Who are we?
-We are an advocacy organization working to ensure that patients who could benefit from medical cannabis receive equal and safe treatment with medical follow-up. The medication group should be financially accessible through public reimbursement schemes, and patients should not lose fundamental rights when receiving legal medicine!
- -What do we want to achieve?
-Our goal is to find a solution to the challenging situation faced by Norwegian patients, doctors, and researchers regarding the use of medical cannabis (MC) in treatment. We aim to do this by establishing a registry study in Norway, along with the following implementation criteria that must be met for the study to be realized:
- -1. Registry study in international collaboration
-We are working to ensure that Norway implements Europe's largest registry study on medical cannabis, developed at Imperial College London. The study follows up on all users of medical cannabis—regardless of their condition or the type of cannabis they use. This way, we can gain an overview of which variants of the medication group work best for different conditions, along with any side effects that may occur. We are already in dialogue with several Norwegian researchers who want to contribute to this effort.
- -2. Broad indication for assessment
-For the study to provide us with expanded knowledge, we need to change the current situation where it is nearly impossible for patients to obtain a prescription for medical cannabis in Norway. This is despite the fact that the medication group is already considered low-risk in a medical context. We want it to be recognized that cannabis affects the body's endocannabinoid system, meaning it can help with many different diseases and ailments. We therefore believe that doctors should be able to try medical cannabis for all conditions where the patient has not received adequate help from other medications—as long as there are no medical reasons to avoid it.
- -3. General prescribing rights for all doctors
-We want doctors who are already authorized to prescribe strong medications (Class A and B drugs) to also be able to prescribe medical cannabis to their patients. We are working to ensure that the doctor who knows the patient best—and who regularly follows up with them—is also the one who makes the decision about medical cannabis. We believe this will provide better follow-up and more holistic treatment for patients. It will also be an important relief for a specialist healthcare service that is already overworked and has long waiting lists.
- -4. Coverage of medication expenses
-A medication is not truly accessible if the patient cannot afford it. Everyone who receives a prescription for medical cannabis should have their costs covered by the public system, just like with other medications. Today, patients mostly have to pay for everything themselves, creating a two-tiered system where only those with good finances have access to treatment. This leads many patients to buy cannabis illegally, where it is cheaper but lacks quality control and safety.
- -5. Continuing education for doctors and healthcare professionals
-It is important that the prescription of medical cannabis is done in a safe and responsible manner. There is therefore a need for doctors to be offered courses and training on how medical cannabis is used to treat various diseases. Doctors themselves say they lack knowledge in this area, which is also confirmed by studies. Without sufficient knowledge, doctors cannot provide patients with the best treatment or feel confident in prescribing medical cannabis.
- -6. Review of health requirements for driver's licenses
-For patients to be able to participate in the study, there is a need for a thorough review of the regulations regarding driver's licenses and medical cannabis. As the only country in Europe, Norway has regulations that result in most patients losing their driving privileges when prescribed medical cannabis—even if they use variants and doses that do not impair their ability to drive. For other medications that may temporarily affect driving ability, Norway operates on a trust-based system. The current regulations therefore discriminate against patients using medical cannabis.
- -What is medical cannabis?
-Medical cannabis is not a single medicine but a group of medications. The medications come in various forms of administration such as capsules, oils, tablets, plant material, and oral sprays. There are three categories of medical products prescribed:
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- Medicines with marketing authorization (In Norway, these are currently Sativex and Epidyolex) -
- Medical products with GMP standard. These fall under the common term Cannabis Based Products for Medical Use, abbreviated as CBPMs. The GMP standard ensures such high quality that the exact content of active ingredients in all these products is known. -
- Magistrally prepared medications with GMP standard (pharmacy-compounded). -
Each product in these categories has a unique combination of active ingredients and form of administration. A patient who does not respond to one variant of the medication, such as Sativex, may still benefit from another variant and/or form of administration. In Norway, we currently have 19 variants of medical cannabis (MC). In comparison, England has 240 variants.
- -The most well-known active ingredients in MC are THC and CBD. THC can increase appetite and reduce nausea. It can also relieve pain, inflammation, and muscle control problems. In cases of overdose, THC can produce a euphoric effect (intoxication). CBD is not intoxicating but can have a relaxing effect. CBD can reduce pain and inflammation, control epileptic seizures, and may potentially help in the treatment of mental illness and addiction. In addition, we find smaller amounts of other cannabinoids such as CBG, CBN, and THCV, as well as non-cannabinoid phenols, flavonoids, terpenes, and alkaloids. These work together in an "entourage" effect and contribute to each variant of the medication having unique effects. This also means that MC should be tailored individually to each patient's needs.
- -The active ingredients in cannabis act on a large receptor system in the body called the endocannabinoid system. This consists of three main components: endocannabinoids (such as anandamide and 2-AG), CB1 and CB2 receptors, and regulatory enzymes. The endocannabinoid system's main task is to maintain the body's natural balance, or homeostasis. It is central in regulating many important processes such as anxiety, pain, inflammation, stress and immune responses, mood, and appetite. Dysregulations in the system are also believed to influence the development of symptoms in Huntington's disease, Alzheimer's disease, Parkinson's disease, and multiple sclerosis (MS). The effect on the endocannabinoid system explains why cannabis can have an effect on so many symptoms and diagnoses. Approximately 50% of prescriptions currently written in England are for all types of chronic pain, 40% for various mental health conditions, 6% for neurological conditions, and 4% for other diagnoses.
- -Cannabis is associated with several misunderstandings and stigmas due to the fact that the active ingredient THC can also be used as a recreational drug. Variants containing less than 1% THC cannot produce an intoxicating effect. This typically applies to isolated CBD (such as in Epidyolex) or whole-plant CBD with GMP standard. For higher amounts of THC, the following applies: In medical use, intoxication is considered an unwanted side effect that can occur with THC overdose. In this regard, medical cannabis is not unique—many medications can cause intoxication when overdosed. It all depends on dosage, titration, adaptation, and the content of active ingredients. Common doses of THC for medical use typically range between 0.5–20 mg per day after adaptation, comparable to medications like Lyrica and benzodiazepines. Starting doses are usually between 0.5–2.5 mg of THC per day. For comparison, a single recreational dose is considered to start from 10 mg of THC for inexperienced users, and often exceeds 50 mg per dose for experienced users.
- -Addiction potential is a concern for many, which is understandable given the experiences with OxyContin and the aggressive marketing associated with it. MC is minimally physically addictive. An RCT study examining what happens with rapid discontinuation of Sativex found no withdrawal problems after 3 years of use. Another RCT study following arthritis patients over 5 months showed no issues related to stopping treatment. In recreational use, it is estimated that around 9% develop addiction, but the concept of addiction should be used with caution when discussing medical use, as discontinuation often results in the return of symptoms that MC is used to treat. Tolerance development (requiring increased doses) may occur, but this is managed by the doctor monitoring dose development and implementing tapering periods if necessary.
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