Cannabis on prescription: What remains of the expectations?

Status: 01/19/2022 04:49 a.m

Five years ago, the Bundestag cleared the way for cannabis on prescription. But the health system and authorities were not prepared for this. Does the error repeat itself?

By Juri Sonnenholzner, SWR

“There is no other molecule in the world that simultaneously has an analgesic, nausea-inhibiting, appetite-enhancing, muscle-relaxing, uplifting, sleep-inducing, anti-inflammatory, and bronchodilator effect.” When Franjo Grotenhermen talks about cannabis and its active ingredient THC, it sounds as if parts of the pharmaceutical industry could pack up.

Yuri Sonnenholzner

He is a doctor and managing director of both the German Association for Cannabis as Medicine (ACM) and the International Association for Cannabinoid Medicines (IACM). “THC is the molecule with the broadest pharmacological spectrum. By far.”

Recipe under conditions

He has been able to legally prescribe it on prescription for five years now, and the health insurance company has to pay. On January 19, 2017, the Bundestag approved medical marijuana in the form of cannabis on prescription. Doctors can prescribe it to seriously ill people, provided no other medication helps. “We are taking an important step towards improving the care of seriously ill patients,” said Ingrid Fischbach (CDU), then Parliamentary State Secretary in the Ministry of Health, before the Bundestag. “We want to alleviate their suffering.”

relief from pain

Chronic pain patients in particular should experience this relief. Multiple sclerosis, the consequences of diabetes mellitus or the chronic intestinal inflammation Crohn’s disease, for example, but also anxiety and sleep disorders can be treated with it. Doctors also check the previous illnesses. For example, cannabis can intensify psychosis. In addition, there must be a prospect that the course of the disease will improve and severe symptoms will be alleviated by medical cannabis alone and that no conventional alternative can achieve this.

costs are high

Some of the patients are actually not sufficiently treatable with standard medication, but benefit very well from cannabis, explains Grotenhermen. But the cost of cannabis flowers is high because they are treated like prescription drugs under the Drug Price Ordinance.

As a result, the prices are significantly higher than in other countries, more than three times as high as in the Netherlands, for example. According to the GKV, cannabinoid-containing finished medicinal products and preparations generated gross sales of 44 million euros in the first quarter of last year alone.

burden on health insurance companies

Doctors prescribed cannabis more than 90,000 times during this period. This places a significant financial burden on health insurance companies. Grotenhermen reports that health insurance companies require appropriate studies on the effectiveness before they can cover the costs. But how to fulfill this wish?

“Cannabis is effective for 100, 200 indications such as migraine, chronic inflammation of the colon, muscle spasticity or ADHD. Then you would have to carry out a corresponding number of large clinical studies just to have a situation similar to approval. The next 20 years will not be enough for that,” is himself Grotenhermen for sure. And there was also a lack of public funding for such studies.

The inadequate study situation is also cited by large parts of the medical profession. Too many studies failed to meet scientific standards. The studies, which are well-founded, raise considerable doubts about the effectiveness of cannabis as a pain medication.

“Do not overestimate the effect”

Doctors like Dominik Irnich generally welcome cannabis on prescription. As head of the pain outpatient clinic at the Ludwig Maximilian University in Munich, he warns against overestimating the effects of cannabis. “It doesn’t help every patient, and chronic pain isn’t easy to stop either. Here the results are a little glossed over – perhaps because a whole armada of manufacturers is already ready. There’s also a lot of money at stake.”

supply has improved

At least the supply situation on the medical cannabis market has improved after five years: there are now around 150 different varieties and 60 different extracts from the hemp plant. But cannabis medicines still have to be imported to Germany. The market could change again: The traffic light coalition wants to introduce “controlled sales of cannabis to adults for recreational purposes in licensed shops”, according to the coalition agreement.

Natural product cannabis

Will there then be less medicinal cannabis left? After all, it is a natural product: cannabis flowers are difficult to produce as standardized products.

Farmer’s President Joachim Rukwied says that in view of the expected legalization of cannabis, many farmers are already dealing with it: “Cultivation of hemp is a hip topic among German farmers. There is a lot of discussion about it. One or the other has already read up on how it can work with the hemp.”

costs remain

Doctor Grotenhermen believes that legalization could also help patients – depending on how the law is structured. But: “With general legalization, there would be no need to look for a doctor and there would be no medical costs. But the costs for the cannabis products remain.”

These could get stuck with the patients – who, in his experience, are often unable to work and live on Hartz IV. A remedy here could be a general obligation for health insurance companies to cover the costs or the legalization of self-cultivation for personal use by patients or their carers. “As is already the case in some other countries today.”

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