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24/Feb/2021

Almost three quarters of the people who receive cannabis medicines on prescription in Germany use them to treat pain. Of these patients, 70 percent perceive an improvement in symptoms. This is shown by the interim result of the accompanying cannabis survey of the BfArM (Federal Institute for Drugs and Medical Devices).

What is medical cannabis used for?

With 73%, the lion’s share of all cannabis prescriptions in Germany is issued for the therapy of pain. This is followed at a great distance by the treatment of spasticity (10%), anorexia/wasting (6%) and other indications (10%). Doctors prescribe dronabinol in 65% of the cases, followed by cannabis flowers, Sativex, with an increasing tendency cannabis extracts and in last place nabilone.

Which specialist groups prescribe cannabis?

The largest group of doctors prescribing cannabis are pain physicians (anaesthesiologists) with a share of 49%. This is followed by general medicine (17%), neurology (12%) and internal medicine (10%).

How successful is cannabis therapy?

In the largest group of cannabis patients, those with pain as their primary symptom, 34% felt their pain was significantly improved and 36% felt it was moderately improved. Thus, medical cannabis was able to alleviate the suffering of a total of 70% of pain patients. 28% said their pain was unchanged.

Among people with multiple sclerosis as their main diagnosis, spasticity improved significantly in 41% and moderately in 43%.

35% of the cannabis patients discontinued their therapy within one year. In 25% of the cases, this was due to the side effects and in almost 40% due to insufficient effect of the therapy. In 21% of the cases, the person concerned died ­– this is also counted as a therapy discontinuation in the accompanying survey.

Private prescriptions not recorded

When looking at these results, it must always be kept in mind that the accompanying survey does not cover all patients treated with cannabis medicines in Germany: The data of self-payers, privately insured persons, inpatients and persons treated within the framework of clinical studies are not transmitted. Furthermore, no survey is compiled for persons who receive the finished medicinal products Sativex and Canemes according to the approved indications.

Accompanying cannabis survey – what is it?

In Germany, doctors who prescribe medical cannabis at the expense of the statutory health insurance are obliged to take part in an accompanying survey on the use of these medicinal products. The survey is conducted by the Federal Institute for Drugs and Medical Devices (BfArM). After three years, this institute has drawn up an interim balance with more than 10,000 data sets that were available by the evaluation deadline on 11 May 2020. One year earlier, the BfArM had already published an interim result based on the data evaluated by then.

The objectives of the survey are the monitoring of side effects and the tolerability of cannabis products. In addition, the survey is to show for which indications cannabis is prescribed. The results should serve as a basis for the planning of later clinical studies.

 

Source:

Schmidt-Wolf, G., Cremer-Schaeffer, P. 3 Jahre Cannabis als Medizin – Zwischenergebnisse der Cannabisbegleiterhebung. Bundesgesundheitsbl (2021). https://doi.org/10.1007/s00103-021-03285-1


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10/Feb/2021

A survey among people with Parkinson’s disease (PD) found that over 8 percent of PD patients use cannabis products. More than half of these people report a positive effect of cannabis treatment. The results are based on a survey from Germany.

Parkinson’s disease and cannabis: interest is high

Interest in the therapeutic use of cannabinoids to alleviate various symptoms is growing steadily – and this is also true for Parkinson’s disease. The survey was conducted among the members of the German Parkinson’s Association (Deutsche Parkinson Vereinigung e.V.).This is the largest association of Parkinson’s patients in German-speaking countries with almost 21,000 members. The researchers aimed to investigate the attitudes of people with Parkinson’s disease towards medicinal cannabis and to evaluate the experiences of patients who already use cannabis products. The research was published in the Journal of Parkinson’s Disease.

For the survey, researchers analysed more than 1,300 responses. These showed that the Parkinson’s community’s interest in medicinal cannabis is high, but knowledge on the subject is limited. At least 28 percent of the respondents knew about the different forms of intake, such as inhalation and oral intake. However, only 9 percent were aware of the difference between the active cannabis ingredients THC and CBD.

How does cannabis help with Parkinson’s disease?

More than 8% of survey participants reported using cannabis products, and more than half of these users (54%) reported a positive clinical effect. The general tolerability was good. More than 40 percent of the respondents said that it helped them with pain and muscle cramps. And more than 20 percent noticed a reduction in stiffness (akinesia), restless legs and tremors, as well as depression and anxiety.

