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20/Sep/2022

The most common symptoms of arthritis include pain during daily movements and swelling of the joints. A study by U.S. researchers encourages sufferers: taking CBD appears to have positive effects on pain and physical functioning. In addition, an improvement in sleep quality was observed during therapy with medical cannabis. 

As part of the study, 428 patients suffering from joint pain were anonymously interviewed about the efficacy of CBD. Participants were recruited via social media and activities of the US patient associations “Arthritis Foundation” and “Savvy Cooperative”. The results are promising: CBD therapy is associated with improvements in pain (83 percent), physical functioning (66 percent) and sleep quality (66 percent). Especially those patients who had been diagnosed with osteoarthritis benefited from pain reduction through pharmaceutical cannabis.   

The majority of respondents also reported that their use of other pain medications had decreased or even stopped altogether as a result of taking CBD. 

The authors of the study advocate greater openness to alternative treatment options for inflammatory joint conditions such as arthritis – for example CBD therapy. In addition, further clinical studies are needed to explore the efficacy of cannabinoids in pain management for these conditions.   

source  

Frane, N., Stapleton, E., Iturriaga, C., Ganz, M., Rasquinha, V., & Duarte, R. (2022). Cannabidiol as a treatment for arthritis and joint pain: an exploratory cross-sectional study. Journal of Cannabis Research, 4(1).


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29/Jun/2022

Many people who suffer from cancer have distressing symptoms such as pain and fatigue, but also  psychological complaints such as insomnia, depression or anxiety. An Israeli research team has now presented a promising prospective study with oncological patients.  The long-term study provides evidence for a reduction in the overall burden of cancer after therapy with medical cannabis. 

 

Structure of the cancer study 

The research group surveyed oncology patients over a total period of 2.5 years at various points in time with regard to individual pain perception, quality of sleep, sexual activity, depression and anxiety. At the beginning of the study, a total of 324 patients were involved, and the last survey was conducted with 126 individuals. The average age in the study group was 64 years, and women slightly outnumbered men, accounting for 59 percent. All participants suffered from advanced stage cancer (“Stage IV”). Breast, colon, lung and ovarian tumors were most prevalent. Therapy was with well-tolerated cannabis oils, the dosage of which was documented separately.    

Results 

The therapy with medicinal cannabis brought a significant improvement in almost all questioned aspects. The authors described the reduction in the overall burden of cancer symptoms after 6 months as particularly striking: The median decreased by 18 percent compared with baseline. Side effects were observed, but were not severe and remained stable during therapy.   

Reduction of pain symptoms, less analgesics needed 

Another interesting finding: treatment with medicinal cannabis led to a reduction in pain symptoms and less need for opiates, but also other painkillers such as non-steroidal analgesics as well as anticonvulsants or antidepressants.   

Significant improvements after 6 months of therapy 

Last but not least, the results of the study seem to indicate that the success of treatment with medical cannabis depends, among other things, on the duration of therapy. Therefore, the statistically significant changes in symptoms appeared only after 6 months of continuous intake of cannabinoids. In a previous study, the authors investigated the short-term effects of pharmaceutical cannabis therapy and found no significant improvements in cancer symptoms.  

source  

Aviram, Joshua, et al. “The Effectiveness and Safety of Medical Cannabis for Treating Cancer Related Symptoms in Oncology Patients.” Frontiers in Pain Research, vol. 3, 20 May2022, 10.3389/fpain.2022.861037. Accessed 24 June 2022. 


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01/Jun/2022

Each individual has a unique endocannabinoid system (ECS) tonus that reflects the level of ECS constituents. Both, too low and too high ECS tonus levels can lead to health problems and appear to be involved in the development and chronicity of diseases. Unfortunately, the connections are largely unknown in the medical community.   

We asked Robert Uhlenbrock, a Kalapa Clinic physician and expert in the use of medical cannabis, about the importance of ECS tonus.   

CanPharma: Mr. Uhlenbrock, what happens in the human body when the ECS tonus deviates from the norm (the average values)? 

