Organizer:  
Speaker: Prof. Dr. med. Hartmut Göbel, Dr. Christian Ude
Thursday, June 29, 2017, 8:00 p.m. – 10:00 p.m
Bad Segeberg
Lecture for pharmacists + doctors
Lecture / Cat. 3
 

Cannabis regulations: A challenge for doctors and pharmacists

A very exciting change has taken place: Cannabis, previously only known to be used improperly in Germany, has been available to patients since the beginning of March as part of a legal distribution in public pharmacies, in consistent quality and for certain medical indications according to a doctor's prescription. An illegal drug became a legal medicine! Due to this innovation, doctors and pharmacists have numerous questions regarding how to deal with it.

In this context, the mechanisms of action described and the actual evidence of the effectiveness of cannabis and its ingredients are of course of interest. Cannabis can be used and consumed in numerous different forms: inhalatively, in the form of finished medicinal products (including extracts) or, if necessary, purely in the form of the isolated ingredients that determine effectiveness. If cannabis is handled as a drug (flowers) in the pharmacy, all aspects of handling it according to the prescription must of course be considered and regulations must be met. Experiences with regulation and delivery will also be reported, which will already be available by the time the event takes place.

The aim of this event is to provide security and a sound basis for handling in the doctor's and pharmacy practice.

Contents:

  • Effectiveness-determining ingredients and mechanisms of action
  • Characterization of the different cannabis varieties
  • Importance of cannabis for the various indications
  • Evidence of existing forms of application
  • Prescription help for doctors
  • Aspects of narcotics law: maximum prescription quantities, duration of validity of the prescription, etc.
  • Risk of abuse, side effects and interactions, contraindications
  • Special features in the recipe
  • Health insurance approval, costs covered by the GKV
  • First experiences in prescribing and dealing with cannabis

Dr. Christian Ude , pharmacist, Darmstadt
Prof. Dr. med. Dipl.-Psych. Hartmut Göbel, specialist neurologist, pain therapist, Kiel

Cannabis has anti-inflammatory, anti-emetic, muscle relaxant, sedative, appetite-stimulating, analgesic and anti-depressant effects. Since March 2017, cannabis has been officially usable in Germany for serious illnesses without specific indications; the costs can be reimbursed by health insurance companies after individual approval.

To date, the active ingredients THC (Delta-9-tetrahydrocannabinol) have been used in Germany. CBD (cannabidiol) is also available. Thanks to the new legal regulation, the flowers can also be prescribed.

The two main active ingredients have different mechanisms of action:

  • THC: Analgesic, muscle relaxant, antiemetic, appetite stimulant, psychoactive (mood increase, euphoria, talkativeness, altered perception, etc.), panic, anxiety, dysphoria, psychoses, memory and concentration disorders, tachycardia, tremor, ataxia.
  • CBD: Anti-inflammatory, muscle relaxant, antiemetic, anticonvulsant, antipsychotic, anxiolytic, neuroprotective.

CBD cancels out the psychoactive effects of THC, so medical cannabis should contain THC and CBD in a balanced ratio. The ready-made spray Sativex contains 50% THC and CBD. When using flowers, care should be taken to ensure that the proportion of the two active ingredients is balanced.

Contraindications are: psychoses, affective disorders, anxiety disorders, childhood and adolescence, as irreversible cognitive sequelae are to be expected. Pregnancy, cardiac arrhythmias, hypertension.

Insured people with serious illnesses are entitled to treatment with cannabis if there is no alternative therapy, the established measures do not work or are not sufficient and if there is a prospect of improvement through this therapy. The first prescription must be approved by the health insurance company. A justified request from the doctor is required. It may only be rejected in justified exceptional cases.

The doctor is obliged to collect data for an accompanying survey. These are collected for application observation.

Ready-made medicines such as Sativex, Canemes or Marinol as well as dronabinol (THC), oily cannabis extracts and cannabis flowers can be prescribed. The latter can be ground up and, after evaporation, inhaled using a vaporizer.

To date, more extensive scientific knowledge is only available for the accompanying treatment of spasticity, nausea and vomiting with cytostatic drugs and chronic pain.

Possible effectiveness is discussed for loss of appetite and weight loss in HIV, schizophrenia, Parkinson's, Tourette's, epilepsy and chronic inflammatory bowel disease.

The statutory health insurance companies can reimburse the therapy after a justified request from the treating doctor. The decision as to whether a patient needs to be treated with cannabis rests with the treating or prescribing doctor. However, the reimbursement must be approved by the health insurance company. The necessity must be present, contraindications must be excluded and the minimization of psychoactive effects through a targeted combination of active ingredients should be ensured.