For two years, and Cannabis is approved as a prescription drug in Germany. Palliative physician, Henning Cuhls says in a DW Interview, the use in the practice had been manageable.
Deutsche Welle: Mr Cuhls, on 10. March will mark the second Time the approval of medical Cannabis in Germany. As a palliative care physician at the University hospital of Bonn for use of this drug as well. How often this happens in practice?
Henning Cuhls: There was a very large Hype right after the approval. This has now subsided significantly. In palliative medicine we had used prior to the approval of Cannabis, however, only in the case of Nausea, vomiting, or weakness. At the time, it was less about pain.
Who suffers because, in palliative care, particularly Nausea and vomiting?
Many patients who get chemotherapy, or those who have tumors in the bowel area, suffer. Then Cannabis will no longer work, sometimes very well, when other drugs use, as well.
How to help the Cannabis?
Usually, patients suffering from Nausea, have no appetite for more. You must first eliminate the Nausea, the appetite returns and the patient to take sufficient calories. We have very many severely ill patients, who often have no appetite and are therefore very fast to lose weight.
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Dr. Cuhls no longer recommends that his patients use Cannabis as a other active ingredients to help.
Why helps, of all things Cannabis?
How Cannabis works exactly, is not yet properly known. But we know for a long time that Cannabis often leads to weight gain.
Cannabis is also as agents for the treatment of gastro-intestinal disease Crohn’s disease known. Do you have any experience of this?
No, but I do know that Cannabis is not requested for the treatment of Crohn’s disease very often. In a further development of the Ärtzekammer, in which I recently participated was summarized, for which indications Cannabis was ever requested. It was interesting that it was applied to 57 percent for the treatment of pain. For example, at ten percent, it has been requested for the treatment of spasticity and five percent for loss of appetite. Bowel disorders play only about three percent of all applications for a role. The is very little.
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Cannabis as a drug
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Cannabis as a drug
We come to the subject of pain: Someone who once had contact with Cannabis, would say that Cannabis feelings of power reinforced or changed – so the perception more intense. It does not kill pain. Why is Cannabis as a painkiller?
That’s right. In the case of pain, Cannabis also does not work very well. It is not a good indication. It is estimated that only one out of 15 patients really benefited from it. But some anti-inflammatory painkillers are no longer effective and sometimes very good. Then can be achieved with the Cannabis, an additional analgesic effect.
But we must say quite clearly that, In the case of Nausea the Chance that Cannabis really helps, and the Patient benefits from perhaps one to ten, the pain is even worse.
How often, Cannabis is prescribed at all in practice?
It is rather the exception. Usually it happens only when patients come with the desire in the advice. I would suggest Cannabis as a palliative physician, of me, if I notice that the other drugs will help anything.
But I also have a very special group of patients, it is very bad. Since it remains mostly in the trial – whether it helps or not. You can try it, as long as the side effects are low. If it helps, it is good, and if it helps nothing, forgive nothing, and the patient certainly does not hurt.
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Cannabis – pro and contra
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Cannabis – pro and contra
How to take the patient to the effects of Cannabis? You need to smoke it?
Smoking is the worst variant, because the Patient has then in a very short time a very high drug levels, it drops relatively quickly. The goal is to have the appropriate effect.
There is a special fleet of vaporizers, which heat cannabis flowers and the drugs – without the tobacco. This is not as harmful as Smoking. There is the Cannabis active ingredient as a Spray or drops. You can drizzle on a piece of bread or sugar, and so. As a third variant, there are tablets.
In the case of cannabis flowers was shortly after the release of the market swept completely empty. They were in pharmacies.
Cannabis oil, which does not contain the intoxicating part of the medical Cannabis, Tetra – hydro – cannabiol (THC) – is found in Germany in drugstores and supermarkets. It also helps against Nausea or stomach problems?
The Cannabis oil, you can buy free, contains Cannabidiol (CBD). It is not as a drug but as a dietary Supplement. It causes, in contrast to THC, no Delirium, hallucinations or Confusion.
The CBD is not explored nearly as well. There are not enough studies and I can’t prescribe as a doctor. Patients can buy it but yourself.
Some patients have reported personally that they absolutely need the THC-containing drug, in order to notice an improvement. Some have reported to me that they would have tolerated CBD better than THC drops. But this is only a subjective Feeling, described to me three to four patients, and not a scientific statement.
Dr. Henning Cuhls is a senior physician in the palliative medicine at the University hospital Bonn (UKB).
The Interview was conducted by Fabian Schmidt.
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