title: Medical use of cannabis products: Lessons to be learned from Israel and Canada.
abstract: BACKGROUND
  The German government intends to reduce the barriers for the medical use of cannabis products. A discussion on the indications and contraindications of the medical use of cannabis and on the changes of the regulatory framework has already begun in Germany. It is useful to draw from the experiences of other countries with a more liberal medical use of cannabis.
  
  
  METHODS
  The Israeli and Canadian experience is outlined by physicians who have been charged with expertise on the medical use of cannabis by their jurisdiction.
  
  
  RESULTS
  In Israel, only the plant-based cannabinoid nabiximol (mixture of tetrahydrocannabinol/cannabidiol) can be prescribed for spasticity/chronic pain in multiple sclerosis and for cancer pain. The costs of nabiximole are reimbursed by some, but not by all health maintenance organizations. The medical use of marijuana is permitted; however, it is strictly regulated by the government. Selected companies are allowed to produce marijuana for medical use, and only certain physicians are licensed to prescribe marijuana as a therapeutic drug for specific indications such as chronic neuropathic, and cancer pain, inflammatory bowel diseases, or posttraumatic stress disorder if conventional treatments have failed. The costs of marijuana are not reimbursed by health insurance companies. In Canada, synthetic cannabinoids and the plant-based (nabiximol) are licensed for neuropathic and cancer pain, HIV-related anorexia and chemotherapy-associate nausea. The costs of these synthetic cannabinoids are covered by health insurance companies. The medical use of marijuana as a treatment option is allowed for individual patients suffering from any medical condition when authorized by a medical practitioner or nurse. Licensed producers are the only source for patients to newly access medical cannabis, although those with previous permission to grow may continue cultivation at the present time. The costs of marijuana are not reimbursed by health insurance companies. There are multiple contraindications for the medical use of cannabis products in both countries.
  
  
  CONCLUSIONS
  The use of standardized, synthetic, and plant-based cannabis products should be allowed in Germany for defined medical conditions when high-level evidence of efficacy and safety exists. The costs should be reimbursed by the health insurance companies. Contraindications for the medical use of cannabis should be defined. Growing marijuana by patients for their medical use should not be allowed.
authors.affiliation: Institute of Rheumatology, Tel Aviv Sourasky Medical Center and Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: J
authors.initials: J
authors.lastname: Ablin
authors.affiliation: Division of Rheumatology, McGill University, Montreal, Quebec, Canada.|Alan Edwards Pain Management Unit, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: P A
authors.initials: PA
authors.lastname: Ste-Marie
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Charité University, Berlin Campus Virchow Klinikum, Berlin, Germany.
authors.forename: M
authors.initials: M
authors.lastname: Schäfer
authors.affiliation: Klinikum Saarbrücken gGmbH, Innere Medizin 1, Winterberg 1, 66119, Saarbrücken, Germany. whaeuser@klinikum-saarbruecken.de.|Department Psychosomatic Medicine and Psychotherapy, Technische Universität München, Munich, Germany. whaeuser@klinikum-saarbruecken.de.
authors.forename: W
authors.initials: W
authors.lastname: Häuser
authors.affiliation: Division of Rheumatology, McGill University, Montreal, Quebec, Canada.|Alan Edwards Pain Management Unit, McGill University Health Center, Montreal, Quebec, Canada.
authors.forename: M-A
authors.initials: MA
authors.lastname: Fitzcharles
mesh_terms: D002170:Canada; D002185:Cannabidiol / Q000009:adverse effects / Q000627:therapeutic use; D003431:Cross-Cultural Comparison; D013759:Dronabinol / Q000009:adverse effects / Q000627:therapeutic use; D004338:Drug Combinations; D004335:Drug and Narcotic Control / Q000331:legislation & jurisprudence; D005858:Germany; D006801:Humans; D019458:Insurance Coverage / Q000331:legislation & jurisprudence; D007557:Israel; D064086:Medical Marijuana / Q000009:adverse effects / Q000627:therapeutic use*; D009313:National Health Programs / Q000331:legislation & jurisprudence*; D010146:Pain / Q000188:drug therapy*
chemical_list: D004338:Drug Combinations; D064086:Medical Marijuana; D002185:Cannabidiol; D013759:Dronabinol; C587251:nabiximols
keywords: Cannabinoids; Herbal cannabis; Israel–Canada; Medical use; Regulatory framework