How do medical marijuana delivery services work

Medical cannabis

 

1. How do you get cannabis on prescription?

Before the new “Cannabis Law” came into force in March 2017, there were around 1,200 seriously ill people in Germany who could obtain an exemption from the Federal Opium Agency. The new legislation makes it easier for physicians to prescribe medical cannabis and accessories such as vaporizers for a reimbursement.

 

2. For which ailments is medical cannabis used?

The legislature has refrained from listing individual indications. Cannabis flowers and extracts can therefore be prescribed for every indication if “a generally recognized service corresponding to the medical standard is not available in an individual case” or if this service is “in individual cases based on the justified assessment of the treating contracted doctor, weighing the expected side effects and taking into account the state of illness of the insured person cannot be applied ”.

The effectiveness of cannabis therapy must therefore be checked in each individual case by a doctor and the dose determined.

Established indications for cannabis-based drugs are chronic - especially neuropathic - pain, cluster headache, spasticity and painful muscle tension in MS, loss of appetite, nausea and vomiting (including nausea and vomiting caused by drugs such as opiates and cytostatics). But according to the literature, cannabis is also used for many other inflammatory diseases such as Crohn's disease, ulcerative colitis and some psychiatric diseases.

 

3. What is the effect of cannabis?

Cannabis works through the body's own cannabinoid receptors. The mechanism of action can be explained very simply as follows: The endocannabinoids / cannabinoids such as THC modulate the neurotransmitter concentration (e.g. acetylcholine, dopamine, serotonin, Gaba, noradrenaline) in the central and vegetative nervous system, in which they inhibit the respective neurotransmitters when the neurotransmitter activity is too high Act. In the immune system, cannabinoids are said to have anti-inflammatory properties by inhibiting the release of pro-inflammatory cytokines such as TNF-alpha and IFN-gamma.

 

4. When can a patient be treated with cannabis? When does the statutory health insurance cover the costs?

Since cannabis is included in Annex III of the Narcotics Act, a doctor can generally prescribe cannabis for self-payers.

The assumption of costs for cannabis therapy by the statutory health insurance companies is regulated by Section 31 (6) of the Social Code Book V.

Insured persons with a serious illness are entitled to a supply of cannabis in the form of dried flowers or extracts in standardized quality and to a supply of drugs with the active ingredients dronabinol or nabilone, if

1. a generally recognized service corresponding to the medical standard

a) is not available or

b) in individual cases, based on the justified assessment of the treating contract doctor, considering the expected side effects and taking into account the condition of the disease, the insured person cannot be used,

2. There is a not entirely remote prospect of a noticeable positive effect on the course of the disease or on serious symptoms.

In the case of the first prescription for an insured person, the benefit requires the approval of the health insurance fund, which can only be refused in justified exceptional cases, and which must be issued before the start of the benefit. If the contract doctor prescribes the service according to sentence 1 as part of the care according to § 37b, a decision on the application for approval according to sentence 2, in deviation from § 13 paragraph 3a sentence 1, must be made within three days of receipt of the application.

The attending physician can prescribe up to 100g of cannabis flowers per month. This is independent of how much THC content a flower variety has, i.e. it is possible to prescribe different varieties.

 

5. Which cannabis strains can be used medicinally?

Various types of flowers are permitted in Germany. The Federal Institute for Drugs is currently planning to cultivate cannabis in Germany. The majority of medicinal cannabis is therefore currently imported from Holland and Canada. The varieties from there have standardized THC and CBD levels.

There are also cannabis preparations that can be prescribed, such as dronabinol solutions or capsules.

 

6. What side effects can cannabis drugs have? Can you get addicted to cannabis?

When used in low medical doses, the following side effects may occur, among others: restlessness, anxiety, high pulse, dry mouth, dizziness, reduced ability to react and tiredness, euphoria.

Cannabis should not be prescribed for severe personality disorder, psychosis and severe cardiovascular diseases. The same applies to pregnant women and nursing mothers. In adolescents, cannabis has been shown to lead to a disruption of brain development and also to an increased development of psychoses at a later point in time, which is why cannabis should not be prescribed here either.

If you have any further questions about risks or side effects, please contact your doctor or pharmacy.

 

7. How is medical cannabis used?

Cannabis flowers can be inhaled with a vaporizer or orally in the form of a tea. Pharmacies can also produce cannabis extracts that are adjusted to a certain THC content.

Oral ingestion through tea is also possible. The preparation of tea is somewhat difficult for the patients, as it requires a lot of experience due to the necessary decarboxylation and the poor water solubility of the THCA / CBDA in order to achieve reproducible results of the cannabis tea preparation.

 

8. What works better? The inhalation of cannabis flowers or the oral ingestion as cannabis extract?

Inhalation has the great advantage that it is very easy to dose. In addition, the effect occurs after less than a minute and lasts for about 2 to 3 hours. The disadvantage is a very high level of active ingredient in the blood for a short time and the generally short duration of action of approx. 2-3 hours. When taking cannabis extract / tincture or tea orally, it takes about 30 to 90 minutes for the effects to occur. On the other hand, the duration of action when taken orally is much longer due to the effective active metabolites and is between five and nine hours, depending on the stomach filling.

 

9. How high is cannabis dosed?

In general, the dose is slowly increased up to the therapeutically effective amount after consultation with the attending physician. The required amounts of cannabis vary greatly depending on the patient and indication. It is important to know that the therapeutically effective dose must always be, and as a rule, well below the psychoactive dose.

 

10. Which cannabis flowers and cannabis extracts are currently available?

The delivery capacity of the flowers and extracts is updated daily. In some cases there are currently delivery problems for individual flower varieties due to the high demand in Germany. Please inquire at the pharmacy which flowers and flower extracts are available.

 

11. What does the pharmacy do with cannabis flowers? How can patients be advised?

First, the pharmacy checks the identity in the laboratory:

When the cannabis flowers arrive at the pharmacy, they are first checked for identity using thin layer chromatography, wet chemical methods and microscopy in accordance with the pharmacopoeia. In addition, the quality is checked on the basis of the test certificate. This is very important so that it can always be ensured that the patients only receive high-quality cannabis flowers with the prescribed content of THC and, depending on the type of flower, also CBD.

Once the identity has been verified, the cannabis flowers are finely cut and sieved in the pharmacy at a low temperature. This is necessary so that the patient can always dose the cannabis flowers exactly the same volumetrically with a measuring spoon. There is, for example, a measuring spoon that, when leveled, always contains exactly 100 mg of flowers when optimally ground. Alternatively, the doctor can also prescribe the cannabis flowers in the unscrushed state and the patient grinds the flowers himself before use. The pharmacy can also pack the appropriate dose in each case.

 

 

Deutsche Apotheker Zeitung, 2017, 8, Cannabis in the pharmacy

Deutsche Apotheker Zeitung, 2017, 10, Cannabis as medicine

Cannabis: Working aid in pharmacies, Häußermann / Grotenhermen, Deutscher Apotheker Verlag 2017, 1st edition

Cannabis: Regulation aid for doctors, Grotenhermen / Häußermann, Deutscher Apotheker Verlag 2017, 2nd edition

Deutsches Ärzteblatt 2017; 114 (8): Medical cannabis: the main changes

Apotheker Zeitung No. 48, November 26th, 2018: Greens want to facilitate cannabis therapy