FAQ
Frequently asked questions
Questions and answers about medical cannabis
You are not alone with your questions about medical canabis – you may find the answers here.
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The term ‘medical cannabis’ covers manufactured cannabis products containing the full spectrum of active substances from the cannabis plant, including cannabinoids, terpenes, flavonoids and more. The products do not hold a marketing authorisation, as they have not been through the conventional application process with the authorities, including clinical trial data. However, they are produced under strictly controlled pharmaceutical conditions to ensure products of high quality, with reproducible levels of active ingredients.
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Medical cannabis is primarily used by patients with chronic illnesses, for symptom relief in cases where effective treatments are lacking, or where conventional drugs don´t have an acceptable efficacy or are poorly tolerated. The doctor can prescribe medical cannabis for any indication in cases of severe illness if considered beneficial. Medical cannabis can be used alone or together with order medications, and it may be used to reduce the dosage and/or side-effects of other medications1,2.
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All cannabis products with a THC content of more than 0.2% require a prescription from a doctor and can only be bought from pharmacies. CBD products with a THC level of less than 0.2% can be bought without a prescription outside of pharmacies, but they are then not subject to the special quality and control requirements for pharmaceutical products with regard to active ingredient content and quality, so that the effectiveness and safety of these products is not guaranteed to the same extent as with products from the pharmacy. Therefore, CBD products used for medical purposes should be prescribed by a doctor and bought from a pharmacy3.
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The adverse reactions observed for medical cannabis are usually mild or moderate and pass within a few hours. In most cases they can be controlled by reducing the dosage and will decline with repeat usage.
The most well-known side effects of cannabis are those related to the THC content, such as euphoria; these effects might be less pronounced if THC is combined with CBD. Other common side effects of cannabis include dry mouth, nausea, fatigue, dizziness, anxiety and disorientation. More severe psychoactive effects such as hallucinations, depression and paranoia are less common at clinically relevant dosages1,2. This information is not exhaustive and does not claim to be correct. Your doctor will provide you with comprehensive and individual information about risks and side effects in a personal consultation.
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Medical cannabis can be prescribed as dried cannabis flowers to drink as a tea or to inhale using a vaporiser. It can also be prescribed as extracts such as oils, which are typically swallowed or placed under the tongue using a dropper. The extracts can also be filled into capsules for oral administration or made into topical products for application onto the skin.
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Because medical cannabis is often used for symptom relief, patients are often treated with other medications at the same time. So it makes sense to consider interactions with other drugs.
When using cannabis in combination with other tranquillising substances such as alcohol, benzodiazepines and opiates, there might be an additive tranquillising effect.
As cannabis is metabolised in the liver, all diseases, or drugs that are administered at the same time, that affect the activity or levels of liver enzymes might influence cannabinoid concentrations in the blood. This is not unique to cannabis but is a general consideration for all drugs containing active ingredients that are metabolised in the liver.
Cannabinoids themselves might also affect the activity of liver enzymes and can potentially influence the concentration of other drugs metabolised in the liver. An important clinical example of this is the increase in the active metabolite of the anti-epileptic drug clobazam when co-administered with CBD.
In relevant cases, the above considerations and theoretical possibilities can be circumvented by adjusting dosages, but there are no identified drugs that cannot be used together with cannabis if necessary, and clinically significant drug interactions are rare1,2. Please note that the information given here is not exhaustive and does not claim to be correct. Please discuss possible drug-drug interactions with your doctor, who will give you final advice and coordinate the therapy with you.
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Usage of cannabis should be avoided during pregnancy. Cannabinoids will reach the foetus through the umbilical cord and may slow foetal growth. Cannabis should also be avoided during breastfeeding, as it is detected in breast milk. Cannabis should be used with caution in patients with severe liver, renal or cardiac diseases. Prescription of medical cannabis containing THC is usually not advised for children and adolescents, and for patients with a history of substance abuse (drugs, alcohol, medication) or psychiatric disorders (such as schizophrenia)1,2. In these cases, the doctor will evaluate on a case-by-case basis whether the benefits outweigh the risks.
