Medical cannabis is used in about 80 percent of cases for the treatment of pain. "About one-third of patients have no effects," explains physician Ondrej Straw of the Masaryk Cancer Institute in Brno, who uses it in his practice.
"It just doesn't work for them. Another approximately one-third also has slightly positive and negative effects. Slightly relieves pain, but patients feel slightly dizzy and numb. Therefore, most of them will stop using cannabis. About one third works fine. "
How one will react is not known in advance. You should try it. Most doctors start giving small doses of cannabis to patients: 62.5 mg per capsule. And then they look for a dose to alleviate the problem, but the patient has a clear head after it and feels good.
"We start with low doses and because we want to test whether it develops an allergic reaction or other side effects," says Radovan Hrib of the Pain Center at St. John's University Hospital. Anna in Brno.
Against nausea and appetite
Cancer patients can also help cannabis by improving their appetite and alleviating nausea. This is a welcome effect mainly in chemotherapy and radiation.
"They also improve sleep and anxiety problems," says Dr. Sláma. "This has a positive effect on better tolerance to pain. Anxious people often perceive it more intensely. Cannabis can sometimes cause anxiety in the patient. It's not often, but it happens. Therefore, it is necessary to be careful in the treatment and gradually increase the small doses. "
It will also help with multiple sclerosis
Cannabis is often used to treat multiple sclerosis (MS), in which a person's own immunity attacks nerve sheaths as if they were foreign tissue, thereby damaging them.
"Her cannabis relieves muscle tension, muscle stiffness and spasms or pain that often accompany the disease," says Marta Vachova of the RS Center at the Teplice Hospital Neurology Unit.
"It also has an anti-inflammatory effect. This is useful because inflammation is accompanied by damage to the covering that covers the nerves. "
It also alleviates involuntary movements and ticks that the patient does not control, or neurological tremor (which is also characteristic of Parkinson's disease) and other muscular or neurological problems. Improves mobility, quality of sleep, anxiety, balance disorders and more.
The first dose should be taken under the supervision of a doctor
"In multiple sclerosis, it is important that the cannabis product used contains the same amount of the two main active substances, THC and CBD," says Dr. Vachova.
"Patients can tolerate it better, especially those who have never used cannabis. CBD, cannabidiol, is mainly against anxiety, convulsions and the onset of psychotic conditions. "
Because patients' first reactions are individual, experts recommend that they take the first dose under the supervision of a doctor or an educated person, such as a family member.
Sometimes the patient may have a headache, feel sick, have a heartbeat, feel weak, develop mild arrhythmias or other problems. Although not very common or dramatic because of the low doses they start with, it can still happen. Especially the elderly.
Home cannabis is a risk
A number of patients come to doctors to smoke marijuana, which they themselves have grown or who has discovered their relatives or grandchildren.
Usually, doctors advise them to switch to medical cannabis, which is sold in pharmacies. It has a clear and controlled content of active substances. It is therefore easier to avoid side effects and more precisely to determine the therapeutic dose that is essential.
"The content of substances in home-grown plants is largely unknown," says Dr. Hrib. "In addition, mandatory analyzes of products sold in pharmacies ensure that they are not contaminated with undesirable substances such as heavy metals."
Adverse reactions cannot then be ruled out. Like eczema if used as an ointment for pain.
When not allowed
- During pregnancy and lactation,
- in psychiatric diagnoses, in particular schizophrenia and schizoid attacks, which are characterized by the patient's internal ambivalence, i.
- heart rhythm disorders and severe liver disease,
- it should not be combined with alcohol.
The advantage is that cannabis can be taken with opiates and other pain medications. Complement their action, if not enough.
"But this is definitely not the first choice medicine for the doctor, but rather the next choice," says Dr. Sláma. But there are exceptions.
Dr. Straw had a patient who hated opioids and other painkillers. She had no choice but to try medical cannabis, which really helped her, even though her tumor was growing. But this was a very unusual case.
Cannabis used under the supervision of a doctor is at low risk of addiction but cannot be ruled out. Especially in chronic pain and multiple sclerosis, when patients have been taking it for many years.
Although the doses are not very high and usually remain relatively stable for a long time, they can be increased gradually over a period of ten years or more. Addiction occurs in about nine percent of cases.
How it is used and what it costs
Patients usually use cannabis in gelatin capsules that they buy from pharmacies. This allows accurate dosing.
Another application is a evaporator in which a precisely measured dose of cannabis is heated so that no unwanted combustion products are obtained, as in smoking. The patient inhales the vapors. They have a faster onset of action (about 5 minutes instead of 30 to 60 minutes, common to the capsules), but they act for a shorter time (4 to 5 hours instead of 6 to 8 hours).
Patients pay for medical cannabis. A gram vaporizer costs around CZK 170, while capsule processing is about CZK 200. The average monthly dose to treat pain is about 3 g, but there are patients who take between 25 and 30 g.
From next year, health insurance companies have to pay 90% of the cost of cannabis to sick people.