific analysis, Heidelberg. Jumper

[2] Whiting PF et al. (2015): Cannabinoids for Medical Use - A Systematic Review and Meta-analysis. In: JAMA 2015; 313 (24): 2456-2473. doi: 10.1001 / jama.2015.6358

[3] National Academies of Sciences, Engineering, and Medicine (2017): The health effects of cannabis and cannabinoids: https://www.nap.edu/catalog/24625/the-health-effects-of-cannabis-and- cannabinoids-the-current-state

[4] https://www.gelbe-liste.de/produkte/sativex-spray-zur-anendung-in-der-mundhoehle_534377/fachinformation

[5] https://www.gelbe-liste.de/produkte/canemes-1-mg-kapseln_976309/fachinformation

[6] Müller-Vahl, K .; Grotenhermen, F. (2017): Medical cannabis, The most important changes, in: Dtsch Arztebl, 2017, 114 (8): A 352–6