Furthermore, it is interesting that the patients reported that inhaled cannabis products containing THC were more efficient in treating stiffness than oral products containing CBD. On the other hand, THC was slightly less well tolerated.

Cannabinoid treatment for Parkinson’s disease

Parkinson’s patients who used cannabis tended to be younger, lived in large cities and were better informed about the legal and therapeutic aspects of medical cannabis. 65 percent of the respondents who did not use cannabinoids before were interested in using medical cannabis. Lack of knowledge and fear of the side effects were given as the main reasons for not trying it.

“Our data confirm that patients with Parkinson’s disease have a high interest in treatment with medicinal cannabis, but they lack knowledge about how to take it and especially about the differences between the two most important cannabinoids, THC and CBD,” says study leader Prof. Dr. Carsten Buhmann, medical director of neurology at the University Medical Center Hamburg-Eppendorf (UKE). “Doctors should take these aspects into account when advising their patients about treatment with medicinal cannabis. The data reported here can help doctors decide which patients might benefit, which symptoms might be treated, and which type of cannabinoid and route of administration might be appropriate.”

Taking cannabis, Prof. Buhmann admits, could be associated with a placebo effect due to the high expectations of those affected. However, the medical doctor does not assess this negatively, because “even that can be seen as a therapeutic effect.” Nevertheless, he points out that the results of the study are based on subjective reports and that clinically appropriate studies are urgently needed.


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03/Feb/2021

Klagenfurt Clinic is currently using the cannabis substance CBD for covid patients – with good results. The anti-inflammatory and immune-strengthening properties of the cannabinoid are particularly interesting here. A study is already in progress, which should provide well-founded findings.

Positive results with CBD in covid patients

As reported by ORF, intensive care physicians at the Klagenfurt Clinic in Austria are achieving positive results with cannabidiol (CBD) in covid therapy. CBD is a highly interesting substance, also in the treatment of covid patients, explains Prof. Rudolf Likar, who is head of the department of intensive care medicine at Klagenfurt Clinic. CBD works in many ways. It has anti-inflammatory properties and can positively influence the immune system. In Klagenfurt, certain patients received CBD over a period of three weeks. Initially in a dosage of 200 mg, which was then increased to 300 mg.

“We saw that the inflammation parameters in the blood decreased and that people left the hospital faster than the comparison group. CBD supports the immune system,” Prof. Likar told ORF.

A study on the use of CBD is currently underway at Klagenfurt Clinic. Prof. Likar is satisfied with the data and results so far. Therefore, he wants to use CBD “probably routinely, just because it has no side effects.” The medical doctor explains that his team has been researching cannabidiol for quite some time. “It’s an interesting substance and Israel is even in the process of approving CBD for covid therapy. So we are not the only ones working with it.“

Cannabidiol (CBD) – a valuable cannabinoid

THC and CBD are the two main active substances of the cannabis plant. A large number of studies on the use of cannabidiol are already available and science has been able to gain many important insights. Since 2013, PubMed, a US medical research database, has indexed more than 1,500 studies on cannabidiol. This is another reason why many researchers consider CBD to be one of the most important cannabinoids discovered so far.

Unlike THC, CBD does not produce a high. When CBD is used in combination with THC, cannabidiol reduces the psychoactive effects and side effects of THC. Experts who have studied the relationship between CBD and the immune system have already outlined the positive effect of CBD in inflammatory and autoimmune diseases. In addition, there are studies that have investigated the effect of cannabidiol for the relief of chronic pain or for the treatment of epilepsy.

Other studies have shown that CBD can relieve pain and have a calming effect on people with cancer. Scientists have also found that cannabidiol can reduce cell growth in breast cancer.

 

Photo by Martin Sanchez on Unsplash


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27/Jan/2021

Cannabinoids enable pain patients to reduce or even completely discontinue opioids. This is the result of an American survey. In addition, cannabinoids can reduce the severity of pain. The vast majority of respondents experienced a higher quality of life and improved functioning thanks to the use of cannabinoids.

40 percent were able to stop all opioids

American researchers from the Society of Cannabis Clinicians in Sebastopol, USA, conducted an online survey of patients from three medical cannabis clinics. Of the total group of over 1,000 respondents, 525 had been taking prescription opioid medications in combination with medical cannabis for at least three months to treat their chronic pain.

