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Regulation in Germany….and we aren’t talking about soccer :)

The current regulation in Germany made it difficult for German companies to apply to get a license for Cannabis cultivation.

** And that is why the process is now held up in litigation in the German court system. One of the unsuccessful bidders has sued over the requirements and the entire application process is on hold, with any potential awards being made in Q1 or Q2 2018 at the earliest.

What is the most popular model for cannabis cultivation in Germany, so far?
The cultivation in Germany is currently not legal, done outdoors and indoors and hidden from sight and smell as best as possible.

There is no legal German cultivation currently allowed, even for patients with valid medical approvals.

There is small cultivation being done as part of R+D projects in Universities and Scientific companies.

Regarding joint ventures: How do foreign cannabis companies usually work together with German companies?

In various ways, based on their business objectives and strategy. Three examples are:

Canopy Growth Corporation purchased a German firm Medcann, which became Spektrum Germany. They are considered by many to be the premier cannabis firm in Germany today.

Maricann of Canada purchased a former cargo facility in Dresden for 3€ million and is ramping up their European operations, adding staff, and building out their new European headquarters.

An international firm is currently in discussions with a German startup, to establish a joint venture partnership which will make news around the world. This partnership should be made public in early 2018 and will be ground-breaking.

To cover the demand of medical cannabis Germany is importing from other countries. Supply is coming especially from Canada. Which other countries might be relevant cannabis suppliers in the future?

Canada and The Netherlands are currently the only authorized countries to import into Germany. Supplies are seriously constrained and with Canada becoming a legal recreational country in July 2018, the supply bottlenecks are expected to be exacerbated well into 2019.

Tilray has announced plans to establish a cultivation facility in Portugal to supply the German, and European market in the future.

The governments of Greece, Israel, South Africa, Australia, Chile, Uruguay, and others are currently working with private sector companies to establish their own cultivation and export capabilities.

Germany, with twice the population of California, is a key market for any serious player in the global cannabis industry.

What is your personal opinion about the current German regulation. What will be the next major steps?

Regulation and taxation is always better than the illegality and violence of the black market. Always.

Thank God for the German court system which has brought legalized medical marijuana to the people, if it were up to the politicians, we would still be waiting.

Now the intelligent implementation of recreational laws need to be established to legalize the plant which has been used for thousands of years.

Reducing opioid deaths, helping certain people with their medical conditions, and enabling super-straight people to enjoy jazz music are just some of the benefits of a world where ganja is regulated, safe, and profitable.

The flower of cannabis will always have a place in the market, but in the next years we will see an increase in other forms of cannabis that are more easily consumed….edibles, oils, salves and the like. As a result, GMP (Good Manufacturing Process) certification is going to become very important for those wanting to establish a quality product in the German and European markets.

And if we look at the European Cannabis market. Which major market trends do you identify?

1- Everyone seems to be focusing on cultivation, but this segment is expected to become a commodity item in the near term. Companies may want to look at establishing a product line including “finished products with GMP certification” to become a leading force in this market.

2- At some point the insurance companies are going to become true partners in providing cannabis therapies to the German pharmacies. This will happen as a result of cost-savings and health-benefits realized vs. the current pharmaceuticals offered to patients.

3- In the words of Peter Tosh:
“Legalize it.”

The Berlin Peace Accords (attached) calls for an end to the 80 year World War On Cannabis, and we agree. Legal, regulated, safe and non-violent recreational marijuana markets have already been established in the US and Uruguay, with Canada and others joining the party in 2018.

Pharmaceutical companies don’t like it, Beer companies don’t like it (although the owners of Corona beer just invested $250 million in Canopy Growth’s cannabis business last month) and some short-sighted politicians don’t like it. But “We the People…” have made our opinions known and the calls for a rational, legal, safe and non-violent cannabis market is just a few moments away here in the center of Europe.

These are historic times, Germany is leading the world in many ways, 2018 will be an interesting year.

peace,
Phil

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MERKEL GETS RELIGION on the 500-year anniversary of Martin Luther’s Reformation project. Legalized marijuana in Germany now on the horizon.

Cannabis Consultant in Germany

Cenedella.DE

October 31, 2017

As many Americans start the day making plans for Halloween 2017, the folks here in Germany have the day off of work to celebrate the 500-year Anniversary of Martin Luther’s project to reform German society. Surprisingly, the newspapers today also announced Chancellor Angela Merkel’s intentions, along with her new coalition partners called the “Jamaican coalition” to consider legalizing marijuana.

