Skip to main navigation menu Skip to main content Skip to site footer
##common.pageHeaderLogo.altText##

Original article

Vol. 147 No. 2728 (2017)

Medical use of cannabis in Switzerland: analysis of approved exceptional licences

DOI
https://doi.org/10.4414/smw.2017.14463
Cite this as:
Swiss Med Wkly. 2017;147:w14463
Published
10.07.2017

Summary

AIMS OF THE STUDY: In recent years, the Swiss Federal Office of Public Health (FOPH) granted exceptional licenses for the medical use of cannabinoids, typically for 6 months with possible extensions. A systematic review of cannabinoids for medical use commissioned by the FOPH supports the use of cannabinoids for the treatment of chronic pain and spasticity. However, little is known about the patients treated with cannabinoids. We aimed to study medical uses of cannabinoids as part of the FOPH’s programme of exceptional licenses.

METHODS

We examined all requests for medical use of cannabinoids sent to FOPH in 2013 and 2014. A standardised data sheet was developed to extract data from the files of approved requests. We extracted the duration of the licence, the year it was granted, and the payer of the therapy. At the level of the patient we collected the date of birth, sex, region of residence, diagnosis and the indication. Ethical approval was granted by the Ethics Committee of the Canton of Bern.

RESULTS

We analysed 1193 patients licenced for cannabinoid treatment in 2013 or 2014. During 2013, 542 patients were treated under the exceptional licencing programme (332 requesting physicians) compared with 825 in 2014 (446 physicians). Over half of patients (685; 57%) were women. The mean age was 57 years (standard deviation 15.0), chronic pain (49%) and spasticity (40%) were the most common symptoms, and co-medication was reported for 39% of patients. Seventy-eight different diagnoses were recorded, including multiple sclerosis (257 patients, 22%), soft tissue disorders (119, 10%), dorsalgia (97, 8.1%), spinal muscular atrophy (65, 5.5%) and paraplegia/tetraplegia (62, 5.2%). Licence extensions were granted to 143 patients (26.4%) in 2013 and 324 patients (39.3%) in 2014. There were substantial regional variations of the rates of patients treated with cannabinoids. On average, eight patients per 100 000 residents received an exceptional licence. Most patients (1083, 91%) paid out of pocket.

CONCLUSIONS

Exceptional licences for medical use of cannabinoids have increased substantially in Switzerland, with the programme including patients with a wide range of conditions.