Of these 525 people, about 40 percent reported that they had stopped all opioids thanks to taking cannabinoids. About 45 percent were able to reduce the amount of opioids. No changes in their opioid medication were reported by 13 percent and one percent had to take more opioids. About one third of the respondents reported that they were able to maintain the change in their opioid medication for more than one year.

The cannabis patients not only reported positively on the reduction of opioids – the pain intensity also decreased. Almost half (48%) felt 40 to 100 percent less pain. Nine percent did not notice any change in pain, while three percent experienced an increase in pain.

Clear majority gains in quality of life

Another particularly pleasing result of the survey is that the vast majority of respondents – namely 80 percent – felt an improved ability to function. And even 87 percent stated that their quality of life had improved with medical cannabis. Most of the pain patients (62%) did not want to take opioids in the future. While the change in pain intensity was not influenced by age and gender, the younger age group had improved functioning compared to the middle and older age groups.

Cannabis useful for chronic pain

The researchers therefore conclude that “cannabis may be a useful adjunct and substitute for prescription opioids” in the treatment of chronic pain. Furthermore, cannabinoids have the added benefit of improving functioning and quality of life.

According to the researchers, this is one of the largest surveys of its kind. The results show a remarkable percentage of patients reporting both complete discontinuation of opioids and a reduction in opioids with the addition of medical cannabis. The researchers hypothesise that these effects are due to the “synergistic pain relief shown when cannabis is added to opioids”.

 

Source:

Takakuwa K M, Sulak D (December 02, 2020) A Survey on the Effect That Medical Cannabis Has on Prescription Opioid Medication Usage for the Treatment of Chronic Pain at Three Medical Cannabis Practice Sites. Cureus 12(12): e11848. doi:10.7759/cureus.11848

Photo by Christine Sandu on Unsplash


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20/Jan/2021

CBD can reduce the symptoms of fibromyalgia, especially pain-related symptoms. This is shown by an online survey with 2,700 participants, mainly from the USA, who suffer from fibromyalgia. The survey also reveals that the use of cannabidiol (CBD) is widespread among people with fibromyalgia.

Many fibromyalgia patients use CBD

The anonymous online survey was conducted by researchers from the Department of Anesthesiology at the University of Michigan Medical School in Ann Arbor, USA. Overall, about 38 percent of respondents reported never using CBD, but 29 percent reported past use of CBD and 32 percent reported current CBD use. Thus, more than 60 percent of respondents have tried or are still using cannabidiol.

The people taking CBD mostly suffer from fibromyalgia symptoms that are not sufficiently relieved by their regular therapy. The patients who do not use CBD gave safety concerns as the main reason.

Two thirds of the interviewed patients who take CBD informed their doctor about it. It is noteworthy that only 33 percent sought medical advice on the use of CBD. Participants used CBD for many fibromyalgia symptoms, most commonly pain. CBD achieved mild to strong improvements in all symptom areas. About half of the respondents reported minor side effects.

Fibromyalgia – what is it?

Fibromyalgia often means severe pain, exhaustion, sleep disturbances and not infrequently psychological suffering. The symptoms of chronic pain syndrome are manifold and vary greatly from person to person. Many sufferers have great difficulty in coping with their daily lives and the level of suffering is very high. Some studies have already shown that the medical use of cannabis can have a beneficial effect on the symptoms.

The disease manifests itself through muscle and connective tissue pain, which is particularly expressed at certain pain points (tender points). The pain can occur all over the body, but usually shows up near the joints. In Germany, 2 percent of the population is affected by the chronic pain syndrome, women six to seven times more often than men.

Die Ursache der Erkrankung ist ungeklärt, medizinische Fachleute gehen aber davon aus, dass eine genetisch bedingte Krankheitsanfälligkeit eine Rolle spielt. Darüber hinaus können Traumata wie beispielsweise Misshandlungen im Kindesalter, aktuelle psychische Belastungen oder chronische psychische Belastungen wie Stress die Entstehung fördern.

The cause of the disease is unknown, but medical experts assume that a genetically determined susceptibility to the disease plays a role. In addition, traumas such as abuse in childhood, current psychological stress or chronic psychological stress such as stress can promote the development.

