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MEDICAL USE OF CANNABIS IN THE NETHERLANDS

Introduction

Lately, there has been a renewed interest in the medical use of Cannabis sativa and its main constituent delta-9-Tetrahydrocannabinol (THC), both in scientific literature and in the media, in conditions like anorexia and cachexia in cancer and AIDS (Gorter, 1991; Gorter et al. 1992; Gorter, 1999), Multiple Sclerosis (Brenneisen et al. 1996; Ungerleider et al. 1987; Meinck et al. 1989), migraine, spinal cord injuries (Pertwee, 1997), movement disorders (Muller-Vahl et al. 1999) and chronic pain.

In 1997, in an anonymous questionnaire, 112 multiple sclerosis (MS) patients in the USA and the UK were asked about their medical use of Cannabis for the relief of symptoms. Respondents were about equally divided between the USA and the UK, and half male and half female patients. After Cannabis consumption, there was a strong improvement of spasticity at the onset of sleep, and upon awakening in the morning, as well as reduction in pain and tremor. Patients also reported improvement in the ability to walk, in recovery of balance, and in sexual function. There was only minor improvement in memory loss, faecal incontinence, and constipation (Consroe et al. 1997).

In another study in 1997, all 7407 members of the Dutch Society of Multiple Sclerosis, who had been diagnosed with MS, received an anonymous questionnaire to investigate knowledge and use of Cannabis among MS patients in the Netherlands. The response rate was 68.1%. Almost half of all respondents knew about the possible benefits of Cannabis in MS; 13% had ever used Cannabis for their symptoms; 5% indicated they used it regularly, at the time of the survey. Most patients started using Cannabis for relief of symptoms are of an elderly age and tended to live in cities with a population of 100,000 or more. In Amsterdam, above age 40, relatively more MS patients use Cannabis than the general population in this capital. In the Netherlands as a whole, approximately 5% of the population above age 12 uses Cannabis occasionally, against 13% of all MS patients who responded (Zaadstra et al. 1999). In 1998, an anonymous questionnaire about Cannabis use was distributed to patients in Germany, Austria and the German-speaking part of Switzerland. In one year, 170 patients returned their questionnaire; 128 could be evaluated. The most frequently mentioned indications for Cannabis were depression (12.0%), MS (10.8%), HIV-infection (9.0%), migraine (6.6%), asthma (6.0%), back pain (5.4%) and sleeping disorders (4.8%). The large majority had used Cannabis; in just 5 cases Dronabinol (delta-9-tetrahydrocannabinol, or Marinol (C)) was taken by prescription. The route of administration was in 14.3% oral and in 49.2% by inhalation; and in 36.5%, both routes of administration were applied. Of the 128 patients, 72.2% stated that that the symptoms of their diseases were ?gmuch improved?h by taking Cannabis; 23.4% were ?gslightly improved?h, and 1.6% described their symptoms as gotten ?gworse?h (Schnelle et al. 1999).

In the Netherlands, recreational use of Cannabis is illegal, but consumption of small amounts, under certain conditions, is condoned. The concept of using Cannabis for medical purposes seems to be acceptable by large parts of the Dutch population, and physicians are allowed to prescribe Cannabis through a pharmacy. There are Buyer?fs Clubs in the Netherlands, which provide Cannabis to patients, in a similar way as it was done in California, USA. Founded in 1995, Maripharm, a non-profit patient-oriented organization in Rotterdam, delivers ?gmedical grade Cannabis?h (MGC) on prescription to pharmacies throughout the country. When a patient presents a prescription from his doctor for MGC, the pharmacy will forward the prescription to Maripharm, which delivers within 24 hours units of 25g or 5g of standardized, sterile and vacuum-packed MGM to the pharmacy. The THC content in MGM is standardized at 10.2%.

To augment existing information about the medical use of Cannabis in the Netherlands, a new questionnaire was developed to document for which indications MGC was taken, for which duration, whether a patient had any side effects and whether the patient was content with the effects of Cannabis. The objective was to obtain input not only from patients but also from physicians prescribing MGC. For this reason a standardized questionnaire accompanied each order of MGC, which was filled out by both the patient and the prescribing physician.

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