Seems an unintended benefit of the AFD’s victories in the last elections, is the CDU ruling party is now more receptive to working with those with divergent views in order to maintain their leadership position.

Could this really be the start of the Reformation of the 20th century drug laws in Germany and beyond?

Has the work of the DHV in Berlin and their partners finally started to pay dividends?

Was the signing of the BERLIN PEACE ACCORDS http://www.berlinpeaceaccords.de , which begins with “We the people of the Year 2017 do…
Hereby declare that it is our inalienable basic human right to have the freedom to grow, medicate and enjoy the plant we call Cannabis, without any governmental limitations.
We demand our plant has no more regulations or limitations than a tomato plant…..” really have been the precursor to this historic moment?

Good questions, time will tell, but for sure our collective efforts as cannabis business executives are starting to pay dividends.

The month of October had started off with over 350 doctors, scientists, investors and industry professionals waking up in view of the massive Cologne Cathedral, which is truly an amazing sight to see in person! The International Association for Cannabinoid Medicines’ (IACM) CANNABINOID CONFERENCE was held in downtown Cologne bringing together experts from Canada, Australia, Germany, and from throughout the world. Their website is http://www.cannabis-med.org and three take-aways were:

The idea that “Marijuana has no medicinal value” was pretty much, fully debunked 😊

The breath and quantity of existing “clinical trials” on our plant is amazing.

Meeting Josh Stanley, whose company has arguably helped more medical marijuana patients than anyone, was a privilege. CW Hemp’s team continues to lead the industry in many ways,…and additionally they are simply very cool people.

Later in the month, the folks from the regulatory and compliance organization ASTM came to Berlin for a 2-day intensive session for their new “Technical Committee D37 on Cannabis” section. You know we are becoming a real industry when 2 days is spent talking only about compliance related issues. Half the group was from Germany, including executives from the first licensed marijuana testing facility located within Germany, scientists from the University of Berlin currently working on marijuana clinical trials, and a few of the leading homegrown companies on the front lines including ABCann Germany, MH Hemp, Pedanois, and two guys who reminded me of what a young Ed Rosenthal would be like. 😊

So as November 2017 begins, many of us will meet in Berlin this weekend for the first annual DHV Convention. Their website is https://hanfverband.de and they are unequivocally the leading organization for marijuana reform in Germany today. This convention will probably confirm these four truths of the marijuana landscape in Germany today:

Canadian firms are kicking butt!
They understand the requirement of GMP certification, their government is supportive of providing qualified companies an export license for their THC-based products, and their executives are damn smart.

German firms are coming of age, are intelligent and committed.
The first DHV convention will be highlighting the work of patient advocates, industry professionals, knowledgeable physicians and forward-looking politicians involved in building this new industry within the German borders.

The European, South American, African, Israeli and Australian firms are all actively making plans to succeed.
Governments, investors, and executives from throughout the world are looking at Germany and making their plans to enter the European market with its 750+ million potential customers. They are forming strategic partnerships, investing in commercial facilities, and making Europe a priority for 2018.

The USA is an abysmal no-show in the game.
America started the war on Marihuana last century, and somehow tries to keep the war alive today. Scientist, Stoners and Society have evolved quite a bit since the 1930s. The Germans have taken note, changed course in their direction, and their people will be better off as a result.

Maybe now it’s time for President Trump get religion and start his own Marijuana Reformation project?

– Philip J. Cenedella


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“My fellow conservatives should protect medical marijuana from the government” – U.S. CONGRESSMAN DANA ROHRABACHER

http://www.philly.com/philly/opinion/commentary/conservatives-medical-marijuana-veterans-ptsd-20170906.html?mc_cid=3df8db3886&mc_eid=cd290ff91e

by Dana Rohrabacher

Not long ago, a supporter of mine visiting from California dropped by my Capitol office. A retired military officer and staunch conservative, he and I spent much of our conversation discussing the Republican agenda.

Finally, I drew a breath and asked him about an issue I feared might divide us: the liberalization of our marijuana laws, specifically medical marijuana reform, on which for years I had been leading the charge. What did he think about that controversial position?

“Dana,” he replied, “there are some things about me you don’t know.” He told me about his three sons, all of whom enlisted after 9/11.

Two of his sons returned from the battlefield whole and healthy. The third, however, came home suffering multiple seizures each day. His prospects were bleak.

