Regulatory Developments in Europe
In March 2017, it became legal to prescribe 14 strains of cannabis in Germany, which is also seeing an increase in patient requests for cannabis prescriptions, according to Winfried Häuser, MD, a professor of psychosomatic medicine, at the Technical University of Munich and a regular contributor on published research addressing cannabinoids with Dr. Fitzcharles and Dr. Clauw.
With medicinal cannabis now legal in Germany, patients who meet specific criteria and are prescribed marijuana are being tracked through a registry by Germany’s Federal Institute for Drugs and Medical Devices, with all patient-identifying information removed. Dr. Häuser believes these data could be valuable to better understand the patient populations using medicinal herbal cannabis. He is also working to receive funding from pharmaceutical companies and a public foundation in Germany to further explore cannabis use for chronic pain.
Beyond Germany, Dr. Häuser is working with colleagues across Europe as head of the task force of the European Pain Federation (EFIC) to establish a position statement on the application of cannabis-based medicines to treat chronic pain. He recently co-authored a survey published in the European Journal of Pain that highlights the availability and approval of cannabis-based medicines for chronic pain management and palliative/supportive care in Europe.8
“[Although] there are marked differences between the countries represented in EFIC in the approval and availability of cannabis-based products for medical use, there is one commonality: There is a significant gap between the public perception of the effectiveness and the safety of cannabis for medical use,” Dr. Häuser asserts.
What Patients Need to Know
“Patients need to understand that the rheumatology community is actively seeking clinical data to better understand the safe application of cannabinoids for pain management,” Dr. Clauw stresses.
For patients who do choose to use medicinal cannabis, Dr. Clauw and Dr. Fitzcharles make the following suggestions:
- Don’t smoke it;
- Know the THC level, and choose an application with low THC and high CBD;
- Look for a low dose (e.g., 0.5 g at nighttime) because it may be more effective;
- Understand that cannabis impairs mobility, and don’t drive for 24 hours after taking it; and
- Understand that turning only to marijuana for pain management may set your treatment back to square one. Consider it more for intermittent use, such as during periods of distress/flare.
“There’s no question that cannabinoids are here to stay,” Dr. Fitzcharles says. With the popularity and increased marketing of cannabis products, she fears that people may incorrectly view cannabis as a panacea. “Like any drug, cannabinoids offer opportunities for clinical application, and we would be remiss not to explore those opportunities. However, the barriers to studying cannabinoids in clinical applications may require us to be innovative in moving research forward.”