 Currently, science assumes that, for example, a clinically relevant endocannabinoid deficiency leads to an imbalance in the body’s system. This imbalance seems to be involved in a number of chronic diseases. Several studies suggest a link between low ECS tonus and irritable bowel syndrome, migraine as well as fibromyalgia complaints [1]. Especially in the development of migraine, there is increasing evidence for an involvement of the endogenous endocannabinoid system [2].    

 What are the causes for a deficiency of endogenous cannabinoids and how can this knowledge be used therapeutically? 

 Low ECS tone can have both genetic causes and be influenced by a person’s individual health behavior. For example, if the human body produces too many enzymes that break down the body’s own endocannabinoids, the tone will be too low. Since endocannabinoids play a crucial role in human physiology, deficient ECS tone can be associated with individual complaints or manifest diseases. 

 This knowledge has therapeutic relevance: If, for example, the anandamide* level in the blood were examined at regular intervals, we would notice a clinically relevant imbalance at an early stage and be able to react. I am thinking here of the intake of exogenous – i.e. plant-based – cannabinoids, but also regulation via sport, stress reduction and a healthy diet. For the so-called lifestyle factors in particular, there are now promising studies that demonstrate a health-promoting effect [3].   

 CanPharma: Why is the ECS tonus hardly considered among physicians? 

 Knowledge of the body’s endocannabinoid system is not a topic of university teaching and is therefore hardly anchored in the professional world. Whoever asks treating physicians for a determination of the anandamide level will most likely encounter little knowledge. Furthermore, as far as I know, there is no laboratory that measures this parameter as part of a blood count. The therapeutic importance of ECS the tonus is significantly underestimated. This must change urgently!  

 * Anandamide, is the best known and scientifically first described endocannabinoid. It is one of the most important endocannabinoids for controlling the balance in our body, called homeostasis. 

sources  

[1] Russo, Ethan B. “Clinical Endocannabinoid Deficiency Reconsidered: Current Research Supports the Theory in Migraine, Fibromyalgia, Irritable Bowel, and Other Treatment-Resistant Syndromes.” Cannabis and Cannabinoid Research, vol. 1, no. 1, Dec. 2016, pp. 154–165, ncbi.nlm.nih.gov/pmc/articles/PMC5576607/, 10.1089/can.2016.0009. 

[2] Greco, Rosaria, et al. “Endocannabinoid System and Migraine Pain: An Update.” Frontiers in Neuroscience, vol. 12, 19 Mar. 2018, www.ncbi.nlm.nih.gov/pmc/articles/PMC5867306/, 10.3389/fnins.2018.00172. Accessed 23 Nov. 2020. 

[3] “Beeinflusst Sport Endocannabinoide Im Blut Und Migräne? • DGP.” DeutschesGesundheitsPortal,  25 Nov. 2021, www.deutschesgesundheitsportal.de/2021/11/25/beeinflusst-sport-endocannabinoide-im-blut-und-migraene/. Accessed 17 May 2022. 


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05/May/2022

Elderly (geriatric) patients often suffer from chronic pain and are sensitive to opiates and other centrally acting substances. A retrospective evaluation from a medical practice shows: Medical cannabis – in this case dronabinol – can alleviate the symptoms of those affected.   

Study participants included all geriatric patients aged 80 and older who were treated in a pain medicine practice in Potsdam, Germany from the time the cannabis law came into effect in March 2017 until mid-July 2018. Group A consisted of geriatric, non-palliative pain patients, group B included geriatric palliative pain patients.   

Questionnaire with information on dosages and pain intensity  

 The basis for the retrospective monocentric cohort study was a questionnaire with information on pain intensity, dosage, effects and side effects of dronabinol therapy. The results are encouraging: 21 out of 40 patients whose data were analyzed achieved a pain reduction of more than 30 percent. Another ten percent even reported an improvement of more than half. According to the respondents, about four symptoms or side effects of the previous therapy were positively influenced.  

 The authors of the study conclude from the results that cannabis-based medicines represent an effective and low-risk therapy option for the treatment of geriatric pain and palliative patients. At the same time, they call for further clinical studies – especially on the indication spectrum of the substances.   

