General practitioner Kurt Blaas has specialized in cannabis medicine for twenty years. We spoke with him about the legal situation, leading countries, and the advantages of natural cannabinoids.
Key topics at a glance:
- Natural cannabinoids have broader and more effective effects compared to chemical substances.
- Cannabis flowers contain approximately 80 different cannabinoids with diverse spectra of effects and can be easily used for therapeutic purposes. If allowed, pharmacists could straightforwardly and affordably produce an extract.
- Hemp varieties with specific cannabinoid compositions can now be standardized, cultivated, and propagated. This allows for the production of extracts that can be precisely used and dosed by doctors.
- Leading countries in the use of medicinal cannabis are the Netherlands and Canada.
They have been employing cannabis in medicine for about 20 years. What experiences have you made?
My patients want something that works well without side effects. Through careful selection of cannabis substances and under medical supervision, this is easily achievable today. Natural cannabis substances, in particular, can be much more effectively used than chemical substances. Teas and drops made from natural cannabis substances are very well tolerated and easy to use, especially for older and chronic patients. We have our own endocannabinoid system in the body, which is very well attuned to natural cannabinoids. Natural cannabinoids work better and more broadly.
What is the advantage of using natural cannabinoids in medical practice?
A natural substance is closer to the human body and its biological processes than a purely chemically produced substance. Studies with purely synthetic cannabinoids have also shown that side effects can occur, which do not occur with natural cannabinoids.
Why is natural cannabis not legalized for medical treatment in Austria?
Primarily because of the Single Convention (UN Convention against Narcotic Drugs) from the 1970s, introduced by the WHO. I t states that cannabis as a plant should not be used either recreationally or medically. The UN International Narcotics Control Board influences the legislation of national governments. The Austrian legislature believes it is doing everything correctly here and wants to be correct, to the detriment of research and patients. Cannabinoids are not panaceas, but they often work excellently, and without burdensome side effects. This fact is ignored by the legislature.
How high do you estimate the demand for cannabis medications?
Currently, about 7,000 to 10,000 people in Austria are being treated with cannabinoids. Demand is rising sharply, and I estimate that 25,000 people are interested in this medicine. The demand is enormous; what is lacking is a new legal framework and affordable supply.
Dronabinol, produced in Germany from natural THC, is unaffordable for many patients. What makes Dronabinol so expensive?
The elaborate manufacturing process and cumbersome production and supply chain. Tetrahydrocannabinol (THC) must be extracted from hemp for production, and this extraction undergoes a purification process. The high-quality product becomes so expensive due to the many chemical purification steps. Additionally, intermediaries further increase the cost through their work steps..
Does THC, such as in Dronabinol, have the disadvantage, like all monosubstances, that all other potentially effective cannabinoids are not used in application and effect? Do we need the whole flower in medicine?
Yes, we definitely need the flower as raw material to produce standardized extracts with normalized values. Cannabis flowers contain around 80 different cannabinoids and 500 ingredients with diverse spectra of effects, which can be easily used for therapeutic purposes, whether in the form of drops, teas, or cannabis butter. Vaporization is also sensible for inhalation. I reject smoking because it produces combustion products that sooner or later attack the lungs. If the flower were allowed, pharmacists could easily and affordably produce an extract. Hemp varieties with specific cannabinoid compositions can now be standardized, cultivated, and specifically propagated. This makes it easy to produce an extract that I, as a doctor, can use and dose very precisely.
Which countries have, in your opinion, best solved the issue of medicinal cannabis?
A model country in Europe is the Netherlands, where highly qualified medicinal cannabis is grown and distributed in pharmacies in a quality-controlled form. Many doctors there are adept in the application and dosing and have long since learned to use vaporizers for medical purposes. Overseas, Canada stands out for its use of various medicinal hemp varieties. The state promotes education, and thousands of doctors have understood this type of medicine and provide it to their patients, accompanied by scientific monitoring programs.
What are the most common prejudices against cannabis in medicine?
That cannabis serves as a gateway drug to the population, is addictive, and quickly alters the psyche of the consumer. This is a lack of education. The fact is that we have long known that only people predisposed to mental illnesses can be affected. When cannabis is taken in therapeutic doses, no physiological functions are disturbed or organs damaged.
Why is pharmaceutical interest in medications with cannabinoids so low?
I don’t see it that way. The debate and sale of cannabidiol show that there are already many, albeit small, providers distributing this medication. Large pharmaceutical companies like Bionorica and GW Pharmaceuticals want to succeed with their products in the global market. Ultimately, for many companies, it’s a question of profitability: Do large-scale studies on the production of finished cannabinoid drugs pay off or not?
What legislative changes do you wish for your patients?
Laws must be changed so that in the medical field, the approval of all cannabis products—whether synthetic or natural—is possible for patients. Medicinal hemp in geriatrics would be very worthwhile. Many studies have shown that older people can benefit immensely from cannabis products, such as improved sleep quality, reduction of geriatric depression, pain relief, appetite stimulation, and weight gain. After legalization and liberalization in Austria, cannabis products could be affordable and, above all, easy to use. However, the current legal situation prevents this.
Why are cannabis medications still so sparsely used by doctors?
This is due, on the one hand, to current education—cannabinoids and their medical application possibilities are not covered in the entire medical curriculum—and, on the other hand, many colleagues are poorly informed and therefore biased against therapy. Especially in rural areas, despite good experiences with Dronabinol, doctors fear being stigmatized as “drug doctors”. This requires a lot of education and patients who ask questions and demand change.
Infobox
Dr. med. univ. Kurt Blaas (58) has specialized in cannabis medicine as a general practitioner and practical doctor since 1998. The practical doctor has been treating patients in his Vienna practice for twenty years with synthetic and natural cannabinoids and is considered a pioneer in cannabis medicine. Kurt Blaas, together with psychiatrist and neurologist Thomas Herrmann-Meng, founded the Cannabis as Medicine Working Group and is its chairman. The Cannabis as Medicine Working Group advocates for cannabis and cannabis products to be obtained with a simple prescription from any pharmacy within the framework of a medically justified need and under medical prescription. The association also advocates that affected individuals or their caregivers be allowed to cultivate, harvest, possess, and consume medical hemp with appropriate medical certification.