Relevant indications
Medical cannabis
How to participate in the pilot programme?
Medical cannabis is an option for patients with chronic conditions who experience a lack of efficacy or poor tolerance to conventional medicine1). Your condition is considered chronic if symptoms last over three months.
Medical cannabis is often used as an adjunct to your current medication. Some patients may be able to reduce the dosage of, or eventually discontinue, some of their other treatments2).
Below, you will find a list of approved conditions where medical cannabis is currently used by patients in Denmark seeking relief and improved quality of life. Approved indications by the Danish Health Authority are1):
Chronic pain conditions
Pain is considered chronic after 3-6 months when conventional treatment has failed. Before medical cannabis is prescribed, assessment and delineation of target group and evidence is required by the Danish Medicines Agency[1,2,3,4,5].
Nerve pain (neuropathic pain):
Caused by disease or damage to the nervous system.
Medicinal cannabis may have a weak analgesic effect on central nervous system and peripheral nerve pain.Generalised musculoskeletal pain:
The experience of diffuse pain with no known cause.
No relevant clinical studies support medical cannabis for treatment.Inflammatory pain and degenerative joint diseases:
Modern treatments are effective.
Only limited support for cannabinoids as pain relief.Pain in osteoarthritis and osteoporosis:
No specific support for medical cannabis in clinical studies.Cancer pain:
May be relevant to treat with medical cannabis.
Limited efficacy of Sativex® and dronabinol; no conclusive evidence of synergistic effect with opioids.
Multiple sclerosis (MS)
Sativex® is approved to relieve symptoms in adults with moderate to severe spasticity due to multiple sclerosis (MS). This is especially true for those who have not benefited sufficiently from other medications for muscle stiffness and experience a marked improvement during an initial trial treatment. There are some guidelines and background information on this.
The effect of the treatment especially helps with subjective symptoms of muscle stiffness, but it is not huge. Since some patients experience improvement even when given an inactive treatment (placebo) and the effect is inconsistent across studies, experts believe there is only moderate evidence that the treatment is beneficial. Although there may be side effects, the treatment is generally considered relatively safe [6].
For those suffering from central nerve pain and painful muscle stiffness due to MS, medical cannabis may be a relevant treatment option. However, there is less clarity on how effective it is for urinary problems related to MS, as there is no proven effect on incontinence. Still, some patients have reported improved urinary urgency.
Spinal cord injury (paraplegia)
Spinal cord injuries are often accompanied by central nerve pain, painful muscle stiffness and problems with bladder function. Medical cannabis is considered to be a relevant treatment for spinal cord injuries. However, there are only a few studies that have specifically investigated pain relief in spinal cord injuries[5]. Still, cannabis seems to help with several symptoms in patients with paraplegia, particularly nerve pain and painful muscle stiffness. However, a more extensive study with 116 participants found no effect of Sativex compared to placebo[6]. A recent Danish study of 537 patients with traumatic spinal cord injury found that over a third of patients had tried cannabis, and almost 60% experienced subjective improvement. However, most patients had started using cannabis before the spinal cord injury, and the main reason for use was primarily recreational[7].
Nausea and vomiting after chemotherapy
Cesamet® and Marinol®/Syndros® are approved for treatment in the US. It is worth noting that the clinical studies that led to their approval were mainly conducted before 1990, before serotonin receptor antagonists, neurokinin receptor antagonists, and more frequent use of glucocorticoids in preventive treatment became common. Medical cannabis has barely been compared to modern means of nausea relief.
It is considered that medicinal cannabis may be a relevant treatment for nausea and vomiting after chemotherapy. A Cochrane review concludes that medical cannabis can be used in patients with severe nausea and vomiting after chemotherapy. Still, it should be noted that the data is old, and using newer agents to relieve nausea may change this recommendation[8].
Criteria for prescribing medical cannabis
The responsibility for medical treatment with cannabis always lies with the treating doctor. Therefore, it is the doctor who determines whether a patient should be treated with medical cannabis.
According to the cannabis guidelines from the Danish Medicines Agency, the following should be considered:
Relevant approved marketed medications should be tried before attempting treatment with medical cannabis.
Cannabis should not be used for children and young people under 18 years of age due to a lack of knowledge about long-term effects, including cognitive development.
A doctor can prescribe a maximum of one month's supply on a prescription.
Doctors, as a rule, do not treat with medical cannabis outside their area of expertise.
Consult your doctor or private medical clinic
It's important to note that the medicinal cannabis trial programme is only available for patients who have not had satisfactory results with conventional treatment. Your doctor will assess your situation and determine if you can participate in the programme.
If you are interested in being part of the medicinal cannabis pilot programme, you should contact your doctor to discuss your symptoms and treatment options. Your doctor will be able to guide you on whether medical cannabis may be a suitable treatment for you.
Remember that medical cannabis should only be used under medical supervision and by the recommended doses and instructions. It is important to be aware of any side effects and to follow up with your doctor regularly to evaluate the effectiveness of the treatment.
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Note: this page is for informational purposes only and does not replace professional medical advice. If you are considering medical cannabis as a treatment option, you should always consult a doctor or specialist.
References:
Lynch ME, Campbell F. Cannabinoids for treatment of chronic non-cancer pain; a systematic review of randomised trials. Br J Clin Pharmacol. 2011; 72:735-44.
Andreae MH, Carter GM, Shaparin N et al. Inhaled Cannabis for Chronic Neuropathic Pain: A Meta-analysis of Individual Patient Data. J Pain. 2015; 16:1221-32.
Lynch ME, Ware MA. Cannabinoids for the Treatment of Chronic Non-Cancer Pain: An Updated Systematic Review of Randomized Controlled Trials. J Neuroimmune Pharmacol. 2015; 10:293-301
Canadian Agency for Drugs and Technologies in Health; 2016 Sep 21. Cannabinoid Buccal Spray for Chronic Non-Cancer or Neuropathic Pain: A Review of Clinical Effectiveness, Safety, and Guidelines.
Wallitt B, Klose P, Fitzcharles M-A et al. Cannabinoids for fibromyalgia. Cochrane Database of Systematic Reviews (2016).
Richards BL, Whittle SL, Buchbinder R. Neuromodulators for pain management in rheumatoid arthritis. Cochrane Database of Systematic Reviews 2012.
Fitzcharles M-A, Baerwald C, Ablin J and Häuser W. Efficacy, tolerability and safety of cannabinoids in chronic pain associated with rheumatic diseases (fibromyalgia syndrome, back pain, osteoarthritis, rheumatoid arthritis): A systematic review of randomized controlled trials. Schmerz 2016; 30: 47-61.
Beaulieu P. Effects of nabilone, a synthetic cannabinoid, on postoperative pain Can J Anaesth. 2006 Aug; 53(8):769-75