 

Source:

Boehnke KF, Gagnier JJ, Matallana L, Williams DA. Cannabidiol Use for Fibromyalgia: Prevalence of Use and Perceptions of Effectiveness in a Large Online Survey. J Pain. 2021 Jan 2:S1526-5900(20)30117-6. doi: 10.1016/j.jpain.2020.12.001. Epub ahead of print. PMID: 33400996.

Photo by Annie Spratt on Unsplash


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13/Jan/2021

Cannabidiol (CBD) can provide relief for Parkinson’s patients. This was shown in a study by the Department of Neurology at the University of Colorado School of Medicine in Aurora (USA). The motor symptoms of the disease were reduced, but also nighttime sleep and emotional disturbances improved significantly. However, liver enzymes elevated in some participants of the study due to the high dosage.

People with Parkinson’s disease can benefit from CBD

In the study, 13 people with PD and substantial rest tremor received herbal, highly purified CBD (Epidiolex; 100 mg/mL). The CBD extract was titrated from 5 to 20-25 mg per kilogram of body weight and maintained for 10 to 15 days. The patients had an average age of 68 years.

All 13 participants in the study reported mild side effects, such as diarrhoea (85%), somnolence (69%), fatigue (62%), weight gain (31%), dizziness (23%), abdominal pain (23%) and headache, weight loss, nausea, anorexia and increased appetite (5% each). Elevated liver enzymes occurred in five people, representing 38.5% of the total group.

Three people dropped out of the study due to intolerances. The remaining ten achieved an improvement in overall and motor scores. Other positive results were that nightly sleep and emotional or behavioural control disorders improved significantly. The researchers therefore conclude that CBD in the form of Epidiolex may be effective in PD. However, the relatively high dose used in this study was also associated with increases in liver enzymes.

Parkinson’s disease

Parkinson’s disease is the second most common neurodegenerative disease after Alzheimer’s disease. In Germany, about one percent of people over 60 are affected by the incurable disease. The medical treatment options are limited. Therapy is primarily aimed at alleviating the symptoms and improving the quality of life of those affected.

At the beginning of the disease, the symptoms are non-specific. These include pain in the shoulder or neck area or in the back, as well as a slowing down and decrease in movement. In addition, there is a rest tremor that begins on one side. In the course of the disease, the gait pattern changes. Those affected bend forward and take only small, short steps.

In addition to motor symptoms, sleep disturbances, pain in muscles and joints and depressive moods may occur. Later, affect lability, apathy, anxiety disorders and dementia may develop. These non-motor symptoms should not be underestimated, as they often severely limit the patient’s quality of life.

 

Source:

Leehey MA, Liu Y, Hart F, Epstein C, Cook M, Sillau S, Klawitter J, Newman H, Sempio C, Forman L, Seeberger L, Klepitskaya O, Baud Z, Bainbridge J. Safety and Tolerability of Cannabidiol in Parkinson Disease: An Open Label, Dose-Escalation Study. Cannabis Cannabinoid Res. 2020;5(4):326-336.

Photo by Hugo Delauney on Unsplash


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17/Dec/2020

According to estimates, up to nine million people in Germany suffer from migraines. Women are affected more often than men. Although migraine is one of the most common neurological diseases, its causes are not yet fully understood.

By definition, migraine is a type of headache in which there is a temporary functional disorder in the brain. This results in increased nerve excitability. In addition, more pain-triggering neurotransmitters are released in the brain, so that the vessels in the brain temporarily become inflamed.

The symptoms of migraine are expressed by an attack-like, pulsating and often hemiplegic headache. Often, sufferers also experience vegetative symptoms such as nausea/vomiting and sensitivity to noise or light.

About 15 per cent of sufferers also suffer from an aura phase, which occurs before the actual headache. In a few cases, there is no headache after the aura phase. Symptoms in the aura phase include flashes of light, double vision, blinding sensations, visual field defects, speech disorders and/or motor disorders. Perceptual disturbances are also possible, such as disturbances of the sense of colour or a magnification/reduction of objects.

Migraine: treatment and therapy options

According to the German Neurological Society (DGN) and the German Migraine and Headache Society (DMKG), painkillers such as ibuprofen, ASA, naproxen and diclofenac are effective for mild and moderate migraine attacks.