References

  1. Fankhauser M. Haschisch als Medikament:[zur Bedeutung von Cannabis sativa in der westlichen Medizin]. SGGP; 2002.
  2. Le Foll B, Tyndale RF. Cannabinoids: Friend or foe? Clin Pharmacol Ther. 2015;97(6):528–31. https://doi.org/10.1002/cpt.119
  3. Mechoulam R, Gaoni Y. A Total Synthesis of DL-Delta-1-Tetrahydrocannabinol, The Active Constituent of Hashish. J Am Chem Soc. 1965;87(14):3273–5. https://doi.org/10.1021/ja01092a065
  4. Grotenhermen F. Cannabis und Cannabinoide. Pharmakologie, Toxikologie und Ther Potential 2nd Ed Göttingen Hans Huber. 2004
  5. Pertwee RG. Cannabinoid receptor ligands: clinical and neuropharmacological considerations, relevant to future drug discovery and development. Expert Opin Investig Drugs. 2000;9(7):1553–71. https://doi.org/10.1517/13543784.9.7.1553
  6. Pertwee RG. Cannabis and cannabinoids: pharmacology and rationale for clinical use. Forsch Komplementarmed. 1999;6(Suppl 3):12–5. https://doi.org/10.1159/000057150
  7. Lenk R, Likar R. Cannabinoids in medicine. Wien Med Wochenschr. 2008;158(23-24):668–73. https://doi.org/10.1007/s10354-008-0619-7
  8. Borgelt LM, Franson KL, Nussbaum AM, Wang GS. The pharmacologic and clinical effects of medical cannabis. Pharmacotherapy. 2013;33(2):195–209. https://doi.org/10.1002/phar.1187
  9. Pacher P, Bátkai S, Kunos G. The endocannabinoid system as an emerging target of pharmacotherapy. Pharmacol Rev. 2006;58(3):389–462. https://doi.org/10.1124/pr.58.3.2
  10. Vemuri VK, Makriyannis A. Medicinal chemistry of cannabinoids. Clin Pharmacol Ther. 2015;97(6):553–8. https://doi.org/10.1002/cpt.115
  11. Göbel H. Dronabinol-Therapie: Cannabis in der Medizin, chronische Schmerzen, Schmerztherapie nach Querschnittslähmung, diabetische Polyneuropathie, neuropsychiatrische Erkrankungen, Langzeittherapie bei Multipler Sklerose, Anorexie-Kachexie-Syndrom, rechtliche Aspekte. Springer; 2004.
  12. Noyes R, Jr, Brunk SF, Avery DA, Canter AC. The analgesic properties of delta-9-tetrahydrocannabinol and codeine. Clin Pharmacol Ther. 1975;18(1):84–9. https://doi.org/10.1002/cpt197518184
  13. Holdcroft A, Maze M, Doré C, Tebbs S, Thompson S. A multicenter dose-escalation study of the analgesic and adverse effects of an oral cannabis extract (Cannador) for postoperative pain management. Anesthesiology. 2006;104(5):1040–6. https://doi.org/10.1097/00000542-200605000-00021
  14. Elikkottil J, Gupta P, Gupta K. The analgesic potential of cannabinoids. J Opioid Manag. 2009;5(6):341–57.
  15. Johnson JR, Burnell-Nugent M, Lossignol D, Ganae-Motan ED, Potts R, Fallon MT. Multicenter, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC:CBD extract and THC extract in patients with intractable cancer-related pain. J Pain Symptom Manage. 2010;39(2):167–79. https://doi.org/10.1016/j.jpainsymman.2009.06.008
  16. Portenoy RK, Ganae-Motan ED, Allende S, Yanagihara R, Shaiova L, Weinstein S, et al. Nabiximols for opioid-treated cancer patients with poorly-controlled chronic pain: a randomized, placebo-controlled, graded-dose trial. J Pain. 2012;13(5):438–49. https://doi.org/10.1016/j.jpain.2012.01.003
  17. Ware MA, Wang T, Shapiro S, Robinson A, Ducruet T, Huynh T, et al. Smoked cannabis for chronic neuropathic pain: a randomized controlled trial. CMAJ. 2010;182(14):E694–701. https://doi.org/10.1503/cmaj.091414
  18. Nurmikko TJ, Serpell MG, Hoggart B, Toomey PJ, Morlion BJ, Haines D. Sativex successfully treats neuropathic pain characterised by allodynia: a randomised, double-blind, placebo-controlled clinical trial. Pain. 2007;133(1-3):210–20. https://doi.org/10.1016/j.pain.2007.08.028
  19. United Nations Office on Drug and Crime (UNODC). Schedules of the Convention on Psychotropic Substances of 1971. In: The International Drug Control Conventions. New York: United Nations; 2013 pp 67–106.
  20. Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernandez AV, et al. Cannabinoids for Medical Use: A Systematic Review and Meta-analysis. JAMA. 2015;313(24):2456–73. https://doi.org/10.1001/jama.2015.6358
  21. Fankhauser M. Station Dispensary in Langnau Emmental - Curaplant. 2016.
  22. EpiData Association. EpiData Software. EpiData Software. 2001.
  23. Federal Statistical Office (FSO). Classification of 7 territorial units of Switzerland (7 major regions)- Basic Statistics. Swiss Statistics. 2013.
  24. World Health Organization. WHO | International Classification of Diseases (ICD). Geneva: WHO; 2016.
  25. Schweizerisches Institut für ärztliche Weiter- und Fortbildung [Swiss Institute of Advanced Medical Education]. Facharzttitel und Schwerpunkte (Weiterbildung) [Specialization title and main emphasis in advanced medical education]. 2016. Available from: http://www.fmh.ch/bildung-siwf/fachgebiete/facharzttitel-und-schwerpunkte.html
  26. European Commission [internet]. Eurostat / Regional Statistics Illustrated. Eurostat Your key to European statistics. 2013. Available from: http://ec.europa.eu/eurostat/cache/RCI/#?vis=nuts2.labourmarket&lang=en
  27. Madras B. Update of cannabis and its medical use. Geneva: World Health Organization; 2015.
  28. Hazekamp A, Ware MA, Muller-Vahl KR, Abrams D, Grotenhermen F. The medicinal use of cannabis and cannabinoids--an international cross-sectional survey on administration forms. J Psychoactive Drugs. 2013;45(3):199–210. https://doi.org/10.1080/02791072.2013.805976
  29. Ryan-Ibarra S, Induni M, Ewing D. Prevalence of medical marijuana use in California, 2012. Drug Alcohol Rev. 2015;34(2):141–6. https://doi.org/10.1111/dar.12207
  30. Swift W, Gates P, Dillon P. Survey of Australians using cannabis for medical purposes. Harm Reduct J. 2005;2(1):18. https://doi.org/10.1186/1477-7517-2-18
  31. Walsh Z, Callaway R, Belle-Isle L, Capler R, Kay R, Lucas P, et al. Cannabis for therapeutic purposes: patient characteristics, access, and reasons for use. Int J Drug Policy. 2013;24(6):511–6. https://doi.org/10.1016/j.drugpo.2013.08.010
  32. Ware MA, Adams H, Guy GW. The medicinal use of cannabis in the UK: results of a nationwide survey. Int J Clin Pract. 2005;59(3):291–5. https://doi.org/10.1111/j.1742-1241.2004.00271.x
  33. Boehnke KF, Litinas E, Clauw DJ. Medical Cannabis Use Is Associated With Decreased Opiate Medication Use in a Retrospective Cross-Sectional Survey of Patients With Chronic Pain. J Pain. 2016;17(6):739–44. https://doi.org/10.1016/j.jpain.2016.03.002
  34. Bradford AC, Bradford WD. Medical Marijuana Laws Reduce Prescription Medication Use In Medicare Part D. Health Aff (Millwood). 2016;35(7):1230–6. https://doi.org/10.1377/hlthaff.2015.1661
  35. St-Amant H, Ware MA, Julien N, Lacasse A. Prevalence and determinants of cannabinoid prescription for the management of chronic noncancer pain: a postal survey of physicians in the Abitibi-Témiscamingue region of Quebec. CMAJ Open. 2015;3(2):E251–7. https://doi.org/10.9778/cmajo.20140095
  36. Belyea DA, Alhabshan R, Del Rio-Gonzalez AM, Chadha N, Lamba T, Golshani C, et al. Marijuana Use Among Patients With Glaucoma in a City With Legalized Medical Marijuana Use. JAMA Ophthalmol. 2016;134(3):259–64. https://doi.org/10.1001/jamaophthalmol.2015.5209
  37. Swiss Drug Compendium. Product information for Sativex. Available from: http://compendium.ch/mpro/mnr/24719/html/de. 2016.
  38. The Lancet Oncology. Cannabis: high time for evidence-based policies. Lancet Oncol. 2017;18(1):1. https://doi.org/10.1016/S1470-2045(16)30642-8

Most read articles by the same author(s)

1 2 > >>