 

Source:  

Wendelmuth C, Wirz S, Torontali M, Gastmeier A, Gastmeier K. Dronabinol bei geriatrischen Schmerz- und Palliativpatienten : Eine retrospektive Auswertung der ambulanten kassenärztlichen Therapie [Dronabinol in geriatric pain and palliative care patients : A retrospective evaluation of statutory-health-insurance-covered outpatient medical treatment]. Schmerz. 2019 Oct;33(5):384-391. German. doi: 10.1007/s00482-019-00408-1. Erratum in: Schmerz. 2019 Dec;33(6):562. PMID: 31473816. 


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05/Apr/2022

Inhaling cannabidiol e-liquid has positive effects on the verbal episodic memory of young healthy people. This was recently found by a group of Swiss researchers in a placebo-controlled study. Thirty-four people with an average age of 22 and no previous illnesses were asked to memorize 15 unrelated nouns. They were then given a single dose of CBD (12.5 mg cannabidiol e-liquid) once and once a placebo to vaporize. After about 20 minutes, they were assessed on their verbal episodic memory.

CBD outperforms placebo

The result is clear: compared to the placebo, CBD improved the short-term memory performance. The Basel research group concludes that not only does CBD have no negative effect on basic cognitive functions, they also see further evidence of the interaction of the central endocannabinoid system with vaporized CBD. In conclusion, CBD may be able to positively influence memory processes and may have further therapeutic potential if appropriate.

To investigate optimal dose-response relationships, the neuroscientists from Switzerland recommend further extensive studies.

 

Source: 

Hotz J, Fehlmann B, Papassotiropoulos A, de Quervain DJ, Schicktanz NS. Cannabidiol enhances verbal episodic memory in healthy young participants: A randomized clinical trial. J Psychiatr Res. 2021 Nov;143:327-333. doi: 10.1016/j.jpsychires.2021.09.007. Epub 2021 Sep 7. PMID: 34536664. 


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16/Mar/2022

A group of U.S. scientists from Florida has made another leap forward in terms of the effectiveness of medical cannabis for chronic pain. Analysis of Real World Data showed improvement in anxiety/depression, sleep, and quality of life.  

The Florida research team examined data of 46 adults (half of which male/female, average age 55 years) who had started treatment with medical cannabis for chronic pain. A feature of the prospective study: The survey on the factors pain intensity, anxiety/depression, sleep and quality of life took place under so-called real-life conditions, i.e. the patients transmitted their data via smartphone directly from their natural environment to the scientists.    

In order to test the effectiveness of the medication, a baseline survey, an EMA (Ecological Momentary Assessment: diagnostic access to the behavior and experience of the subjects) was conducted after one or three weeks, as well as a follow-up survey after three months towards the end of the study.   

First effects already visible after a few weeks of therapy  

The results are clear: shortly after a few weeks of therapy, the self-reported data showed a significant reduction in momentary pain intensity and a similar increase in daily sleep duration.  

After three months, a significant change in the most severe pain as well as in the depressive experience of the patients was observed. In addition, an increase in sleep duration, an improvement in sleep quality, and an increase in quality of life were observed compared to the baseline survey.   

Florida is among the fastest growing markets for medical cannabis within the United States.   

  

source  

Wang Y, Jean Jacques J, Li Z, Sibille KT, Cook RL. Health Outcomes among Adults Initiating Medical Cannabis for Chronic Pain: A 3-month Prospective Study Incorporating Ecological Momentary Assessment (EMA). Cannabis. 2021 Oct;4(2):69-83. doi: 10.26828/cannabis/2021.02.006. PMID: 34671723; PMCID: PMC8525881. 


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16/Feb/2022

In general, they do not have a particularly good reputation: Many amoebae contain bacteria that can cause diseases in humans. A group of researchers from the Leibniz Institute for Natural Product Research and Infection Biology in Jena has now managed to pull off a trick – they have made the amoeba Dictyostelium discoideum produce a precursor of the active ingredient in cannabis, tetrahydrocannabinol (THC).   

Amoebae are single-celled organisms and are capable of producing numerous natural substances. In the case of the genus Dictyostelium discoideum – a slime mould – these are various polyketides that can be used for a whole range of therapeutic applications. These include the cannabinoid precursor olivetolic acid. The principle of action of the single-celled organisms in this respect: they join together to form larger structures that can act like a multicellular organism. 

