Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
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Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz · Jul 2019
Review[Evidence of the efficacy and safety of cannabis medicines for chronic pain management : A methodological minefield].
Recent systematic reviews (SRs) came to divergent conclusions on the efficacy and safety of medical marijuana and cannabis-based medicines for chronic pain management. This paper gives an overview and critical appraisal of the methods of recent SRs of randomized controlled trials (RCTs) with cannabis medicines for chronic pain. Selective search of the literature, incorrect data analyses and presentation in favor of cannabis medicines can be detected in both RCTs and SRs. ⋯ Cannabis medicines can be regarded to be third-line therapy for chronic neuropathic pain. There are signals of a lack of efficacy for all other chronic pain syndromes. New high-quality RCTs and approaches, such as network meta-analyses combining different treatments and controlled and observational including additional outcomes than pain relief, are necessary to better define the importance of cannabis medicines for chronic pain management.
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Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz · Jul 2019
Review[Cannabis and cannabinoids in palliative care].
Cannabis and cannabinoids are discussed as a potential treatment for a broad spectrum of diseases and symptoms. This article presents current evidence for the use of cannabis and cannabinoids in palliative care and delivers background information. For this purpose recent literature was examined and evaluated. ⋯ Cannabinoids may be considered as a therapeutic attempt in the treatment of cancer pain and weight gain in patients with HIV as well as other symptoms (such as nausea and loss of appetite) if established treatments fail. Further studies involving more patients are needed to evaluate the therapeutic potential of cannabis and cannabinoids. However, special conditions in the field of palliative care make it difficult to carry out high-quality studies.
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Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz · Jul 2019
Review[Cannabis for medical purposes and its prescription].
Since 10 March 2017, physicians have been allowed to prescribe cannabis to patients with serious illnesses and in the absence of alternative therapies. Patients can obtain it as dried flowers or extracts in standardised pharmaceutical quality by prescription (narcotic prescription, except for cannabidiol) in pharmacies. When prescribing, physicians have to take a few things into account. ⋯ Also, due to the complex pharmacology of cannabinoids, interindividual genetic differences in the metabolisation of ∆9-tetrahydrocannabinol (THC), the individual structure and function of the cannabinoid receptors, as well as differences in receptor density and distribution, the dosage and frequency of application must be individually determined. Last but not least, the dosage also depends on the type of disease and individual susceptibility to side effects. When prescribed for the first time, a creeping dosage with a very low initial dose is recommended.
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Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz · Jul 2019
Review[Interim analysis of the survey accompanying insurance-covered prescriptions of cannabis-based medicines in Germany].
In Germany, medical doctors who prescribe cannabis medicines at the expense of the statutory health insurance are obliged to take part in a noninterventional survey on the use of these cannabis medicines. The survey collects and evaluates anonymized treatment data and runs until 31 March 2022. Amongst other things, the results of the accompanying survey are the basis on which the Joint Federal Committee (G-BA) regulates the future assumption of treatment costs in the context of a therapy with cannabis medicines in accordance with the Social Code (SGB) V. ⋯ Most often, insufficient effect was the reason for a discontinuation of treatment. The main indication of pain was already apparent in the licensing procedure for the acquisition of cannabis for medical purposes between the years 2005 and 2016. Further evaluations and subgroup analysis will be carried out when higher case numbers are available.
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Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz · Jul 2019
Review[Cannabis for medical purposes-the law of March 2017 and its history].
Since March 2017, the law amending narcotic and other regulations has expanded the options for prescribing cannabis-derived medicines by doctors. Under certain conditions, patients can be treated with cannabis-derived medicines at the expense of the statutory health insurance. With a prescription, cannabis-derived medicines may be available that are not approved as a finished medicinal product. ⋯ The decisive legal regulation increases the responsibility of doctors and pharmacists in supplying their patients with cannabis-derived medicines. A five-year monitoring survey is being conducted by the Federal Institute for Drugs and Medical Devices (BfArM) to evaluate the effects on patient care. In order to ensure the supply of cannabis-derived medicines in the future, the cultivation of cannabis in Germany is planned under the conditions of the 1961 Single Convention on Narcotic Drugs under the control of a cannabis agency.