As with many previous studies, patients largely reported reductions in their daily pain after starting cannabis therapy along with other benefits.  Notably, they reported “greater satisfaction” with cannabis, calling it “more effective” than their previous treatments. Researchers note that part of the intent behind the research is to explore “perspectives of patients whose experiences are not well enough known to date.”  Using a web-based survey of prescription cannabinoid patients, conducted between May 31, 2021 and June 2022, researchers conducted the research anonymously “to reduce treatment provider influence and stigma.

” Subjects were asked to complete questionnaires regarding their cannabis therapy twice in the same session, once for the time of the survey and another for the period prior to their cannabis treatment. Participants were asked to rate their daily pain levels, along with questions around the details of the cannabinoid prescription process — namely any issues they ran into obtaining the medication — and their general attitudes around cannabis. Chronic pain was the most common diagnosis, with 72% of participants indicating that pain relief was the primary reason for their prescriptions.

Germany is currently making waves in the global cannabis space for its pending legalization of recreational cannabis, though plant cannabis and cannabinoid treatments were legalized by prescription use in the country back in 2017. Cannabis medication is also typically only authorized when patients are unresponsive to traditional options. Researchers also note a study finding that the most common reason for German cannabinoid prescriptions from 2017 to 2022 was for pain. “The results of this cross-sectional study suggest that most of the surveyed outpatients treated with prescription cannabinoids in Germany subjectively experience health benefits and symptom reduction associated with these therapies,” researchers state in their discussion.

Across all diagnoses and symptom groups, authors report that participants shared positive effects on physical functioning, emotional states and quality of life. Additionally, they reported fewer problems around fulfilling their social roles and their pain symptoms were perceived to have a lesser impact on their daily lives. Satisfaction was rated by perceived effectiveness, side effects and overall satisfaction. Researchers suggest that the stress-reducing effect of cannabis drugs could be a “significant mediating factor,” in that opioids may have “more ambivalent effects on stress regulation because the kappa opioid receptor signaling pathway is activated by stress stimuli that produce both aversion and dysphoria in humans and other animal species.

” Prior to cannabis therapy, participants generally had a neutral to slightly positive attitude toward cannabis, which shifted to “predominantly positive” during therapy.  Most of the problems during the prescription process didn’t originate with physicians but rather with reimbursement issues involving health insurance providers. Approximately 25% of participants with statutory health insurance coverage reported that they opted to pay out of pocket. “This is likely due to the current legal situation in Germany, where the prescription of cannabinoid medications is characterized by significant complexity and administrative hurdles, comparable to those encountered when prescribing off-label drugs, both for patients and practitioners,” researchers said.

The study notes that comparable studies, in which German patients are directly questioned about cannabinoid therapy, are rare, with most surveys only questioning physicians. Those studies similarly found that pain was the main reason for cannabis prescriptions. Standing apart from much of the current research in the region, researchers note risk of selection bias, in that patients may have been more willing to participate in the study due to successful treatments. They also note potential “expectation bias,” in that the high access barriers for cannabinoid therapies in Germany give many eligible patients high expectations, which could lead to a more favorable evaluation of such therapies, among other potential limitations.

“This observational study nevertheless provides starting points for further discussion in the context of planning clinical cannabinoid trials and formulating appropriate research questions, involving the patients’ perspectives,” researchers concluded. Read less