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Hochdosisdronabinoltherapie vs. Medizinalcannabisblüten

High-dose dronabinol treatment vs. medicinal cannabis flowers

Zusammenfassung

Wir berichten über einen Fall einer ausgeprägten, chronifizierten Lumboischialgie, die sich unter konventioneller Therapie nicht zufriedenstellend schmerztherapeutisch einstellen ließ. Es werden der Schmerzverlauf unter hoch dosierter Dronabinoltherapie mit oraler und inhalativer Applikation sowie der Weg zur Kostenübernahme für Medizinalcannabisblüten, deren Therapieerfolg und Kriterien der wirtschaftlichen Verordnungsweise dargestellt.

Abstract

This article reports a case of pronounced, chronic lumboischialgia, which was not satisfactorily controlled by conventional analgesic treatment. The level of pain under high-dose dronabinol treatment with oral and inhalative administration as well as the way to reimburse the cost of medicinal cannabis flowers, the treatment success and criteria of the economic prescription procedure are presented.

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Literatur

  1. Abrams DI, Couey P, Shade SB et al (2011) Cannabinoid–opioid interaction in chronic pain. Clin Pharmacol Ther 90:844–851. https://doi.org/10.1038/clpt.2011.188

    CAS  Article  PubMed  Google Scholar 

  2. Azad SC, Huge V, Schöps P et al (2005) Endogenes Cannabinoidsystem: Einfluss auf neuronale Plastizität und Schmerzgedächtnis. Schmerz 19:521–527. https://doi.org/10.1007/s00482-004-0342-2

    CAS  Article  PubMed  Google Scholar 

  3. Azad SC, Zieglgänsberger W (2003) Was wissen wir über die Chronifizierung von Schmerz? Schmerz 17:441–444. https://doi.org/10.1007/s00482-003-0257-3

    CAS  Article  PubMed  Google Scholar 

  4. Barrie N, Manolios N (2017) The endocannabinoid system in pain and inflammation: Its relevance to rheumatic disease. Eur J Rheumatol 4:210–218. https://doi.org/10.5152/eurjrheum.2017.17025

    Article  PubMed  PubMed Central  Google Scholar 

  5. Brenneisen R, Egli A, Elsohly MA et al (1996) The effect of orally and rectally administered delta 9‑tetrahydrocannabinol on spasticity: A pilot study with 2 patients. Int J Clin Pharmacol Ther 34:446–452

    CAS  PubMed  Google Scholar 

  6. Chhatwal JP, Ressler KJ (2007) Modulation of fear and anxiety by the endogenous cannabinoid system. CNS Spectr 12:211–220

    Article  PubMed  PubMed Central  Google Scholar 

  7. ElSohly MA, Stanford DF, Harland EC et al (1991) Rectal bioavailability of delta-9-tetrahydrocannabinol from the hemisuccinate ester in monkeys. J Pharm Sci 80:942–945

    CAS  Article  PubMed  Google Scholar 

  8. Frondini C, Lanfranchi G, Minardi M, Cucinotta D (2007) Affective, behavior and cognitive disorders in the elderly with chronic musculoskelatal pain: The impact on an aging population. Arch Gerontol Geriatr 44:167–171. https://doi.org/10.1016/j.archger.2007.01.024

    Article  PubMed  Google Scholar 

  9. Grotenhermen F, Müller-Vahl K (2012) The therapeutic potential of cannabis and cannabinoids. Dtsch Arztebl Int. https://doi.org/10.3238/arztebl.2012.0495

    Article  PubMed  PubMed Central  Google Scholar 

  10. Grotenhermen F, Russo E (2002) Effects of cannabis and cannabinoids. In: Grotenhermen F, Russo E (Hrsg) Cannabis and cannabinoids: Pharmacology, toxicology, and therapeutic potential. Haworth Integrative Healing Press, New York, S 60

    Google Scholar 

  11. Han BH, Sherman SE, Palamar JJ (2019) Prescription opioid misuse among middle-aged and older adults in the United States, 2015–2016. Prev Med 121:94–98. https://doi.org/10.1016/j.ypmed.2019.02.018

