Therapeutic Potential
The pharmacological effects of cannabis are clinically evident. However, due to sociopolitical research hindrances, cannabis is currently only approved for a few indications (nausea and vomiting during chemotherapy, lack of appetite and cachexia in HIV or cancer, neuropathic or chronic pain and spasticity in MS). Therefore, the off-label or no-label use of non-approved cannabis pharmaceuticals is the rule, not the exception. Apparently, the therapeutic potential of cannabis is not limited to individual indications but covers symptom complexes that are important for diseases with completely different etiologies.
The therapeutically utilizable potential of cannabis and cannabinoids is clinically evident but unexplored to a large extent. In Germany cannabis-based pharmaceuticals are currently officially approved only for moderate to severe spasticity in adults with multiple sclerosis. Therefore, the off-label or no-label use of non-approved cannabis pharmaceutical is the rule.
Cannabis is mostly prescribed palliatively, meaning for the relief of symptoms.
Scientific literature (and anecdotal, not scientifically-proven experience reports, e.g. on the internet) also point to future curative as well as preventive application possibilites.1-4
Plant cannabinoids act on the endocannabinoid system (ECS) of the body, that is fundamentally involved in the regulation of diverse functions of the central nervous system and the immune system. Moreover, the ECS also regulates cell mitosis as well as programmed cell death and influences the body’s metabolism. Hence, the therapeutic potential of cannabis is not limited to single indications but covers symptom complexes that are important for diseases with completely different etiologies and may therefore provide relief in various ailments.
The most established indications for cannabis-based medication so far are (see table 1)
- nausea and vomiting (e.g. due to cancer chemotherapy)5
- lack of appetite and cachexia (e.g. in HIV or cancer)6
- neuropathic and chronic pain and spasticity (e.g. in multiple sclerosis) 7,8.
Between 2007 and 2016, the Federal Opium Agency of Germany granted exemption permits for a physician-accompanied self-therapy with cannabis for more than 50 different indications (see table 1).
| Indication | Number of studies found | Total number of patients |
|---|---|---|
| Nausea and vomiting due to cancer-chemotherapy or radiation | 33 | 1581 |
| Appetite and chemosensory perception in cancer or HIV/ AIDS patients | 10 | 973 |
| Neuropathic or chronic pain | 35 | 2046 |
| Experimental or acute pain | 11 | 387 |
| Spasticity in Multiple Sclerosis | 14 | 1740 |
| Tremor in Multiple Sclerosis | 2 | 22 |
| Bladder dysfunction in Multiple Sclerosis | 2 | 765 |
| Disease Progression, inflammation and cognitive impairment in Multiple Sclerosis | 3 | 610 |
| Paraplegia | 3 | 10 |
| Tourette-Syndrome | 2 | 36 |
| Epilepsy | 1 | 15 |
| Glaukoma | 3 | 32 |
| Dystonia | 1 | 15 |
| Intestinal Dysfunction and irritable bowel | 5 | 215 |
| Morbus Crohn | 1 | 21 |
| Diseases of the respiratory tract | 1 | 9 |
| Problematic cannabis use | 2 | 207 |
| Anxiety and PTSD | 4 | 104 |
| Schizophrenia | 2 | 55 |
| Morbus Parkinson | 3 | 47 |
| Dementia | 1 | 50 |
| Cannabinoid interactions | 2 | 58 |
| Total | 140 | ca. 8000 |
Symptoms and diseases for which the BfArm granted exemption permits for the accompanied self-therapy with cannabis (see table 2.)
