“Patients should have access to cannabis when they need it”, says Franjo Grotenhermen M.D., who is a medical doctor and IACM board member: “My main focus is to translate science to normal people and to make it understandable. Also to patients, politicians, decision-makers, to anybody. I publish on cannabis and cannabinoids as THC and CBD in newspapers and newsletters since year 2000. My articles are published into six languages. This is my mayor task.”
YesWeSkunk had the opportunity to ask him about many concerns of all those interested in medical cannabis. And of course, it was mandatory for us to start the interview with a question on the recent changes announced by the German government of the current law.
YWS – In what ways German patients are extremely keen to have access to medical cannabis?
F.G – Well, so far we can only see a change in the law for 2017. The government already decided to change the legislative framework to make cannabis available on prescription for patients of any disease. The second issue is that if there is no other medication available, the national health insurance will have to reimburse the medical users the expenses for their cannabis. In other cases, if there’s an alternative, patients will have to pay for it on their own. This solution is similar to the situation in Canada, for example. Currently we do not have a huge number of medical cannabis users, about 700 approximately. This will have a huge impact on cannabis in medicine in Germany.
YWS – What are the main illnesses that patients suffer, and who could be benefit from this regularization?
F.G. Thousands of people will benefit from cannabis, patients suffering from different diseases. Mainly patients suffering from pain. These are five domains of disorders: one is pain patients. As are those suffering from migraines, traumatic pain and back pain, or similar. A second large group is chronic inflammatory diseases, as it is Chron’s disease or rheumatism. The third large domain is neurological diseases, as multiple sclerosis or the Tourette syndrome. The forth major domain is appetite loss, nausea, vomiting in patients suffering from cancer, HIV or for example hepatitis C. The fifth large group is psychiatric conditions, such as posttraumatic stress disorder, attention deficit syndrome, and depression. These are the five major domains, but we can also see other diseases to be treated with cannabis.
YWS- There is an increasing interest of the public on CBD? Have you notice a change in perception?
F.G.: We see that there’s been a change in the last 10 years. The public is becoming more and more interested in cannabis and cannabinoids. We have made surveys in the past decade, and the number of patients interested in CBD has also grown, as the public opinion has changed significantly. By now there are around the 70 to 80 per cent of the general public in Germany in favour of cannabis use. These figures are very similar in other countries, like USA and more than 90 per cent in Europe, but also in South America we see that the support is increasing.
YWS- Talking about special licenses for home growers among chronic patients in Germany. Would that be a great step in allowing self-cultivation?
F.G.: Actually the reason why the German government is changing the law is to avoid self-cultivation. There was pressure on the government to give the patients access, prescriptions for those who really need it. And if they can’t afford it, to pay for their cannabis in pharmacies, because it is really expensive, the government would have to allow patients to cultivate their own. So that everybody gets access, when they need it, they really need it. This is the reason for the law change. The health insurances have to pay for the costs, if there’s no other treatment is available. They say that they want to avoid self-cultivation, because they can’t control if it is done in this way. But self-cultivation may still be an option, and it should still be possible, as we see in countries like Canada. Even if the government does not want it. We might see if and how self-cultivation will develop after the change in law. We will also see, if the measures are sufficient to fulfil the demands of the patients, those who they really need it. Then we will have to decide on self-cultivation. A decision which will very much depend on how the new law is implemented.
YWS- What is the importance of seed banks for medical use of cannabis? As they are now developing strains with a higher amount of CBD and less or little amount of THC. Do you think that their work is important for the future of medical use?
F.G.: Yes, of course. We know that often the use of cannabis is limited to psychotropic or THC effects. For many people these effects are not a problem, they simply tolerate it. But often we see patients that do not tolerate them. And in addition there are some diseases, for example, inflammatory diseases, where CBD might be helpful, or anxiety disorders, or schizophrenia, or epilepsy, maybe also in children. We have some diseases where CBD is effective and has absolutely or nearly no side effects compared to many other medicines. So there is a huge market also for CBD strains. And it is necessary to develop them. It is another option for treatment.
YWS- These days, there is a whole bunch of publications and articles in the specialized media about how cannabis derivates can ease the pain in cancer patients and lower the chemotherapy’s side effects. Some of them even affirm that cannabis compounds can cure cancer. Does this statement go too far? Can this kind of information misguide some patients and their relatives and give them false hopes?