    Article  PubMed  PubMed Central  Google Scholar 

  12. Häuser W, Finn DP, Kalso E et al (2018) European Pain Federation (EFIC) position paper on appropriate use of cannabis-based medicines and medical cannabis for chronic pain management. Eur J Pain 22:1547–1564. https://doi.org/10.1002/ejp.1297

    Article  PubMed  Google Scholar 

  13. Koch HJ (2017) Effective intermittent administration of nabiximols in a patient with autism (Asperger’s syndrome). Acta Med Median 56:102–104. https://doi.org/10.5633/amm.2017.0215

    Article  Google Scholar 

  14. Herdegen T, Horlemann J, Hornke I et al (2018) Expertenkonsens – Medizinischer Einsatz von Cannabinoiden. Lehre Prax 9:16

    Google Scholar 

  15. Huestis MA (2005) Pharmacokinetics and metabolism of the plant cannabinoids, ∆9-tetrahydrocannibinol, cannabidiol and cannabinol. In: Pertwee RG (Hrsg) Cannabinoids. Springer, Berlin, Heidelberg, S 657–690

    Chapter  Google Scholar 

  16. Huestis MA (2007) Human cannabinoid pharmacokinetics. Chem Biodivers 4:1770–1804. https://doi.org/10.1002/cbdv.200790152

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  17. Kathmann M, Flau K, Redmer A et al (2006) Cannabidiol is an allosteric modulator at mu- and delta-opioid receptors. Naunyn Schmiedebergs Arch Pharmacol 372:354–361. https://doi.org/10.1007/s00210-006-0033-x

    CAS  Article  PubMed  Google Scholar 

  18. Lehnhardt F‑G, Gawronski A, Pfeiffer K et al (2013) The investigation and differential diagnosis of Asperger syndrome in adults. Dtsch Arztebl Int. https://doi.org/10.3238/arztebl.2013.0755

    Article  PubMed  PubMed Central  Google Scholar 

  19. Leinwand KL, Gerich ME, Hoffenberg EJ, Collins CB (2017) Manipulation of the endocannabinoid system in colitis: A comprehensive review. Inflamm Bowel Dis 23:192–199. https://doi.org/10.1097/MIB.0000000000001004

    Article  PubMed  Google Scholar 

  20. Lindberg BW (2018) Policy series: The opioid epidemic and older adults: Pathways to elder abuse and justice. Innov Aging 2:433–434. https://doi.org/10.1093/geroni/igy023.1625

    Article  PubMed Central  Google Scholar 

  21. Lowin T, Straub RH (2015) Cannabinoid-based drugs targeting CB1 and TRPV1, the sympathetic nervous system, and arthritis. Arthritis Res Ther. https://doi.org/10.1186/s13075-015-0743-x

    Article  PubMed  PubMed Central  Google Scholar 

  22. Lucas P (2012) Cannabis as an adjunct to or substitute for opiates in the treatment of chronic pain. J Psychoactive Drugs 44:125–133. https://doi.org/10.1080/02791072.2012.684624

    Article  PubMed  Google Scholar 

  23. Mechoulam R, Ben-Shabat S (1999) From gan-zi-gun-nu to anandamide and 2‑arachidonoylglycerol: The ongoing story of cannabis. Nat Prod Rep 16:131–143

    CAS  Article  PubMed  Google Scholar 

  24. Muller C, Morales P, Reggio PH (2019) Cannabinoid ligands targeting TRP channels. Front Mol Neurosci. https://doi.org/10.3389/fnmol.2018.00487

    Article  PubMed  PubMed Central  Google Scholar 

  25. Nielsen S, Sabioni P, Trigo JM et al (2017) Opioid-sparing effect of cannabinoids: A systematic review and meta-analysis. Neuropsychopharmacology 42:1752–1765. https://doi.org/10.1038/npp.2017.51

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  26. Owens B (2015) Drug development: The treasure chest. Nature 525:S6–S8. https://doi.org/10.1038/525S6a

    CAS  Article  PubMed  Google Scholar 

  27. Remesic M, Hruby VJ, Porreca F, Lee YS (2017) Recent advances in the realm of allosteric modulators for opioid receptors for future therapeutics. Acs Chem Neurosci 8:1147–1158. https://doi.org/10.1021/acschemneuro.7b00090

