Das Thema der medizinischen Verwendung von Marihuana hat in Deutschland in den letzten Jahren an Bedeutung gewonnen. Im Rahmen dieser Debatte hat sich Dr. Franjo Grotenhermen als führender Experte auf diesem Gebiet etabliert. In einem kürzlich geführten Interview sprach er über die Ausstellung von Rezepten für medizinisches Marihuana durch deutsche Ärzte und die Herausforderungen, die damit verbunden sind.

Interview mit Franjo Grotenhermen - Marihuana auf BtM Rezept

Translation:

Today we are at the summer festival of Hamm TV and we have the chance to conduct a small interview with Dr. Franjo Grotenhermen. We are a bit rushed and I have many questions to ask, so I’ll try to ask some that are not usually asked. Dr. Grotenhermen, normally everyone has their personal reasons for becoming involved in the cannabis scene. Can you briefly tell us what motivated you?

Well, when I was healthy, I was a doctor in a hospital and the title didn’t matter much. We all know why we use “Dr.” In the cannabis field I decided to become active when I was sick for 34 years. I thought it would be good to have a doctoral title before I started so that I would be taken seriously as an expert. It was more of a strategic consideration.

The first patient in Germany to be able to obtain marijuana flowers from a pharmacy was Faymann in 2009. Do you still need this exceptional permission? And how fast is the process of obtaining it? What are the requirements to obtain an exceptional permission in a matter of weeks or months as a truly terminally ill patient?

There was already an exceptional permit in 2007 for extracts, and then later on for flowers, as you mentioned. The main thing is that you need support from a doctor. The doctor must justify why cannabis therapy is necessary, and determine whether other therapies are not effective or are ineffective. For example, if a pain patient is not adequately supported by typical treatments such as Elisabethfehn, Tramadol and Telegen, or if they are not tolerated by the patient, strong opiates are not tolerated. If standard therapy is not effective, the doctor can justify that cannabis therapy is necessary. Often, the doctor has already selected the preparation, for example Bedrocan or Sativex, and seen that it works, or the patient has had some experience. For the patient, the main problem is finding a doctor who can do this. It’s not that complicated, but doctors often think it is. We have published a brochure that can be downloaded from our website. The process of obtaining cannabis as medicine is described in detail. The website is “International Working Group for Cannabis as Medicine”. Just click on “medical” and there are brochures you can look at.

Next year, the situation with the cannabis law will change, with doctors being allowed to prescribe marijuana flowers and extracts by BTM prescription, and health insurances paying for it for many illnesses. How can patients find a doctor who will help them get cannabis flowers from a pharmacy, and what steps should they take to ensure that the insurance pays for it?

It is certainly true that the application process is frightening for many doctors. For a normal medical practice where a patient is seen for five minutes and many patients go through, it is simply too much work to sit down and provide 12 pages of justification for why a patient needs it. If it’s easy to write a prescription, the doctor will just write one. The patient can try it out and then during further treatment, the insurance can be discussed so that costs can be reimbursed. The doctor finds this type of exemption process not so unusual - they have to do this often. That means that the exemption with the MDK is nothing special. In the next year, we will undoubtedly see more doctors willing to cooperate. In the last two or three years, I have noticed that there is an increasing interest among doctors. More and more doctors are contacting me because they need help supporting patients in prescribing medication. We even see doctors referring patients to me but not feeling comfortable prescribing it themselves. It will certainly be helpful to have more training in place. We plan to offer training in the spring, and there will be publications. In the future, more and more doctors will be willing to be involved.

Assuming that the insurers pay for the flowers from the pharmacy and more than 10,000 patients are requesting them, where will the marijuana come from?

The experience in other countries suggests that things will start slowly at first. In Israel, for example, 10 years ago there were only about 700 patients, and then it rose to 4,000, 5,000, and 10,000, and they are now up to 25,000. There is great potential for numbers to increase. We already have not only import from Holland, but also from Canada. We have three importers now, so there is even some competition. This has already led to lower prices. I think that the problem of supply gaps in the past will be resolved in the near future. We currently have enough supply from at least one importer. The Canadians can produce enough for the German market. If in three years, I anticipate that it will take three years until German cannabis will be available at pharmacies. We can work within this timeframe, and patients won’t have to wait too long.

There are already speculations that the health insurance providers will have the freedom to not refund the cost. How sick does a patient need to be in order for them to pay for the marijuana, and what diagnoses are necessary requirements?

In Germany, we have the fortunate situation where there are no set indications. In many states in the U.S., there are lists of conditions that qualify for medical marijuana: cancer, pain or HIV/AIDS, irritable bowel syndrome, and so on. However, in Germany, the principle is if other therapies have been tried and have failed, then the patient should be granted access to cannabis. The term “tried and failed” is vague though since this principle is still being discussed. This is an important topic for the hearing in the health committee on September 21, as the conditions for patients to fulfill are still not quite clear. For example, how many therapies must they have undergone? For life-threatening conditions like epilepsy, if cannabis is found to be effective, how much risk should the patient take to try other treatments and may experience severe symptoms during that process? How many antidepressants should a patient try? These questions are still not clear. There are differing opinions, but the majority thinks the MDK cannot make this decision. The doctor should sit down with the patient to discuss if this is necessary or not.
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