REVIEWS:
Greeting/
Surprise guest
After all participants were welcomed by Urs Schwarz (AZ-Ins) and Larissa Blatter ( SSAC ), National Councilor Heinz Siegenthaler (party: BDP, Cannabis Consensus Switzerland) gave us an overview of the current motions and some insight into the Mood around cannabis in general politics in Switzerland. A clear boon for everyone, such optimistic words.
.jpg)
Medicinal effects of phytocannabinoids
presented by Prof. em. Dr. pharm. Rudolf Brenneisen
(Swiss working group for cannabinoids in medicine, SACM, Swiss Academy of Pharmaceutical Sciences, SAPhW, MedCanSult)
Cannabis in old age
-
"Start slow, go slow"
-
Sativex ®, widely used, hardly any side effects
-
Caution is advised with; Polypharmacy, orthostatic hypotension and risk of falling
Cannabis against oblivion?
A study with 10 patients suffering from dementia and being treated with cannabis showed a reduction in behavioral disorders, rigidity and polymedication (psychotropic drugs and opiates). The tolerance was generally good.
The cannabis dilemma
Self-treating patients are the experts. Research cannot / does not want to sufficiently prove this valuable base of experience.
Popular indications according to an IACM survey
Back pain, sleep disorders, depression, general pain, multiple sclerosis, anxiety, osteoarthritis, deg. Arthritis, ADHD, fibromyalgia, migraines, and headaches
Is there enough clinical evidence?
-
Moderate evidence for the treatment of chronic pain (Whiting, JAMA 2015; on behalf of the BAG)
-
Position Paper (EFIC); The current status of the use of medical cannabis against chronic pain is insufficient. They assume that the quantity and quality of evidence and the clinical experience of doctors will improve significantly over the next three years.
Pediatrics
Charlotte Figi suffers from Dravet Syndrome. She had 300 seizures / week, severely disabled. After countless, failed attempts and therapies, the girl was treated with a self-made low THC / high CBD cannabis oil. The seizures were reduced from 0 to a few / day and the girl was able to approach normal life, for example horse riding.
-> Epidiolex, approval in EU.
Pediatric indications from real life
Refractory Epilepsy, Autism, ADHD, Anxiety, Depression, gdp. Disorders, neuroses, eating disorders, Tourette, chron. Pain, Autoimmune Diseases, End of Life.
Pediatrics Case Report Autism
A 16 year old autism patient, severely aggressive, self-mutilation, anxiety and insomnia. After more than 20 different ineffective drugs, a trial with cannabis was started. High doses of THC were effective, but tolerance was not good. So the doses were adjusted, maintenance dose 150mg CBD and 50mg THC. The patient became calm, happy, obedient, and was able to go back to school.
ADHD
Cannabis increased concentration, sleep, and decreased impulsiveness in ADHD patients.
Just an anecdote?
-
A two year old child had a brain stem tumor. After multiple operations and radiotherapy and a spinal cord transplant, there was no improvement in sight. One clinician recommended “Cannabis Juice”, 200g per day. An MRI after two years shows a complete tumor remission.
-
A 22-year-old alpinist with a dislocated shoulder -> at first it was not possible to straighten out on site. After a joint allowed by the doctor over the phone, the shoulder could be adjusted again thanks to the analgesia and spasmolysis on site.
Cannabis for Cancer?
Various clinical data are available, e.g. on apoptosis. The book “Cannabis against Cancer” by Franjo Grotenhermen explains very extensively. The book was published by the Nachtschatten publishing house, which is a sponsor of the SSAC association.
CBD for schizophrenia?
CBD has a comparable effect to amisulpride, only with fewer side effects.
Cannabis in obstetrics
Dysmenorrhea, premature birth, vomiting, obstetrics, toxic seizures, menopause, loss of libido, endometriosis.
CBD interactions
Caution: CBD has an interaction at the level of cytochrome P450 enzymes.
SOURCE: Prof. em. Dr. pharm. Rudolf Brenneisen
Secretary General Schw. Akad. Pharm. Wiss. www.saphw.ch , head of the Schw. working group cannabinoids in medicine, research group leader Dep. Clin. Research Univ. Bern (until 2014)
_edited.jpg)
.jpg)
Lecture on the current and future situation of prescribing and the formulation of
Dr. Cedric Hysek
(Dr Hysek pharmacy)
Dr. Hysek showed that there is general uncertainty and a lack of knowledge among patients, but also among doctors, pharmacists and companies. Which products are there and which ones does this patient need? A salad oil, a CBD extract, a THC extract or a full spectrum preparation? From the kiosk or from the pharmacy?
Educational work is urgently needed, for example this evening and with a pioneering spirit from experts to your patients.
prescription
-
First point: the attending physician must have specialist knowledge of medicinal cannabis and be familiar with the law.
-
Indication, contraindication
-
Narcotics Act (THC> 1%)
-
-> fill out the special permit (huge effort, especially the first time)
-
Which preparation? Where can I get this from? Who pays?
In order to bring a new drug onto the market in Switzerland, it must be approved by Swissmedics. This is a very complex and extremely costly point! Sativex is currently the only approved cannabis drug in Switzerland.
GMP
There are strict regulations for the manufacture of medicines. These are clearly regulated in order to ensure a constant quality of the product and constant concentrations / compositions of the ingredients (cannabinoids etc.). Standardization is a major challenge, especially for a plant-based drug, and increases enormously with the number of active ingredients. A fact, which today Mr. prof. em. Dr. pharm. R. Brenneisen named and confirmed by experienced growers & breeders.
Galenics
In the case of oral intake, the bioavailability is approx. 6%. When smoking, the bioavailability is much higher, but harmful to health due to the pollutants.
It needs new wording!
Health insurance
Do not have to pay the costs, it is not a mandatory service. Approval of costs can be requested, but is still often refused.
Cost: 1.10CHF - 1.80CHF / mg
E.g .: at 20mg / day = 22.00 Chf - 36.00 Chf / day
At 30mg / day = 33.00Chf - 54.00Chf / day
Restrictions on THC consumption
-
Road traffic; re-examination
-
Travel, apply for a certificate
Due to the change in the law, there is no need to apply to the BAG for an exemption.
.jpg)
%20c.jpg)
The aperitif afterwards:
(Q & A / Aperitif / Infotables)
After these really interesting and complementary lectures, Ms. Larissa Blatter opened the Question & Answer session. However, after a few contextual questions it quickly became clear; these lectures leave no questions unanswered this evening. Business cards were exchanged and appointments made at the same time. High time for an aperitif!
Another wonderful buffet of delicacies was presented to us from the AZI's kitchen!
The lectures that were heard, the SSAC information table, and the current economic and legal situation ensured lively discussions. Interested parties could link up and of course also discuss business matters in separate corners.
A wonderful exchange with vison guests!
Thank you very much!
Your SSAC team
Here are some photos of the CSCM 2