| General symptom | in the following diseases |
|---|---|
| Nausea and vomiting | Cancer chemotherapy, HIV/AIDS, Hepatitis C, hyperemesis gravidarium, migraine |
| Anorexia and cachexia | HIV/ AIDS, advanced cancer, Hepatitis C |
| Spasticity, Spasms, Muscle stiffness | Multiple Sclerosis, paraplegia, spasticity after stroke, tension headache, spinal syndromes |
| Hyperkinetic dyskinesia | Tourette-syndrome, dystonia (spastic torticollis or blepharospasm, etc.), Levodopa-induced dyskinesia, tardive dyskinesia, essential tremor, Morbus Parkinson |
| Pain | Migraine, cluster headache, phantom pains, neuralgia, menstrual pain, paresthesia in diabetes mellitus or AIDS, hyperalgesia, hypertonic muscle /spasms, arthrosis, arthritis, colitis ulcerosa, restless legs syndrome, fibromyalgia |
| Allergies | Allergic asthma, hay fever |
| Pruritus | Disorders of the liver, neurodermatitis |
| Chronic-inflammatory diseases | Asthma, arthritis, colitis ulcerosa, Morbus Crohn, Neurodermatitis, Morbus Bechterew, Psoriasis |
| Psychological disorders | Psychological disorders Depression, anxiety, bipolar disorders, PTSD, AD(H)S impotence, addiction to alcohol, opiates and benzodiazepines, insomnia, autism, confused behavior in Alzheimer‘s |
| Overproduction of gastric acid | Gastritis, reflux |
| Heightened intraocular pressure | Glaucoma |
| Sensory | Tinnitus |
| As bronchodilator | Asthma, COPD |
| Epilepsia | |
| Singultus | |
| Skin disorders | Neurodermatitis, Psoriasis, Akne inversa, Hyperhidrosis |
| Colon irritable |
[1] Cabral GA, Rogers TJ, Lichtman AH. Turning Over a New Leaf: Cannabinoid and Endocannabinoid Modulation of Immune Function. J Neuroimmune Pharmacol. 2015;10(2):193-203. doi:10.1007/s11481-015-9615-z
[2] Blasco-Benito S, Seijo-Vila M, Caro-Villalobos M, et al. Appraising the “entourage effect”: Antitumor action of a pure cannabinoid versus a botanical drug preparation in preclinical models of breast cancer. Biochem Pharmacol. June 2018. doi:10.1016/j.bcp.2018.06.025
[3] Liang C, McClean MD, Marsit C, et al. A Population-Based Case-Control Study of Marijuana Use and Head and Neck Squamous Cell Carcinoma. Cancer Prev Res. 2009;2(8):759-768. doi:10.1158/1940-6207.CAPR-09-0048
[4] Dumitru CA, Sandalcioglu IE, Karsak M. Cannabinoids in Glioblastoma Therapy: New Applications for Old Drugs. Front Mol Neurosci. 2018;11:159. doi:10.3389/fnmol.2018.00159
[5]Tramèr MR, Carroll D, Campbell FA, Reynolds DJ, Moore RA, McQuay HJ. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ. 2001;323(7303):16-21. http://www.ncbi.nlm.nih.gov/pubmed/11440936. Accessed July 27, 2018.
[6] Badowski ME, Yanful PK. Dronabinol oral solution in the management of anorexia and weight loss in AIDS and cancer. Ther Clin Risk Manag. 2018;14:643-651. doi:10.2147/TCRM.S126849
[7] Sharon H, Goldway N, Goor-Aryeh I, Eisenberg E, Brill S. Personal experience and attitudes of pain medicine specialists in Israel regarding the medical use of cannabis for chronic pain. J Pain Res. 2018;11:1411-1419. doi:10.2147/JPR.S159852
[8] Zajicek JP, Hobart JC, Slade A, Barnes D, Mattison PG, MUSEC Research Group on behalf of the MR. Multiple sclerosis and extract of cannabis: results of the MUSEC trial. J Neurol Neurosurg Psychiatry. 2012;83(11):1125-1132. doi:10.1136/jnnp-2012-302468
Cannabis: Verordnungshilfe für Ärzte von Franjo Grotenhermen; Klaus Häußermann – ISBN 10: 3804737595 – ISBN 13: 9783804737594