His medical care fell under the total guidance of the Department of Veterans Affairs, whose doctors came under federal restraints regarding the treatments they could prescribe. (Among the treatments allowed were opioids.) Nothing worked.

Finally, a sympathetic doctor advised our young hero to see him in his private office, where he could prescribe medication derived from cannabis. The prescription worked. The seizures, for the most part, ceased.

“Dana,” said my friend, “I could hug you right now for what you’ve been doing, unknowingly, for my son.”

What had I been doing? With my Democratic friend Sam Farr, the now-retired California congressman, I wrote an amendment to spending bills that prohibits the federal government from prosecuting medical marijuana cases in states where voters have legalized such treatment. The amendment passed two consecutive years, the second time with a wider margin than the first, and has been extended through continuing resolutions and an omnibus spending bill.

Surprisingly, given the Obama administration’s generally liberal approach to marijuana, its Justice Department tried to interpret the amendment in such a convoluted way as to allow counterproductive raids on marijuana dispensaries. The courts — most recently the U.S. Court of Appeals for the Ninth Circuit — repeatedly ruled that our amendment meant exactly what it said.

Unfortunately, my longtime friend Jeff Sessions, the attorney general, has urged Congress to drop the amendment, now co-sponsored by Rep. Earl Blumenauer (D., Ore.). This despite President Trump’s belief, made clear in his campaign and as president, that states alone should decide medical marijuana policies.

I should not need to remind our chief law enforcement officer or my fellow Republicans that our system of federalism, also known as states’ rights, was designed to resolve just such a fractious issue. Our party still bears a blemish for wielding the “states’ rights” cudgel against civil rights. If we bury state autonomy in order to deny patients an alternative to opioids, and ominously federalize our police, our hypocrisy will deserve the American people’s contempt.

More than half the states have liberalized medical marijuana laws, some even decriminalizing recreational use. Some 80 percent of Americans favor legalization of medical marijuana. Only a benighted or mean-spirited mind-set would want to block such progress.

Despite federal efforts to restrict supply, studies continue to yield promising results. And mounting anecdotal evidence shows again and again that medical marijuana can dramatically improve the lives of people with epilepsy, post-traumatic stress disorder, arthritis, and many other ailments.

Most Americans know this. The political class, not surprisingly, lags behind them.

Part of the reason is the failure of too many conservatives to apply “public choice economics” to the war on marijuana. Common sense, as well as public choice theory, holds that the government’s interest is to grow, just as private-sector players seek profit and build market share.

The drug-war apparatus will not give ground without a fight, even if it deprives Americans of medical alternatives and inadvertently creates more dependency on opioids. When its existence depends on asset seizures and other affronts to our Constitution, why should anti-medical-marijuana forces care if they’ve contributed inadvertently to a vast market, both legal and illegal, for opioids?

I invite my colleagues to visit a medical marijuana research facility and see for themselves why their cultural distaste might be misplaced. One exists near my district office at the University of California, Irvine, another at the University of California, San Diego.

Better yet, they might travel to Israel — that political guiding light for religious conservatives — and learn how our closest ally in the Middle East has positioned itself on the cutting edge of cannabis research. The Israeli government recently decriminalized first use, so unworried is it about what marijuana might do to its conscript military.

My colleagues should then return to Washington and keep my amendment intact, declaring themselves firmly on the side of medical progress. Failing that, the government will keep trying to eradicate the burgeoning marijuana business, thereby fueling and enriching drug cartels. Trust me: Hugs from grateful supporters are infinitely better.

Republican U.S. Rep. Dana Rohrabacher represents California’s 48th District. He wrote this for the Washington Post.


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Cannabis Shows Promise In Treating Schizophrenia And Tourette Syndrome

Cannabis Shows Promise In Treating Schizophrenia And Tourette Syndrome – by Janet Burns

Despite cannabis’ history in folk pharmacopoeias, clinical studies of its medicinal impact remain limited in many areas. Based on some promising early results, researchers are now calling for a closer look at its applications for certain mental health conditions for which more ‘traditional’ treatments have come up short.

According to recent studies, the cannabis-derived chemical cannabidiol (CBD) may offer meaningful relief with schizophrenia, a frequently chronic condition which can significantly interfere with how we think, feel, and behave.