Reactivation of slime mould enzymes 

In the course of their research, the Jena working group first found that the slime moulds produced either resveratrol (a secondary plant substance to which, among other things, an anti-inflammatory effect is attributed) or olivetolic acid, depending on the experimental set-up. The catch: the synthesis only works if a special chemical additive is present in the nutrient medium. Beyond that, the amount produced is marginal.   

In the next step, the research team developed a way to combine the slime mould enzymes with an enzyme from the hemp plant. A hybrid construct is created that is inserted into the genetic material of Dictyostelium discoideum. As a result, the amoeba directly produces the required precursor – olivetolic acid is thus produced without further additives.   

Dictyostelium discoideum acts as a production platform 

In the next step, the research team wants to produce the end product THC directly in the amoebae by introducing two more missing enzymes into the single-celled organism. A patent for the biotechnological extraction of the plant substances has already been applied for. It is particularly promising because the chemical extraction of THC in its pure form is very time-consuming, expensive and associated with low yields. Microbes, on the other hand, can be cultivated en masse and thus theoretically produce large quantities of THC in a short time. The production is not dependent on the growth of a plant or the climatic conditions. 

Original source:   

Reimer C, Kufs JE, Rautschek J, Regestein L, Valiante V, Hillmann F. Engineering the amoeba Dictyostelium discoideum for biosynthesis of a cannabinoid precursor and other polyketides. Nat Biotechnol. 2022 Jan 6. doi: 10.1038/s41587-021-01143-8. Epub ahead of print. PMID: 34992245.  

 


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28/Jan/2022

The Corona pandemic continues to have the world in its grip. In addition to vaccines, experts are increasingly focusing on medicines that mitigate the course of the disease and prevent severe courses. A study from the USA shows that compounds obtained from hemp can slow down the Sars-CoV-2 coronavirus as it enters human cells.   

Scientists at Oregon State University found out in neutralisation tests in the laboratory that the cannabinoids CBGA (cannabigerolic acid) and CBDA (cannabidiolic acid) prevented the docking and penetration of Sars-CoV-2 into human epithelial cells. Their assumption: The two hemp acids bind to the spike protein of the virus, which sits like a spike on its surface. This seems to reduce the risk of infection.   

Advantage of the cannbinoids studied is wide distribution

According to the experts around study leader Richard van Breemen, CBGA and CBDA have the advantage that they are widespread and easily available. The two active substances are present in the hemp plant and in numerous hemp extracts, they are easily extractable and do not have a psychoactive effect. Van Breemen also recommends oral intake of the preparations, for example in the form of drops or tablets. Last but not least, the researchers assume that they can kill two birds with one stone by using the cannabinoids: Not only will the risk of infection be minimised, but the symptoms of the disease will also be easier to bear in the acute course.   

Efficacy against variants B.1.1.7 (alpha) and B.1.351 (beta) investigated  

The study shows that the ingredients of cannabis were effective against the alpha and beta variants of Sars-CoV-2. So far, no statements can be made about the subsequent variants. Nevertheless, the authors are optimistic and assume that the two acids investigated also have effects on other currently existing and future variants of the corona virus.   

There is no way around the Covid-19 vaccine  

For van Breemen and his team, it is clear that cannabinoids alone cannot end the fight against the global pandemic. They therefore recommend the combination of CBGA, CBDA and a vaccination. The currently available vaccines and possible antibody therapies also target the spike protein of the corona virus.   

Sources:   

Van Breemen RB, Muchiri RN, Bates TA, Weinstein JB, Leier HC, Farley S, Tafesse FG. Cannabinoids Block Cellular Entry of SARS-CoV-2 and the Emerging Variants. J Nat Prod. 2022 Jan 10:acs.jnatprod.1c00946. doi: 10.1021/acs.jnatprod.1c00946. Epub ahead of print. PMID: 35007072; PMCID: PMC8768006. 

Oregon State research shows hemp compounds prevent coronavirus from entering human cells | Oregon State University 


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02/Jun/2021

Venous leg ulcers – also called “open leg” – are deep, poorly healing wounds on the lower leg. Older, chronically ill patients suffer most often from this disease. An additional therapy with topical cannabis-based medicines accelerates wound healing. A Canadian research team recently found this out in an open study. One reason for this is the cannabinoids tetrahydrocannabinol (THC) and cannabidiol (CBD), as well as flavonoids and terpenes, which are contained in the cannabis plant.

