Support medical marijuana

Medical cannabis

1. The most important things in a nutshell

If common pain relievers do not help enough, the use of drugs made from cannabis can be considered. Cannabinoids, for example, are increasingly used for chronic pain and since March 2017 can be prescribed by a doctor under certain conditions. Dried flowers, extracts and drugs with the active ingredients dronabinol and nabilone can be prescribed.

Before the change in the law, patients had to have a special permit under Section 3 (2) BtMG and apply for it at great expense.

2. Requirements

If the following requirements are met, those with statutory health insurance are entitled to the assumption of costs by the health insurance company (Section 31 (6) SGB V):

  • A generally recognized service corresponding to the medical standard is not available or cannot be used because of the expected side effects, taking into account the state of the disease.
  • There is a prospect of a noticeable positive effect on the course of the disease or serious symptoms.

For which diseases cannabis can be prescribed is not specified. It must, however serious symptoms are present. In an accompanying study, the Federal Institute for Drugs and Medical Devices (BfArM) collects research results on the benefits and effects of any treatment with drugs containing cannabis. On the basis of these results, the Federal Joint Committee (G-BA) is expected to issue a guideline by 2022, which should further specify the indications for medical cannabis.

3. Effect

Cannabinoids can increase the effect of certain painkillers (e.g. opioids), inhibit the transmission of pain stimuli and at the same time have a mood-enhancing, sleep-promoting and anxiety-relieving effect. However, the current study situation based on clinical standards is still insufficient. The effect on neuropathic pain (nerve pain) is most likely scientifically proven.
The prescribing physician should provide the patient with comprehensive information about possible side effects and interactions with other drugs.

4. Prescription and assumption of costs

In order for the costs to be covered, the cannabis must be prescribed by a doctor and the corresponding approval from the health insurance company must be available. Cannabis can be prescribed by doctors of any specialty, except dentists. It is common for the health insurances to commission the Medical Service (MD) to make a professional assessment of whether the patient is actually suffering from an illness with serious symptoms.

If the prescription is made within the framework of specialized outpatient palliative care (SAPV), the health insurance company must be within 3 days decide on the application (Section 31 (6) SGB V). The period of 3 days also applies if therapy with cannabis has already been started as an inpatient and is to be continued on an outpatient basis upon discharge. In all other cases, the decision period of 3 weeks, if the MD gives an expert opinion, the period is extended to 5 weeks.

5. Prescription cannabis

If the health insurance company has approved, the cannabis can be collected from a pharmacy on presentation of the prescription. The following information must be noted on the prescription:

  • Patient data
  • Date of issue: the prescription must be presented to the pharmacy within 7 days of the date of issue.
  • Details of the type of flower or the name of the medicinal product.
  • Information on dosage and corresponding instructions for use for the patient.
  • Maximum amount according to the legal regulations.
  • Doctor stamp

6. Dosage forms and maximum prescription quantities

The cannabis is available in different forms (§ 2 BtMVV):

  • Cannabis flowers: max. 100,000 mg / 30 days
  • Cannabis extracts: 1000 mg / 30 days
  • Dronabinol (THC): 500 mg / 30 days
  • Finished drugs with the active ingredient nabilone, e.g. Canemes: no information

There are different types of application, e.g. inhalation after vaporizing, making tea or taking drops / capsules.

7. Ability to drive

For the majority of patients who have the approved intake of cannabinoids, driving a car, e.g. because of a very poor general physical condition, is out of the question from the outset. According to the German Bundestag (www.bundestag.de> search term: 18/11701), driving a car is basically possible, because patients do not drive in a state of intoxication when taken as intended. On the contrary: only the use of medical cannabis enables them to participate in road traffic. During the recruitment phase, however, the ability to drive may be impaired due to the start of medication.

There may be deviations from this regulation depending on the federal state.

For more information, see Driving a car while taking medication.

8. Practical tip

The German Medical Association offers further information on the medical use of cannabis at www.bundesaerztekammer.de> Doctors> Supply> Outpatient> FAQ List on the use of cannabis in medicine.

9. Related links

Chronic pain

cancer

Palliative phase

 

Sources of law: Section 31 (6) SGB V