Why does smoking weed make me gasp

Two years of medical cannabis: the hype is over

Deutsche Welle: Mr. Cuhls, March 10th will mark the second anniversary of the approval of medical cannabis in Germany. As a palliative care specialist at the University Hospital Bonn, you also use this drug. How often does this happen in practice?

Henning Cuhls: There was a lot of hype immediately after approval. That has become clear in the meantime. In our palliative medicine department, we had already used cannabis before approval, but only in the case of nausea, vomiting or weakness. Back then it was less about pain.

Who in palliative medicine suffers particularly from nausea and vomiting?

Many patients who are receiving chemotherapy or who have tumors in the intestinal area suffer from it. Then cannabis sometimes works very well when other drugs no longer work as well.

How does cannabis help there?

Most of the time, patients who suffer from nausea also no longer have an appetite. You have to get rid of the nausea first, so that the appetite comes back and the patient gets enough calories again. We have very many seriously ill patients who often no longer have an appetite and therefore lose weight very quickly.

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Dr. Cuhls recommends cannabis to his patients when other active ingredients no longer help.

Why does cannabis of all things help?

Exactly how cannabis works is not yet fully understood. But we have long known that cannabis often leads to weight gain.

Cannabis is also known as a treatment for the gastrointestinal disease of Crohn's disease. Do you have any experience with it?

No, but I know that cannabis applications for the treatment of Crohn's disease are not very common. At a further training course of the Medical Association, in which I recently took part, it was summarized for which indications cannabis was applied for at all. It was interesting that 57 percent of the applications were for pain treatment. For example, ten percent applied for the treatment of spasticity and five percent for loss of appetite. Intestinal diseases only play a role in around three percent of all applications. That is very little.

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Let's get to the subject of pain: someone who has ever had contact with cannabis would say that cannabis enhances or changes feelings - that is, makes perception more intense. It doesn't kill pain. So why do you use cannabis as a pain reliever?

That's right. Cannabis doesn't work very well on pain either. It's not a good indication for it. It is estimated that only one in 15 patients really benefits from it. But some anti-inflammatory pain relievers sometimes stop working very well. Then an additional analgesic effect can be achieved with the cannabis.

But you have to be very clear: If you are sick, the chance that cannabis will really help and the patient will benefit from it is perhaps one in ten, and if you are in pain it is even worse.

How often is cannabis actually prescribed in practice?

It is rather the exception. Most of the time it only happens when patients come to the consultation with the request. As a palliative care practitioner, I would only suggest cannabis if I noticed that the other drugs were no longer helping.

But I also have a very special group of patients who are doing very badly. Most of the time, it stays with the attempt - whether it helps or not. You can try this out as long as the side effects are low. If it helps, it is good, and if it does not help, you have not forgiven yourself and certainly not harmed the patient.

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How do patients use cannabis? Do you have to smoke it?

Smoking is the worst option because the patient then has a very high level of active ingredients in a very short time, which also falls off again relatively quickly. The aim is to have a corresponding effect throughout the day.

There are special vapors that heat cannabis flowers and thus release the active ingredients - without tobacco. It's not as harmful as smoking. The cannabis active ingredient is also available as a spray or drops. You can drizzle it on a piece of bread or sugar and take it that way. The third variant is tablets.

In the case of cannabis flowers, the market was completely emptied shortly after the release. They were hardly available in pharmacies.

Cannabis oil, which does not contain the intoxicating component of medical cannabis - tetrahydrocannabiol (THC) - is available in drugstores and supermarkets in Germany. Does it also help against nausea or stomach problems?

The cannabis oil that you can freely buy contains cannabidiol (CBD). It is not considered a drug, but a dietary supplement. In contrast to THC, it does not cause delirium, hallucinations or states of confusion.

The CBD is nowhere near as well researched. There aren't enough studies, and as a doctor, I can't prescribe it either. However, patients can buy it themselves.

Some patients have personally reported to me that they do not necessarily need the THC-containing drug to notice an improvement. Some even reported to me that they tolerated CBD better than THC drops. But that is only a subjective feeling that three to four patients have described to me and not a scientific statement.

Dr. Henning Cuhls is the senior physician in charge of palliative medicine at the University Hospital Bonn (UKB).

The interview was conducted by Fabian Schmidt.

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