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Medical cannabis products are sometimes simply raw cannabis plant material that has been produced in a strict GACP- (Good Agricultural and Collection Practices) and GMP- (Good Manufacturing Practices) compliant environment from cloned plants that allow for predictable cannabinoid content. Other products are produced as liquids (oils or tinctures) and are made by extracting compounds from plant material using solvents such as ethanol, liquid CO2, etc.
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Patients receive a 50% reimbursement for cannabis products covered by the pilot programme. A maximum of DKK 10,000 in reimbursement for the trial programme's cannabis products can be paid out in a year. The subsidy is automatically deducted from the purchase at the pharmacy. Patients who have a terminal authorisation receive 100% reimbursement for the products in the pilot programme3.
Individual reimbursement can be applied for for magistrally produced THC products when used for neuropathic pain.
Sygesikringen "danmark" provides reimbursement as for other prescription medicines. If you are a member of group 1 or group 2, you will receive 50% reimbursement, and 25% reimbursement if you are a member of group 5.
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Cannabis legislation is decided on a national level and can vary from country to country. It is therefore important when travelling to check the local laws and regulations on medicinal cannabis in transit and destination countries. Medical cannabis can be brought out of the UK if it is accompanied by a certified certificate and if it is authorised in the countries visited. For more information, see useful links.
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From a medical perspective, it is not recommended to smoke cannabis, as the products of combustion are carcinogenic and can be harmful to the lungs. Instead, the flowers should be administered via inhalation through a vaporiser1 or orally as tea.
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It is strictly illegal in Denmark to privately grow all varieties of cannabis, regardless of whether for medical or recreational use.
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Danish Road Traffic Act § 54: A motorised vehicle may not be driven or attempted to be driven by anyone whose blood during or after driving contains mind-altering substances which, according to rules laid down by the Minister of Transport, Building and Housing, are classified as dangerous to road safety and which have not been taken in accordance with a legal prescription, cf. however nos. 2 and 4, tetrahydrocannabinol (THC) to such an extent that the blood content exceeds 0.001 mg THC per kilogram of blood and which has not been taken under a legal prescription, substances covered by point 1 which the person concerned has consumed under a legal prescription if the consumption has not been made in accordance with that prescription, or tetrahydrocannabinol (THC) which the person concerned has consumed under a legal prescription if the consumption has not been made in accordance with that prescription.
It is therefore possible for chronic patients to drive with stable medical cannabis treatment and individual assessment by the doctor.
The euphoric/psychotropic effects of cannabis can impair your driving ability, especially at the beginning of treatment. This should be considered by your doctor and assessed based on your tolerance. As a cannabis patient, it is recommended that you always have a medical certificate or other documentation in your possession while driving.
Please also refer to the Danish Patient Safety Authority's 'Guidelines on health requirements for driving licences', especially the section 'Cannabis-containing medicines and heroin', which states, among other things, that when starting regular treatment with THC-containing and similar medicines and when significantly increasing the dose of an ongoing treatment, the doctor should usually issue a driving ban.
The driving ban should last two to four weeks, but the length should always be based on a specific assessment. The doctor should then, based on the medical history and specific observations, carefully assess whether there are any side effects of importance to road safety. If the doctor assesses that the patient will be impaired while driving, or if there is any doubt about this, a driving ban should be issued for the duration of the treatment.
References
MacCallum, C. A. & Russo, E. B. Practical considerations in medical cannabis administration and dosing. European Journal of Internal Medicine vol. 49 12–19 (2018).
Health Canada. INFORMATION FOR HEALTH CARE PROFESSIONALS. Cannabis (marihuana, marijuana) and the cannabinoids. (2018).
Sundhedsministeriet. Vejledning om lægers behandling af patienter med medicinsk cannabis omfattet af forsøgsordningen. Retsinformation (2018).
Hazekamp, A. The Trouble with CBD Oil. Medical Cannabis and Cannabinoids 1, 65–72 (2018).