A lot has been reported about therapeutic successes with cannabis for a wide variety of chronic illnesses. As is well known, the study situation is not particularly good. For which diseases is there the most experience? I distinguish five groups. The largest therapeutic area is chronic pain. We have good data on neuropathic pain that occurs due to nerve damage, for example after an accident or with diabetes mellitus. There are also good experiences with cancer-related pain or migraines. The second area is psychiatric illnesses such as Tourette syndrome or post-traumatic stress disorder. Smaller studies provide evidence that cannabis can help with sleep disorders. Thirdly, the data situation is also improving for chronic inflammatory diseases such as Crohn’s disease or rheumatoid arthritis. The fourth group includes various forms of nausea, vomiting and loss of appetite, for example as part of chemotherapy or AIDS. Fifth, I am thinking of neurological symptoms such as spasticity in multiple sclerosis or certain forms of epilepsy. There are also approved medications for the latter.
How many patients with chronic diseases for whom conventional therapies fail could benefit from cannabis? This can be easily extrapolated because there are some countries in which cannabis has been prescribed as medicine for some time. There is very good, monthly updated data from Israel on how many patients use cannabis as medicine. The 1.5 percent mark of the population was recently exceeded there. With a population of around nine million, around 140,000 people were prescribed cannabis for medical reasons in January 2024. If we extrapolate that to around 84 million Germans, we would get more than 1.2 million in this country. This number could increase significantly if you look at the steady increase in numbers in Israel. I expect that in a few years two percent of the population there will use cannabis as medicine.
The Federal Institute for Medicines made therapy with cannabis easier seven years ago and launched an accompanying survey with the aim of creating more clarity about which indications cannabis really helps. What came out of it? This accompanying survey did not meet the criteria of a study, it was an application observation. Although the doctors were obliged to document the treatment, this was never checked. Many doctors have never done this. There are only around 17,000 completed data sets in total. From these you can see for which indications cannabis was prescribed and covered by the health insurance companies. In about three quarters of the cases it was chronic pain. However, it was very difficult to get coverage for psychiatric or inflammatory illnesses. For such reasons, these results do not reflect when cannabis was actually prescribed, but only in which cases health insurance companies reimbursed the costs.
You yourself have specialized in cannabis as medicine. How many patients benefit from your prescriptions? Almost all of them. But that is also because my patients are pre-selected. Most of them already have previous experience, they know that cannabis helps them, they tried it with a friend or were in Holland, or they have been taking it for a long time and want to get out of illegality. And they come because they have heard about me.
Doctors have long been very critical of cannabis therapy. Has that changed since the BfArM made the submission process a little easier seven years ago? Acceptance is growing. There are more and more doctors who have been convinced by articles or who have attended congress events, and acceptance in professional societies is also slowly increasing. But this is a process that takes decades. The topic of cannabis is emotionally charged and changes take a lot of time.
Has the partial legalization of cannabis as a recreational drug made it easier for patients to get it prescribed? Absolutely! Cannabis or cannabis-based medicines are now no longer narcotics. The high effort required to prescribe them is eliminated. This required special narcotic prescriptions that are not even available in many practices. Doctors no longer have to worry about violating the narcotics law. It stipulates that the prescription must be justified. It is not justified if the therapeutic goal can also be achieved with other means. As a result, there have been a number of criminal proceedings against doctors in recent years.
This facilitation of prescription is certainly also a great opportunity for patients? Of course. It’s a low threshold, just try it out. As a doctor, you can write a private prescription and see if it works. And if it doesn’t work, then it doesn’t work. Just like with any other medication. The dangers of such a treatment attempt are low.
You’re talking about private prescriptions. However, it would be desirable for health insurance companies to cover the costs in the future. Do you think something will change? I do not believe that. And I fear a development that we also observed in other countries, for example in Canada, after legalization in 2018. The number of cannabis patients there decreased. It could be that doctors will withdraw from cannabis therapy in the future and say, grow your three plants at home or go to the social club, we can talk about the topic here, but don’t burden me with it.
In the future, anyone with enough money left will be able to treat their suffering themselves. However, an increase in self-therapy may not lead to corresponding healing successes. Do you see a danger in this? I assume there will be a lot of self-therapy. And of course it would always be better if the therapy was carried out under the supervision of a doctor, especially in the case of serious illnesses. As a patient, you sometimes misjudge yourself. But predictions are difficult; things can go in any direction. It is possible that many more patients are now approaching their doctors with the desire for therapy with cannabis; Many may go into self-therapy. But it can also be the case that both happen.
The doctor Franjo Grotenhermen specializes in the treatment of chronic diseases with cannabis. Through his practice in Steinheim, he cares for and advises chronically ill patients throughout Germany. He has written many books on the topic, the most recent “The Healing Power of CBD and Cannabis” was published by Rowohlt Verlag in 2020.