    CAS  Article  PubMed  Google Scholar 

  28. Richardson JD, Aanonsen L, Hargreaves KM (1998) Hypoactivity of the spinal cannabinoid system results in NMDA-dependent hyperalgesia. J Neurosci 18:451–457

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  29. Russo EB (2001) The role of cannabis and cannabinoids in pain management. In: Weiner RS (Hrsg) Pain management: A practical guide for clinicians, 6. Aufl. CRC, Boca Raton, S 357–375

    Google Scholar 

  30. Russo EB (2011) Taming THC: Potential cannabis synergy and phytocannabinoid-terpenoid entourage effects: Phytocannabinoid-terpenoid entourage effects. Br J Pharmacol 163:1344–1364. https://doi.org/10.1111/j.1476-5381.2011.01238.x

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  31. Russo EB, McPartland JM (2003) Cannabis is more than simply ∆9-tetrahydrocannabinol. Psychopharmacology (Berl) 165:431–432. https://doi.org/10.1007/s00213-002-1348-z

    CAS  Article  Google Scholar 

  32. Schechter M, Pinhasov A, Weller A, Fride E (2012) Blocking the postpartum mouse dam’s CB1 receptors impairs maternal behavior as well as offspring development and their adult social–emotional behavior. Behav Brain Res 226:481–492. https://doi.org/10.1016/j.bbr.2011.10.016

    CAS  Article  PubMed  Google Scholar 

  33. Sharma P, Murthy P, Bharath MMS (2012) Chemistry, metabolism, and toxicology of cannabis: Clinical implications. Iran J Psychiatry 7:149–156

    PubMed  PubMed Central  Google Scholar 

  34. Siniscalco D, Sapone A, Giordano C et al (2013) Cannabinoid receptor type 2, but not type 1, is up-regulated in peripheral blood mononuclear cells of children affected by autistic disorders. J Autism Dev Disord 43:2686–2695. https://doi.org/10.1007/s10803-013-1824-9

    Article  PubMed  Google Scholar 

  35. Watanabe K, Yamaori S, Funahashi T et al (2007) Cytochrome P450 enzymes involved in the metabolism of tetrahydrocannabinols and cannabinol by human hepatic microsomes. Life Sci 80:1415–1419. https://doi.org/10.1016/j.lfs.2006.12.032

    CAS  Article  PubMed  Google Scholar 

  36. Gesetz zur Änderung betäubungsmittelrechtlicher und anderer Vorschriften. Bundesgesetzblatt Teil I 403

  37. Volcano (2016) Volcano Vaporizer – Hochleistungsverdampfer. https://www.volcanovaporizer.com/eu/de/about/. Zugegriffen: 22. Juni 2019

    Google Scholar 

  38. DGuSV (2019) Definition Gutachter/Sachverständige. https://www.dgusv.de/gutachter-sachverstaendige-definition.html. Zugegriffen: 22. Juni 2019

    Google Scholar 

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Correspondence to Christoph Wendelmuth.

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Interessenkonflikt

C. Wendelmuth: Referententätigkeit für Grünenthal GmbH, Kyowa Kirin GmbH, Aurora Deutschland GmbH. K. Gastmeier: Referententätigkeit für Bionorica ethics GmbH, Kyowa Kirin GmbH, Aurora Deutschland GmbH, Tilray Deutschland GmbH.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien. Für Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts, über die Patienten zu identifizieren sind, liegt von ihnen und/oder ihren gesetzlichen Vertretern eine schriftliche Einwilligung vor.

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Wendelmuth, C., Gastmeier, K. Hochdosisdronabinoltherapie vs. Medizinalcannabisblüten. Schmerz 33, 392–398 (2019). https://doi.org/10.1007/s00482-019-00402-7

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  • DOI: https://doi.org/10.1007/s00482-019-00402-7

Schlüsselwörter

  • Dronabinol
  • Hochdosis
  • Cannabidiol
  • Cannabisblüten
  • Lumboischialgie

Keywords

  • Dronabinol
  • High-dose
  • Cannabidiol
  • Medical marijuana
  • Low back pain