At the University of Wollongong, researchers first discovered that CBD could provide new kinds of symptom relief for schizophrenic individuals by examining what science has uncovered about the chemical so far. To get a sense of CBD’s impact on cognitive function in relation to schizophrenia, Dr. Katrina Green, Professor Nadia Solowij, and Wollongong Ph.D. candidate Ashleigh Osborne conducted a detailed review of 27 extant studies on the chemical and uncovered some “fascinating insights” about its potential therapeutic value.

In a release, Green commented that CBD could provide direct neurological support for a range of conditions affecting the brain, from schizophrenia to dementia. “From this review, we found that CBD will not improve learning and memory in healthy brains, but may improve aspects of learning and memory in illnesses associated with cognitive impairment, including Alzheimer’s disease, as well as neurological and neuro-inflammatory disorders,” including hepatic encephalopathy, meningitis, sepsis, and cerebral malaria.

Green, who led the review, also noted that CBD may well be capable of reducing cognitive impairment that has been associated with THC, the main psychoactive component of cannabis, which has previously shown a potential to aggravate aspects of schizophrenia, anxiety, and other mental disorders.

Following the review, the researchers decided to put CBD’s potential for easing cognitive schizophrenia symptoms to the test with their own study using a rat model. With help from Senior Professor Xu-Feng Huang and Ph.D. candidate Ilijana Babic, what they found was that “chronic” administration of CBD seemed to attenuate the cognitive deficits and social withdrawal that often afflict persons with schizophrenia, which the team simulated in rats using prenatal poly I:C infection.

“We found that CBD was able to restore recognition and working memory, as well as social behavior, to normal levels,” Osborne said in a release. “These findings are interesting because they suggest that CBD may be able to treat some of the symptoms of schizophrenia that are seemingly resistant to existing medications. In addition, CBD treatment did not alter body weight or food intake, which are common side effects of antipsychotic drug treatment.”

Osborne also explained to ABC News Australia, “This is really important because current antipsychotic drugs don’t address the cognitive deficits, which approximately 80% of patients with schizophrenia experience.”

According to the Australian team, the results of their review and study indicate some promising possibilities for treating schizophrenia with CBD, but also that more scientific research is definitely in order.

“This is the first study to prove Cannabidiol can be used to treat symptoms of schizophrenia that aren’t addressed by current medications,” Osborne told ABC News. “These findings are really promising but further research is needed to see if these findings translate to people suffering from schizophrenia.”

She added, “Ultimately, we hope that these findings lead to new improved medications.”

According to a recent study on schizophrenia and cannabis use, people with a greater risk for schizophrenia are likelier than others to keep trying the plant for themselves in the meantime.

In recent years, cannabis has also shown promise as a treatment for Tourette Syndrome, characterized by involuntary physical or verbal tics that are often physically or socially painful to endure.

A preliminary study published this year provided a retrospective evaluation of cannabis’ effectiveness and tolerability in treating adults with Tourette Syndrome. Conducted by researchers at the University of Toronto with support from the Tourette Association of America, the study found that 18 of 19 participants were at least “much improved” after a regimen of inhaled cannabis, while tics scores for the whole group decreased by 60%.

As NORML reported, all of the study’s participants experienced “clinically significant symptom relief,” including reductions in irritability, impulsivity, anxiety, obsessive-compulsive symptoms, and rage outbursts. The drug was also well tolerated by the participants, with mostly minor side effects being reported.

Overall, the researchers wrote, “These study participants experienced substantial improvements in their symptoms, [which] is particularly striking given that almost all participants had failed at least one anti-tic medication trial. … In conclusion, cannabis seems to be a promising treatment option for tics and associated symptoms.”

As NORML pointed out, research has previously determined that oral doses of THC have helped to decrease tics and obsessive-compulsive behavior in patients with Tourette Syndrome by a hearty margin. Patients using inhaled cannabis, however, have “generally shown greater overall improvement.”

Given that cannabis and the chemicals it contains have demonstrated promise or proven effectiveness in treating such ailments as pain, nausea, mental illness, multiple sclerosis, neuropsychiatric disorders, epilepsy, and various symptoms thereof, many patients and practitioners are hoping that the Trump Administration will allow more research on the plant going forward.

In recent months, however, members of the administration have indicated a desire to rather crack down on the drug’s medicinal and recreational usage, at times due to the opinion–or, perhaps more accurately, the notion–that marijuana is not a medicine.

According to Merriam-Webster, a medicine is “a substance or preparation used in treating disease;” according to our own CDC, medicines are “used to treat diseases, manage conditions, and relieve symptoms.”

