EUFAS survey 2017 Medical cannabis in Europe Jørgen G. Bramness, Geert Dom, Toni Gual, Karl Mann, Frieder Wurst

Low evidence supporting the use of cannabinoids in the treatment of Moderate evidence supporting use of cannabinoids in the treatment of chronic pain and spams Low evidence supporting the use of cannabinoids in the treatment of Nausea and vomiting following chemo therapy Wasting after HIV/AIDS Insomnia Tourette's syndrome Associated with increased risk of acute adverse events

Medical cannabis in US

Aim of study To what extent is cannabis and different types of derivatives allowed for medical use in Europe pr. summer 2017? What products have a market authorization? To what extent do clinicians interview about cannabis use?

Method Web-based survey in member societies 2 waves: all 26 member societies asked to name up to five responders If no answer 2-3 reminders Personalized e-mail to these (to avoid spam-filter) Asking any EUFAS council members for additional contacts

Material 28 responders from 17 European countries Where > 1 response – a collapsed response constructed unclear or obviously faulty answers rechecked Supplied by web-information: http://www.talkingdrugs.org/interactive-map-medical-cannabis-in-the-european-union Still --- these are preliminary results

Medical cannabis products Synthetic cannabis Cannabis extract Standardized cannabis Growing for personal use Wild type cannabis Nabilone Dronabinol (Marinol; synthetic THC) Nabiximol (Sativex) Bedrocan, Bedrobinol, Bediol, Bedrolite, Bedica

General clinical awareness of cannabis? Do clinicians ask about: Frequency of cannabis consumption Quantities consumed on a typical smoking occasion  (grams of cannabis, number of joints, etc) Derivate type consumed (e.g. marijuana, hashish, etc.)   Usual administration form (e.g. smoking, happing, eating etc.) Co-use of tobacco Potencies used (e.g. % of 9-THC, other information indicative of the potency like indoor / outdoor cannabis, Indica / Sativa etc.) Source of cannabis  (e.g. street cannabis, self cultivation, etc) Response Points Never Rarely 1 Sometimes 2 Very often 3 Always 4 Don´t know missing Average Interviewing score 0-4

Marked authorization of cannabis products for medical use in Europe Country (number of responders) Synthetic cannabis (Marinol, dronabinol) Cannabis extract (nabiximol; Sativex) Standardized cannabis (Bedrocan, Bedrolite etc.) Growing for personal use Wild type cannabis Austria (2) yes no Belgium (1) Croatia (web) unclear Cyprus (web) Czech Republic (web) Denmark (1) Finland (2) France (1) Germany (2) Greece (web) Ireland (web) Italy (1) Lithuania (2) Malta (web) Netherlands (1) Norway (5) Poland (1) Portugal (1) Romania (1) Russia (1) Slovenia (web) Spain (3) Sweden (1) United Kingdom (1)

Uses of cannabis products Synthetic cannabis Cannabis extract Standardized cannabis Growing personally Wild type cannabis Labelled use Glaucoma Nausea (chemo) Vomiting Pain (also MS) Spasticity (MS) Palliative medicine Tourette Pain (neuropathic and MS) Multiple sclerosis (spasticity; some only treatment resistant) Spasticity in other neurological disorders HIV/AIDS Depression Sleeplessness   Off-label use (other) Cannabis use disorder Mental disorders Cannabis use disorders Inflammatory bowel disorder Cancer glioma Treatment-resistant epilepsy Many indications (more diffuse mentions) Intoxication purposes Muscle pains Spasms Stress Spain: cannabis clubs

Nabiximols; Sativex in Europe http://philarcher.org/diary/2013/euromap/ Answers Yes unclear No No answer

Standardized cannabis in Europe (Bedrocan, Bedrolite etc.) http://philarcher.org/diary/2013/euromap/ Answers Yes unclear No No answer

Interviewing Score Country Interviewing score Sweden 0,71 Norway 0,73 Poland 0,86 Romania Austria 1,00 Belgium Denmark Germany Spain 1,19 Lithuania 1,21 United Kingdom 1,36 Portugal 1,43 Finland 1,50 Netherlands 1,57 France 3,00 Russia 3,71 Italy 3,75

Interviewing Score Country Interviewing score Sweden 0,71 Norway 0,73 Poland 0,86 Romania Austria 1,00 Belgium Denmark Germany Spain 1,19 Lithuania 1,21 United Kingdom 1,36 Portugal 1,43 Finland 1,50 Netherlands 1,57 France 3,00 Russia 3,71 Italy 3,75

Non-response Or talk to me in the break! j.g.bramness@medisin.uio.no Albania Belarus Bosnia Bulgaria Check republic (web) Croatia (web) Estonia Greece (web) Hungary Iceland Ireland (web) Kosovo Latvia Luxembourg Macedonia Moldova Montenegro Serbia Slovakia (web) Slovenia Switzerland Ukraine j.g.bramness@medisin.uio.no Please send an e-mail! Or talk to me in the break!

Conclusion Nabiximols are available throughout many European countries Standardized cannabis is available in 3 countries only Home grown and wild type not readily available 5 countries have synthetic cannabinoids available Interviewing about cannabis obviously varies