Triptans are used for severe migraine attacks, but their use is often accompanied by unpleasant side effects.

In the search for new treatment options, cannabinoid-containing medicines have increasingly become the focus of scientific attention in recent years. Various studies suggest that cannabinoids, especially cannabidiol (CBD) could be helpful in acute migraine attacks. This assumption is also supported by various experience reports and surveys.

New survey among migraine patients

Researchers at the University of Colorado in Boulder (USA) conducted an online survey with 161 migraine patients who have legal access to cannabis. The aim of the survey was to investigate the pattern of cannabis use and the associated improvement in migraine.

Seventy-six per cent of participants endorsed the use of cannabis to treat their migraines and 70 per cent of participants used over-the-counter painkillers as well as triptans in addition to cannabis.

The results state that migraine patients who used cannabis reported more severe attacks compared to patients who did not use cannabis. Compared to painkillers, cannabis was significantly more effective, according to the participants.

In the end, the researchers state that migraine patients experience a high degree of symptom relief through the use of cannabis. Future studies are needed to determine the cannabis forms, potencies and dosages that are most effective in treating migraines, they say.

Source:

Gibson LP, Hitchcock LN, Bryan AD, Bidwell LC. Experience of migraine, its severity, and perceived efficacy of treatments among cannabis users. Complement Ther Med. 2020 Nov 20;56:102619. doi: 10.1016/j.ctim.2020.102619. Epub ahead of print. PMID: 33227352.
https://pubmed.ncbi.nlm.nih.gov/33227352/

 


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09/Dec/2020

Two important judgments within a very short time create movement in the cannabis industry. Firstly, at the end of November, the ruling of the European Court of Justice (ECJ) provided clarity with regard to the sale of CBD products. This states that, according to the current state of scientific knowledge, cannabidiol (CBD), other than tetrahydrocannabinol (THC), does not appear to have psychotropic effects or harmful effects on human health.

Last week, the United Nations Commission on Narcotic Drugs (CND) officially recognised cannabis as a substance with “medical benefits”. Before that, cannabis was considered to be a substance with no or very little benefit. The Commission on Narcotic Drugs thus follows the recommendation of the World Health Organisation (WHO).

The Commission on Narcotic Drugs then voted by 27 votes in favour, 25 against and one abstention to classify cannabis as a substance with medical properties.

According to a media report, Yann Bisiou (assistant professor at the University of Montpellier-III and expert in drug law) made a statement on this historic reassessment:

“This is the first time since 1916 that cannabis has been recognised at international level as being of therapeutic interest. For a century, international conventions on drugs have consistently emphasised that this substance is dangerous and has no medical benefit whatsoever. In 2020, the UN declares that the opposite is true”.

Jürgen Neumeyer from the industry association Cannabiswirtschaft commented on the reclassification as follows:

“Following this international impulse, we expect to see worldwide facilitation in the handling of medical cannabis. We very much welcome this, as importers, growers and distributors can expect less bureaucratic hurdles in the future”.

Way to legalisation?

The decision of the Commission on Narcotic Drugs does not yet pave the way for legalisation of cannabis in the EU member states. Cannabis is still listed as a substance that must be strictly controlled, no longer in the highest category IV with heavy drugs like heroin, but still in subgroup I together with drugs like cocaine and methadone.

However, experts believe that the re-evaluation of cannabis could be a small step towards relaxation. Further developments remain to be seen, however.

In Deutschland bleibt der Besitz von Cannabis strafbar. In vielen Bundesländern werden die Ermittlungsverfahren jedoch häufig wegen Geringfügigkeit eingestellt.

In Germany the possession of cannabis remains a criminal offence. But, in many federal states, investigations are often dropped on the grounds of insignificance.

Sources:
https://www.gentside.de/gesundheit/uno-erkennt-medizinischen-nutzen-von-cannabis-an_art20477.html
https://www.dw.com/de/vereinte-nationen-bewerten-cannabis-neu/a-55807237

 


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02/Dec/2020

Professor Thomas M. Clark of the University of Indiana, while conducting the meta-analysis, found that cannabis use correlated with a decrease in various cancers, including head, neck and lung cancer and cancers associated with obesity. However, Clark also found that cannabis use was associated with a slight increase in testicular cancer.