F.G.: What we know about cannabis and cancer from research, cell and other studies is that both CBD and THC may have anti-cancer effects in many cancers. THC can be used to induce apoptosis, which is the programmed cell death of cancer cells. But not in healthy cells. So THC may be effective in many cancers. In recent years there has been also more research on CBD in cancers. Concerning CBD there are not many cancers that have been researched yet but among them are gastrinoma or lung cancer, or breast cancer. And it has also demonstrated that CBD has anti-cancer-effects. For example that it may reduce metastasis and it may also allow the new immune cells to better recognize cancer cells. So CBD has anti-cancer effects and maybe also an active compound against cancer. Some research show that THC and CBD together work better than one single cannabinoid alone.
YWS – What about the impact of THC and CBD on normal chemotherapy
F.G. There is one research done in Spain where THC and CBD have been given with a normal chemotherapeutic agent. Temozolomide (TMZ) is the name of this agent. The anti-cancer-effect of the three substances was stronger, than by one of them alone. THC, CBD and normal anti-cancer-agents together are maybe more effective than normal chemotherapy. What is totally unclear is, in which cancers do we need more THC or in which cancers do we need more CBD. And what about the substances we use in our chemotherapy? Do they always work together with THC or CBD, or not? We have many different agents that are used in chemotherapy. And we have to investigate everything to know everything. The research is yet limited, but is seems that if you give THC in high doses it shows anti-cancer effects in most cancers. In all cancers that have been investigated so far. CBD has also been effective in those cancers that have been investigated so far, and it should also be taken in high doses. And what we know is that usually THC and CBD should be combined to get the best effect. And it may be the case that THC and CBD may support the outcome of normal chemotherapy. It may be different in different cancers. Our knowledge is limited but it should go in the right direction.
YWS – Is there any reliable research on psychological diseases?
F.G.: Yes, for example on depression, posttraumatic stress disorder or comparative disorders. This is a very recent development. Because about ten years ago, when I started to work on cannabis there was nearly nothing on psychological diseases. People said cannabis was good to treat physical diseases such as pain but it may cause psychologic problems so “this is no medication for such problems”. But we have to differentiate now. We see it might be helpful in some disorders and may not work or may worsen the situation in others. We have increasing knowledge thanks to reports and research that cannabis may work in psychological conditions.
YWS – What’s the IACM mission?
On one hand I’m a political active man, on the other side I am a scientist and, thirdly, I am a medical practitioner who sees patients and I want to treat them with cannabis. We use the IACM to make scientific research available to the public, and to increase the exchange of information between scientists. For example, we are organizing conferences, or we are building up networks, also on our website, where we have partners in many countries, so the people may know in every country who they may trust and who they can contact. We are also building up an ambassador programme, with practitioners and patients ambassadors in many countries. So that people know, who for example live in Spain, Uruguay or Costa Rica, can contact this person who has a partnership with the IACM or is an ambassador. This is one thing.
YWS – In which way does the IACM help patients and how can they contact with you?
F.G. The second corner stone is political activity for patients. Patients who need it should have access to cannabis, independently of where they live, because currently patients can be divided into two classes of patients: Those who have access to cannabis where they live, for example if they live in Canada or in Netherlands, and other patients do not have access, because they live in the wrong country. We have enough information and scientific knowledge to say is their right, that patients should have access to cannabis, when they need it. The practitioners should be able to talk about cannabis with their patients and should be allowed to prescribe it or to accompany their patients when they use cannabis. So this is our political side, where we are also active, but this has to be done very carefully because the IACM is mainly a scientific organization. As a medical practitioner I am, of course, treating patients. They can talk to me and also make an appointment. This also spreads the word. My patients, when they go home, they talk to their family doctor. And he or she will realize, the patient is doing better. That they have to rethink their position on cannabis, and perhaps they will try themselves in other patients.
M.D. Franjo Grotenhermen, founder and executive director of the International Association for Cannabinoid Medicines (IACM) has devoted the past 20 years of his career to the investigation of medical and scientific issues related to the use of cannabis and cannabinoids. He is a private practitioner and author of bestselling books as well as articles translated in many languages published worldwide.
*Journalist Jan Marot contributed to this interview