Medicinal cannabis is now available in Greece.

Anna, a mother of three children who lives in Athens, will pass the pharmacy’s door in the next few days to execute one of the first – probably the first prescription in our country, for the administration of cannabis for medicinal – medicinal use.

Anna Paga is 60 years old and received on February 15 – with great relief, as she tells APE-MPE – the message from the electronic prescription system, which was about the medicinal cannabis preparation that her doctor prescribed for her with the aim of continue treatment for chronic pain due to psoriatic arthritis.

Who can prescribe and with what indications

In our country, the right of initial prescription for medicinal cannabis is currently available to anesthesiologiststhe neurologiststhe pathologists- oncologiststhe pathologists infectious diseases the pathologists- rheumatologists.

The prescription can be repeated by a doctor of another specialty for 6 months, but then the treatment needs to be re-evaluated by a specialist.

As for the internationally recognized indications of use that are also listed in the Greek “instructions for use sheet” of Δ9-THC, these include:

1. Nausea and vomiting due to chemotherapy for cancer or HIV/AIDS.

2. Pain and spasticity in multiple sclerosis.

3. Persistent pain that does not respond to other available treatments or when available treatments are not well tolerated by the patient,

4. As an appetite stimulant in patients receiving end-of-life care (palliative care).

What are the finished medicinal cannabis products?

It is worth noting that the prescription of medicinal cannabis is not a procedure that should be done lightly, as it requires the doctor to be very familiar with the subject and trained in it.

The president of the Hellenic Medical Society for Cannabinoids, Mrs. Karanastasi, explains to APE – MEB: “The cannabis plant is one, Cannabis sativa L. Like all plants, it has several species, which have many common characteristics, but also several various. Among the characteristics that differentiate them is the content of the flowers in psychoactive substance Δ9-tetrahydrocannabinol, Δ9-THC. When we talk about medical or medicinal cannabis, we mean products derived from plants with a flower content of Δ9-THC greater than 0.2%”

But as she points out, in reality this is an oversimplification, as the plant contains an abundance of active substances – over 140 that are chemically classified as cannabinoidsbut also abundantly terpenoids, flavonoids etc.

“All these substances are pharmacologically active, and therefore hemp is a plant with many uses, including medicinal ones, and not a plant that can be medicinal or non-medicinal. Hence the phrase “end medicinal cannabis products” and not “end medicinal cannabis products”” states.

“It should be noted once again that all of this concerns products containing Δ9-tetrahydrocannabinol at a rate of more than 0.2%. However, we must remember that even products that contain a smaller amount, and do not require a prescription, are pharmacologically active, and therefore should not be taken without the supervision of a health professional with relevant training” points out Ms. Karanastasi, who expresses the hope of establishing criteria in prescribing that will not allow reckless use.

“But patients are taking cannabis for many other conditions, from cancer to post-traumatic stress disorder and rheumatic diseases to glaucoma. And of course they don’t only take what is called medical cannabis, i.e. Δ9-THC, but also other cannabinoids, such as cannabidiol (CBD), which is not classified as a controlled prescription substance. And it should be noted here that different combinations of cannabinoids, but also terpenoids and flavonoids, may have different effects on the body”, concludes Ms Karanastasi.

Where can medicinal cannabis treatments be applied?

It is important to note that Anna’s case and every patient is unique and as such must be treated by the attending physician. It does not mean that what works for one works for all.

“There are patients who request that cannabinoid therapy be their first choice. However, because the more we study the plant and its products, the more we realize that we still know very little about its actions, cannabinoids are not among the first-line treatments. Experts disagree on the use of cannabinoids, mainly on how they modify our endocannabinoid system.

Treatment with (phyto)cannabinoids can have a synergistic or antagonistic or additive or inhibitory effect when combined with other treatments, biological or non-biological, regardless of the severity of the condition. Nor is it used only when other treatments have failed. There is always a need for individualization – not all diseases and not all patients are the same,” explains Ms Karanastasi.