Why do patients get venous leg ulcers?

The disease occurs as a result of circulatory problems in the legs. Most often due to weakness of the leg veins. Here, the return transport of the blood to the heart is impaired. The ulcers are usually treated with compression bandages, which support the return transport of the blood. In addition, medicines applied externally to the skin, so-called topical medicines, are used to heal the wounds.

With these methods, however, the chances of complete wound healing are only 50 to 75 percent after six months of optimal treatment. The chance of the ulcers coming back within a year is 40 to 70 per cent. For this reason, patients must wear compression stockings as a preventive measure.

Some risk factors for venous leg ulcers are:

  • Chronic venous insufficiency (weakness of the leg veins)
  • Peripheral arterial occlusive disease
  • Reduced walking ability
  • Advanced age
  • Obesity
  • diabetes mellitus
  • High blood pressure

Complete wound closure in 79% of patients

The open study at a wound centre in Toronto involved 14 patients with a total of 16 wounds. The usual therapies such as compression stockings had not helped the study participants and the ulcers were on average older than six months. One patient had even been suffering from a wound for more than twelve years. The average age of the participants was 75.8 years and they had more complex concomitant diseases. In addition, most patients had risk factors for reduced wound healing such as oedema (water retention) and peripheral arterial circulatory problems.

Treatment was with compression bandages and topical cannabis-based medicines. The cannabis preparation was applied to the wounds and the adjacent area every two days by the patients themselves. The cannabis formulation contained the cannabinoids THC and CBD, the flavonoids quercetin, diosmin and hesperdin, and the terpene beta-caryophyllene.

The outcome of the treatment was very encouraging. Complete wound closure was observed in 11 patients (79 %) and 13 ulcers (81 %) after an average of 34 days of treatment. In the other subjects, advanced wound healing was observed. Side effects did not occur.

Interaction of cannabinoids, flavonoids and terpenes

The endocannabinoid system (ECS) plays an important role in wound healing. The anti-inflammatory effects of THC and CBD are mediated via the CB1 and CB2 receptors. These receptors are abundant in our skin. Cannabinoids also lead to a widening of the blood vessels, which improves tissue perfusion as well as oxygen supply.

The terpene beta-caryophyllene binds to CB2 receptors and also has an anti-inflammatory effect. The flavonoid quercetin can also accelerate wound healing and diosmin, hesperidin as well as flavonoids strengthen the veins.

Simple and safe wound treatment with topical cannabis medicines

The study shows that cannabis preparations for external use accelerate wound healing in venous leg ulcers. Even in wounds where conventional therapies no longer help properly, healing was accelerated significantly. Another advantage is the uncomplicated application, which patients can carry out independently at home. In the future, there will be further studies investigating topical cannabis preparations against other types of wounds.

Source:

Maida V, Shi RB, Fazzari FGT, Zomparelli L. Topical Cannabis-Based Medicines – A Novel Adjuvant Treatment for Venous Leg Ulcers: An Open-Label Trial. Exp Dermatol. 2021 May 19. doi: 10.1111/exd.14395. Epub ahead of print. PMID: 34013652.


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28/Apr/2021

According to the GAMSI report of the statutory health insurance funds in Germany, medical cannabis is becoming increasingly important in the treatment of diseases. In 2020, sales of cannabis-based medicines grew to 165 million euros. 16 million euros of this fell on March alone – the record month in terms of sales. Prescriptions of medical cannabis also increased in 2020 by 27 percent compared to the previous year. Cannabis flowers in unprocessed form or as preparations were prescribed most frequently. Prescriptions for cannabinoid preparations such as dronabinol capsules and finished medicines also rose sharply. From 2019 to 2020, the increase here was 76 percent.

Turnover of cannabis prescriptions increases by 34

In 2020, around 340,000 prescriptions for cannabis-based medicines, flowers and prescriptions were issued by doctors. This is an increase of 27 percent compared to around 267,000 prescriptions in 2019.

This also means an increase in gross sales, which climbed to 165 million euros. In 2019, medical cannabis recorded gross sales of 123 million euros. This means that sales increased by 34 per cent from 2019 to 2020.

