Cannabinoids in medicine - an option!

The international conference “Cannabinoids in Medicine - An Option?” took place on January 22, 2013 at the Inselspital in Bern. We look back on this important event and thus continue our series on the topic of hemp-based medicines. The conference brought together scientists, medical and nursing staff, patients, politicians, members of the authorities and the media, and its program provided an interesting overview of the current state of medical and legal developments in the field of medicinal cannabis.

After Professor Brenneisen's closing words to the conference, which by the way is reproduced in the title of this article, it was clear: Cannabis will increasingly play a role again in modern medicine. The medical potential is simply too great and the currently still prevailing bureaucratic and legal barriers will not stop the so-called re-medicalization of cannabis products in Switzerland. The criminalization of patients who want to alleviate their suffering through cannabis was publicly criticized by the organizers of the event.

The meeting was organized by the Swiss Association for Cannabinoids in Medicine (SACM). Rudolf Brenneisen, head of the Laboratory of Phytopharmacology (science of the interaction between plant substances and living organisms) at the University of Bern, was the main organizer. He has long been perceived as one of the most important exponents of Swiss cannabis research and guided the participants confidently through the event. In order to achieve its goal, namely to provide the basis for an objective discussion by presenting the current scientific, health policy and legal facts, a broad program was offered. After the presentations on the medical fields of application during the morning, the legal and political situation in Switzerland was highlighted in the afternoon and the prescription models in different countries were presented before the speakers answered the questions of the participants. A reflection of the event's versatility was the list of sponsors. In addition to the Dutch producer of medicinal cannabis Bedrocan, for example, the Nachtschattenverlag, the Swiss Multiple Sclerosis Society, the producer of Volcanos, which is well known to our members, and several pharmaceutical companies were among the supporters.

The more than 15 presentations given in English or German were all highly interesting. Trivial for experts, but enlightening for laymen and patients, was Professor Brenneisen's introductory presentation. Cannabis works because humans have their own system for cannabinoids - the best known of which is probably THC. Hemp contains over 60 other cannabinoids that affect the body's endocannabinoid system. Since this system is responsible for fine-tuning communication between cells, it controls, for example, sleep, pain, control of movement, appetite, relaxation, and forgetting. Last but not least, cannabinoids could also play a role in fighting cancer. This astonishing finding was presented by a Spanish researcher from the Complutense University in Madrid. In animal experiments, it was shown in rats that THC blocks the formation of metastases in tumors and triggers apoptosis, i.e. the cancer cells die on their own. Interestingly, cannabis is currently still being touted as a complementary medicine to conventional, extremely harmful chemotherapy; perhaps they don't want to make enemies of “Big Pharma” and the powerful conventional medicine. After further impressive presentations on medical applications in pain management for ALS patients, in psychiatry and in the fight against asthma, AIDS and glaucoma, it was then up to the representatives of the authorities to present their respective points of view.

The participants got the impression that cannabis could definitely get a place in the Swiss healthcare system, but the hurdles are quite high. We have already reported in Legalize it! 59 about the bureaucracy and the fact that hemp-based medicines can only be used in exceptional cases. Thanks to the presentations of the representatives of the Federal Office of Public Health and the Federal Commission on Narcotic Drugs as well as Felix Gutzwiller, member of the Council of States Commission for Social Security and Health, it became clear that the bureaucracy is politically wanted. Questions from the audience then clarified once again what this means: For example, no advertising is allowed for the extemporaneous prescription, which is also dispensed by Manfred Fankhauser from Langnau i. E.. Furthermore, the prescribing physician must take responsibility for the treatment with cannabis, which he does not have to do with other medications, even if they have strong side effects, and thus represents a blatant case of distortion of competition.

In the last block of events, prescription models for cannabis were presented by representatives from Germany, the Netherlands, Austria, Canada and Switzerland. The spectrum of the different regulations is wide. While in the Netherlands severely ill patients can buy hemp flowers with standardized THC levels in pharmacies and even still have the choice between indica and sativa, the authorities in Germany are still struggling but meanwhile allow the prescription of dronabinol (synthetic THC) and in rare cases patients can obtain a special permit for the import of cannabis flowers through their pharmacy. Interestingly, synthetic THC is derived from the cannabidiol (CBD) of fiber hemp in a chemical process. In Austria, about 3,000 patients were treated with synthetic THC from fiber hemp in 2012. Health insurance companies even pay for the treatment if it is prescribed as “ultima ratio” - as a last resort. Since fall 2012, natural THC may also be prescribed in our eastern neighbor, but not in the obvious environmentally friendly and generally efficient form of home-grown cannabis, but as a drug known as “Sativex,” which is manufactured by Bayer. In cooperation with the company Bionorica, the state-owned Austrian Agency for Health and Food Safety GmbH (AGES) has also recently started producing cannabis. The natural THC is then extracted from this in Germany and imported to Austria in the form of capsules and drops. The Canadian prescription model previously allowed patients to grow their own cannabis or hire someone to do so. Currently, there are over 20,000 patients with legal access to their medicine. Unfortunately, there were excesses and part of the production was diverted for consumption purposes, in the interpretation of the authorities, for narcotic purposes. Although this is actually the consequence of the prohibition policy, nothing is changed in it, but now only a state-licensed oligopoly will be allowed to produce medical cannabis. This is to regain control over cannabis production in Canada. The last speaker was Manfred Fankhauser, who presented the Swiss model. We have already reported on his experience with extemporaneous prescription in previous issues.

In the meantime, treatment with natural native THC in the form of a tincture has begun. According to the Emmental pharmacist, treatment costs are about 40 percent lower compared with synthetic THC. However, the number of patients must still increase so that this cost reduction is also perceived in the health policy system. After all, 150 applications for an exemption permit for treatment with THC are submitted to the Federal Office of Public Health every six months.

The meeting has given hope to the participants that in the future the restrictive regime around the medical use of cannabis will loosen. Unfortunately, there is also a tendency for stakeholders in the medical cannabis industry, be they researchers, producers or physicians, to strongly distance themselves from the use of cannabis as a stimulant. Medical cannabis should not be perceived as a vehicle for a general legalization. Unfortunately, they thus ignore the harmful consequences of prohibition, which include damage to health. The attitude is understandable, however, because researchers and practitioners in this field still face hostility. Recently, Prof. Brenneisen had to defend himself against accusations by Sabina Geissbühler-Strupler, an active hemp opponent and member of the Bernese SVP parliament. She suspected the researcher of misusing state funds for “questionable experiments in the field of drugs.” As for hemp-based drugs, it is to be hoped that they will establish themselves not only as a profitable mainstay for pharmaceutical companies and medical practitioners. Apparently, the idea of treating sick people with cannabis is easiest to sell politically via business and special interests. Ideals like freedom or the right to self-medication are hard to lobby for.

Anyone interested in the topic of “cannabinoids in medicine” should consider attending the two-day congress of the International Association for Cannabinoid Medicines (IACM). It will take place in Cologne at the end of September and information about it can be found here.

The documents of the meeting held in Bern can be downloaded here.