Despite the interesting results, Clark says that these are not necessarily conclusive. This is due to the fact that the data sets were very heterogeneous. There were also not enough data sets for many types of cancer.

Risk factors for cancer types

Clark also noted that cannabis users tended to show a low rate of obesity. Obesity is a known risk factor for many cancers. He also noted that most cannabis users have a low rate of inflammation. This is also a risk factor for cancer. This finding is supported by previous research that has already shown links between cannabis use and a reduced risk of inflammation.

The results also showed that cannabis users tended to have improved insulin resistance and thus a lower risk of diabetes than non-users. This association could also contribute to a reduced risk of cancer. This is because poor insulin resistance and diabetes are associated with a higher risk of cancer, as well as faster cancer growth.

As a conclusion, Professor Clark summarised:

“The current analysis does not support the average recreational use of cannabis as an effective stand-alone cure for cancer. However, the results suggest that cannabis therapy added to established cancer treatment regimens not only significantly improves the quality of life of cancer patients, but could also improve the effectiveness of treatment without stimulating tumour growth”.

Clark added that cannabis use could potentially reduce the cancer-related death rate in the USA (around 600,000 people die of cancer every year). However, the available data would give little confidence in this conclusion. This is because there seem to be different responses among cancers. There would also be little or no data available for many cancers.

In addition, Clark notes that although a relationship between cannabis use and cancer can be proven, a causality cannot. Therefore, caution should be exercised in interpreting the data.

Source:
https://www.liebertpub.com/doi/10.1089/can.2019.0095

 

 


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26/Nov/2020

The legal situation for the sale of products containing the cannabinoid cannabidiol (CBD) is still unclear in Germany. Cannabis with all its plant parts is subject to the German Narcotics Law (BtMG). Since CBD is not listed as an active substance in the BtMG, it could be assumed that it is therefore not considered a narcotic in the legal sense. However, there are different judgements on this.

However, a recent ruling by the European Court of Justice (ECJ) now provides clarity. In France, the entrepreneurs Sebastien Beguerie and Antonin Cohen-Adad were sentenced by the court in Marseille to 18 and 15 months imprisonment and a fine of €10,000 each for importing CBD-containing liquids for e-cigarettes from the Czech Republic and offering them for sale in France. Only hemp fibres and seeds may be used commercially here.

After the entrepreneurs appealed against the judgement, the proceedings finally reached the ECJ. This was to clarify the question whether the marketing of a CBD product manufactured in an EU Member State from the entire cannabis plant and not only from hemp fibres/seeds is compatible with EU law.

According to a report, the judges of the ECJ decided that the French law discriminates against competitors from other EU Member States. The reasoning stated that it could not refer to the free movement of goods when dealing with narcotics. This is because the marketing of narcotics is prohibited in all member states. An exception is the supervised trade in narcotics for scientific and medical use.

“On the other hand, the Court observes that the provisions on the free movement of goods within the European Union (Articles 34 and 36 TFEU) are applicable, since the CBD at issue in the main proceedings cannot be regarded as a ‘narcotic drug’”, the ECJ stated.

CBD has no harmful effects on health

The judges also stated that the terms “narcotic drugs” and “narcotic substances” are defined in the Convention on Psychotropic Substances and the Single Convention on Narcotic Drugs. While the cannabis plant is not mentioned in the first-mentioned Convention, the second Convention refers to the plant Cannabis Sativa L., which led the European Commission to conclude that the CBD, produced from the flowers and fruit of the plant, should be classified as a narcotic.

According to the ECJ, this interpretation by the EU Commission contradicted “the general spirit of that convention and to its objective of protecting ‘the health and welfare of mankind’”.

„According to the current state of scientific knowledge, which it is necessary to take into account, unlike tetrahydrocannabinol (commonly called THC), another hemp cannabinoid, the CBD at issue does not appear to have any psychotropic effect or any harmful effect on human health “.

For the CBD industry, the ECJ’s ruling is ground-breaking, as both European and national courts will be guided by it in the future.

Source:
https://www.apotheke-adhoc.de/nachrichten/detail/apothekenpraxis/eugh-cbd-ist-kein-betaeubungsmittel/?fbclid=IwAR3t-oEnXrFnJLWrGOZCqCKIE6iuQd_DSzR5BPiXndIHn4OYnpkFkdN2GAM

 


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