Unprocessed cannabis flowers are preferred

The report of the statutory health insurance funds states that in 2020, unprocessed cannabis flowers and the preparations from cannabis flowers have the largest share of total gross sales with 43 percent. However, the number of prescriptions of these decreased by 9.7 percent.

More precisely, this means: unprocessed cannabis flowers are increasingly prescribed. From 2019 to 2020, prescriptions have increased from 91,229 to 100,090. That is an increase of 10.5 percent.

The situation is different for flower preparations. These fell from 43,952 in 2019 to 21,262 in 2020, a 51.6 percent reduction in prescriptions in one year.

Prescriptions for cannabinoid prescriptions and finished medicinal products increase

In 2019, 66,359 prescriptions for cannabinoid preparations (e.g. dronabinol capsule) and finished medicines were prescribed. This was the second highest value of all cannabinoid-containing medicines.

In the following year, the ratios changed significantly. If the prescription figures for unprocessed cannabis flowers and cannabis preparations are considered separately in 2020, cannabinoid and finished medicinal product prescriptions are the largest group with 117,171. Unprocessed cannabis flowers rank second and Sativex® ranks third.

Constant turnover figures in 2020

Turnover in 2020 is relatively constant at around 41 million euros per quarter. A year earlier in 2019, the turnover figures increased from quarter to quarter. In the first quarter of 2019, around 24.5 million euros were recorded. In the last quarter, these then rose to 36.6 million euros. This means that turnover grew by 67 %.

One reason for the increase in total annual sales from 2019 to 2020 is the approval of Epidyolex®. Epidyolex® is a cannabidiol-containing drug for rare forms of epilepsy in children (Dravet syndrome and Lennox-Gastaut syndrome). This was approved in Germany in October 2019. Other cannabis medicines include Canemes® and Sativex®, which generated steady sales.

Cannabis extracts are gaining in importance

Turnover with unchanged extracts, on the other hand, has increased. In the first half of 2020, i.e. from January to June, sales were 3.96 million euros. In the second half of the year, gross sales rose to almost 5 million euros. This corresponds to an increase of 26.1 percent.

 

Gross sales of finished cannabinoid-containing medicinal products and preparations

2019Gross sales in million euros*
1st quarter (January - March)24,5
2nd quarter (April - June)29,5
3rd quarter (July - September)32,3
4th quarter (October - December)36,6
Full year123

2020Gross sales in million euros*
1st quarter (January - March)41,9
2nd quarter (April - June)40,1
3rd quarter (July - September)40,1
4th quarter (October - December)42,7
Full Year165

* Rounded values

In what form is medical cannabis prescribed?

  • Unaltered cannabis flowers
  • Cannabis flowers in preparations: cannabis flowers crushed, sieved and, where appropriate, packaged in individual doses for inhalation after vaporisation or tea preparation.
  • Unmodified cannabinoid-containing substances such as cannabis extracts
  • Cannabinoid-containing substances or finished cannabis medicinal products in preparations: e.g. dronabinol in the form of drops and capsules; other finished medicinal products in preparations such as alcoholic inhalation solution or oily cannabis resin solution.
  • Imported cannabinoid-containing finished medicinal products: Marinol® (dronabinol capsules), Syndros® (dronabinol solution).
  • Cannabinoid-containing finished medicinal products: Canemes® (nabilone capsules), Epidyolex® (cannabidiol solution), Sativex ® (oral spray with tetrahydrocannabinol and cannabidiol).

 

The GAMSI report only contains the data of statutory health insurance patients. Data from private patients and self-pay patients are not statistically recorded here.

Sources:

https://www.gkv-gamsi.de/media/dokumente/quartalsberichte/2019/q4_21/Bundesbericht_GAmSi_201912_konsolidiert_Sonderbeilage_Cannabis.pdf

https://www.gkv-gamsi.de/media/dokumente/quartalsberichte/2020/q4_23/Bundesbericht_GAmSi_202012_konsolidiert_Sonderbeilage_Cannabis.pdf

https://www.deutschesapothekenportal.de/rezept-retax/dap-retax-arbeitshilfen/rezeptur/sonder-pzn/


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