Here, more and more people are getting cannabis on prescription

It has been just over four and a half years since the Danish parliament gave the go-ahead for doctors to try to prescribe cannabis as medicine to patients – a decision that was criticized by the Swedish Medical Association.

Within the framework of the pilot program, 7,154 Danes have been prescribed cannabis.

The Danish pain doctor Tina Horsted became interested in cannabis therapy several years before the pilot program was launched, and has treated around 6,000 patients with cannabis at her own clinic. Many of them suffer from chronic pain problems, for example as a result of spinal cord injuries, MS, cancer or with side effects of cancer treatment.

– There is often the image of the typical patient as a young man who wants to get hold of cannabis legally. But we can see from the statistics that this is not true, she says.

On the contrary, the average cannabis patient is a woman aged fifty and up, often multi-sick with a long history, usually heavily medicated with opioids with severe side effects and low quality of life as a result.

Reduce opioids

It is therefore a priority to gradually cut back on opioid drugs as cannabis is added to the patient. American research has found that patients with chronic pain in some cases have been able to reduce their opioid intake significantly in combination with cannabis medication.

– Pain patients often have insomnia and are often depressed. If we can get the patient to sleep well, they can often handle the pain in a different way, and they can sometimes skip medication with cannabis during the day.

TT: But cannabis, don’t patients get drunk?

– When you are treated with cannabis medically, it is for therapeutic purposes, not to get high, says Tina Horsted and explains that it is important to distinguish this.

Doctor Tina Horsted runs a pain clinic in Copenhagen.

The intoxicating effect of cannabis can in medical contexts be considered a side effect – a price for other desirable effects such as pain relief, improved sleep or stimulated appetite – while those who use cannabis for intoxication can be said to strive for that particular side effect.

“They can not be high”

Any intoxication in medical contexts can also act as a signal that the dose is too high and must be reduced.

– We do not want our patients to be tall or stoned. Many of our patients have jobs, and they must be able to do their jobs. So they can not be high.

But if the purposes differ, does that also mean that there is a difference between the cannabis doctors prescribing the seriously ill and the “grass” people smoke to get tall?

A couple of steps from Tina Horsted’s clinic in Copenhagen is Christiania, the so-called sanctuary, where illegal cannabis trafficking has been going on in front of open curtains for decades. On the tables in the “hash booths” you can buy what is signposted as “medical cannabis”.

– The only thing that cannabis has in common with ours is the sign, says Thomas Skovlund Schnegelsberg, CEO of the Danish listed cannabis producer company Stenocare, in connection with his visit to Stockholm for a conference on medical cannabis.

Thomas Skovlund Schnegelsberg, CEO of the cannabis producer company Stenocare.

He describes a culture process in a laboratory environment surrounded by rigorous control, so that treating physicians can trust the content. On behalf of the patient, the harvested cannabis flower can then be smoked or heated and inhaled as steam. But this particular company has chosen to only make oil from its cannabis, which is ingested with a mouth spray.

Entourage effects

The cannabis plant contains over a hundred different cannabinoids, where THC – which is psychoactive – and CBD are the components that medical research is interested in in a broader sense. In addition, there are several hundred different so-called terpenes and flavonoids – substances that, among other things, give cannabis its strong smell, and which are suggested to have different therapeutic functions.

The Danish Medicines Agency also emphasizes that the cannabis products used in the trial were not necessarily tested as ordinary medicines, that the side effects are unknown and that it is important that both doctors and patients understand this.

A Swedish doctor who visits the conference asks himself how a preparation boiled down from a plant in its entirety can be given to a patient. Conventional Western medicines consist of isolated substances, carefully balanced, she objects.

The motivation is the so-called “entourage effect”, more than ten years old findings that suggest that the medicinal properties benefit from a mutual support effect from the various substances in the plant. But the research provides weak support for the theory, points out Amir Englund, cannabis researcher at King’s College London.

– Different cannabinoids can enhance each other’s effect. But it is just as likely that cannabinoids may inhibit each other’s effects, because they have opposite pharmacology.

Endocannabinoid system

A key to understanding how cannabis works in the human body is the endocannabinoid system (ECS) – a complex homeostatic signaling system we share with all vertebrates on earth – which affects the immune system, sleep, appetite and a host of other functions.

For example, when we are exposed to stress, the body’s own cannabinoids, so-called endocannabinoids, are released, which bind to receptors in the cells and a process is started.

In the same way, ECS can be stimulated by supplying the cannabinoids present in the cannabis plant, so-called phytocannabinoids, and reminiscent of endocannabinoids, to the body.

While endocannabinoids are in sync with the normal activity of the brain, the supply of phytocannabinoids can enhance and potentially disrupt normal function.

– This is what causes intoxication when smoking cannabis, and it explains why you then experience things differently. In the same way, cannabis can function as medicine, by boosting certain activities in the body, says Amir Englund.

Although the existence of ECS has been known since the late 1980s, we are very early in our understanding of its role in various disease processes.

– In some studies of certain disease states, it has been seen that it seems that ECS is overactive, sometimes it is underactive. But we do not have a clear picture of how it works, he says.