Hemp products have been used for centuries by people for recreational and medical purposes. At present, cannabis is used in therapy for a large group of medical indications, in particular in the field of analgesic and palliative therapy, as well as oncology and neurology, as well as psychiatric and neurological diseases.
In March 2017, the German parliament amended the medical cannabis law. As a result, cannabis has become a medicinal product that is prescribed by prescription.
There are now over 100 different cannabis products available. Most are oral preparations (oils) or capsules containing delta-9-tetrahydrocannabinol or cannabidiol. Products made of dried flowers are also available.
Since most products are unregistered drugs, they require approval under the Special Therapy Access B Program or the Prescription Program.
According to the World Health Organization, cannabis is the most cultivated, traded, seized and consumed drug in the world.
At the same time, the popularity of its medical use in many diseases is growing. Medical marijuana benefits from many chronic diseases, including neurogenic pain, for which no effective treatment has yet been found.
What is medicinal marijuana?
The cannabis plant contains hundreds of bioactive molecules, most of which have yet to be characterized. The two most studied cannabinoids are delta-9-tetrahydrocannabinol (THC) and cannabidol (CBD). These substances are mainly in the form of acids, which are decarboxylated to the most effective form when the plant material is heated. Both cannabinoids bind to the body’s CB1 and CB2 receptors and can reduce excessive neurotransmitter activity. The flowers of most cannabis strains contain THC as the highest concentration of cannabinoid. It is responsible for the psychotropic effect.
Medical cannabis in pain management, oncology and palliative medicine.
Medical cannabis stimulates a wide range of interactions that can contribute to improving the quality of life of seriously ill patients. In this case, the potential effect in terms of pain relief, antiemetic and appetite stimulating effects is of particular importance. The effects of medical cannabis-based medicinal products in the treatment of pain have been investigated in numerous randomized, controlled trials.
Chronic pain is the most frequently cited reason why patients use and request marijuana. Data suggest that recreational or medical use of cannabis may be associated with an increased risk of non-medical prescription opioid use or opioid use disorders. Thus, while the use of cannabis for pain management is supported by clinical data, very little is known about the efficacy, dosage, routes of administration, or adverse effects of commonly used and available cannabis products in the United States. Some data suggest that THC-CBD blended products have better pain benefits compared to CBD alone.
Nausea and vomiting caused by chemotherapy
The antiemetic effect was one of the first scientifically studied effects of cannabinoid use. Already in the 1970s, it was shown that THC can be effective in relieving nausea and vomiting in patients undergoing chemotherapy.
Pain in the central nervous system
Two systematic reviews looked at cannabinoids for the treatment of muscle spasticity in patients with spinal cord injury or multiple sclerosis. The use of medical cannabis in the treatment of multiple sclerosis patients has been shown in research centers in several European countries to reduce spasticity as well as reduce the frequency of spasms and improve sleep.
Anorexia and cachexia
The appetite-stimulating effect of cannabinoids has been studied in HIV and cancer patients. Many research centers have proven the effectiveness of medicinal cannabis-based medicinal products in stimulating the appetite of HIV-infected patients. Patients with advanced stage cancer reported that their appetite improved after using THC in therapy.
There is currently no conclusive or compelling evidence to suggest that cannabis is effective in treating any medical conditions, and instead suggests that it may only be effective in combating symptoms.
How to prescribe medical cannabis products?
Medical cannabis can be prescribed in the form of dried flowers or extracts of standardized quality as a pharmaceutical raw material for making a prescription drug.
Medical cannabis flowers are administered orally by inhalation. Undoubtedly, the advantage of inhalation is the rapid action of the active substance, usually within a few seconds or minutes. Due to the potential negative health effects, smoking is not recommended. Vaporizers should be used in the inhalation procedure. It should be noted that any dose increase should be gradual.
– caution should be exercised when considering medical marijuana for those under the age of 25 as the brain grows to this age and the potential of marijuana can have a lasting effect on cognition
– pregnancy and breastfeeding
– cannabis-induced schizophrenia and psychosis
– diseases of the heart and circulatory system
– past drug abuse
Frequently occurring intense side effects include dizziness, dry mouth, euphoria, nausea and vomiting, fatigue and sleepiness.
The benefits of using medical cannabis
Medical marijuana laws give doctors the ability to provide selected patients with an additional tool to help them cope with distressing symptoms. Being aware of the doctor about the potential benefits and side effects will help patients make informed choices about using medical marijuana to improve their quality of life. Doctors have a unique opportunity to show selected patients this new treatment strategy.
- Jon O. Ebbert, MSc Eugene L. Scharf, Ryan T. Hurt, Medical Cannabis,
- Md Ruhul Amin, Declan W Ali, Pharmacology of Medical Cannabi.