As the CDC points out, medicines can also contain a number of different drugs, and thereby pose different health risks depending on each patient. For example, over-the-counter (OTC) pain medicines like Tylenol and Excedrin contain the drug acetaminophen, which can easily be overdosed on (and/or do real liver damage) by doubling the dose once or twice, regardless of its interactions with other drugs, while over-dosing or incorrect use of OTC’s like Advil and Aleve, which contain drugs called NSAIDs, cause tens of thousands of hospitalizations each year, and thousands of deaths, though exact estimates vary.

Nevertheless, these drugs continue to be available as medicines because their perceived benefits are thought to outweigh the risks involved in taking them–an assessment which is critical for both doctors and drug manufacturers to perform, according to the FDA.

And since research and experts have consistently suggested that the potential benefits of cannabis would far outweigh the risks and side-effects involved–enough to warrant further study, in the very least–hopefully our elected officials and appointed administrators will realign their sense of the plant with science’s definition soon.

Janet Burns covers tech, culture, and other fun stuff from Brooklyn, NY. She also hosts the cannabis news podcast The Toke.


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“It’s California in 1995 All Over Again, Man” – Opportunities and Problems Piling Up in the European Cannabis Market – from Cannabis Business Executive magazine / Philip J. Cenedella IV

“It’s California in 1995 all over again, man.”

That was a comment I overhead during a conversation between an American and a German entrepreneur at the Mary Jane Berlin event held in Berlin in the second week of June, 2017.

Indeed, there may not be a better way to sum up the current state of the state here in Europe’s most populous country. Having been on the frontlines of the grassroots efforts in San Diego last century, it is fun to see how our industry is now growing in Germany and throughout Europe.  And like California back then, or now, the struggle is not always easy.

Here’s another interesting quote of the month:

“European markets are increasingly important to the cannabis sector. Each has a well-funded medical system, residents who seek natural and complementary therapies, and a government-supported mandate to stop the rising tide of opiate addiction related to chronic pain treatment.”

-Benjamin Ward, CEO, Maricann Group, Inc.

As of August, 2017 starts, the medical marijuana patients in Germany are experiencing “sold out” conditions nationwide, and the two exclusive importing countries (Canada and the Netherlands) are anticipating further bottlenecks as their in-country supply needs change. This is a significant problem – but also an opportunity for GMP-certified growers to fill the gap. If, and how, the German government opens up alternative supply to support their medical patients will be the top story in Germany this year.

From the patients perspective, there are two bad things about the current state of affairs: Little to no choice in their required medicine and their insurance companies are now refusing to cover the costs for the medicine as stipulated in the federal law.

Of course, lawyers are now getting involved and insurance companies are starting to be forced into approving valid claims from their policy-paying customers. But it is a silly, slow process to say the least.

The solution the German government is pursuing is to award 10 grow licenses to companies that will then produce 200 lbs. cannabis ​each within the country. The first bud from those plants are not scheduled to be picked until sometime in 2019, which is simply too long for patients to wait.

Some of the companies that have been publicly mentioned as potential winners of a grow license are Spektrum Cannabis, which is the Canopy Growth company formerly known as MedCann; Maricann GmbH, which is the new German subsidiary of its Canadian parent, Bedrocan, that has been a leader in the industry but recently run into a dispute with their Canadian licensee, Bedrocan International; Aurora Cannabis from Canada, which recently acquired the German firm Pedianos adding an EU-wide, medical marijuana distribution capability; and ABCann of Canada, which touts the “Father of THC” Dr. Raphael Mechoulam as a key member of their board of directors.

Homegrow options in Germany are currently not permitted, and existing indoor/outdoor farm operations are not yet able to be registered, licensed and taxed.

The black market continues to win, and patients continue to lose.  Cannabis business executives worldwide need to effectively work with the German government to develop the solutions we all know exist.  Three organizations that are key to this effort are the BfArM (www.bfarm.de )  the DHV (www.hanfverband.de )  and the GTAI ( www.gtai.de )

My personal comment is the government, politicians and regulators here in Germany need to listen to their constituents who support our industry by over 60 percent nationwide, according to a recent poll. The total quantity of flower to be delivered by the 10 licensees is probably less than what my buddy Butch has in his building back in California to handle his patients which live within five miles of the office.

Yes I am joking, Butch usually has less, but the point is – ​it simply is not enough for a population twice the size of California.

With all the talk about Germany, it is also important to remember that it is one of 18 countries within Europe that currently allow for some form of medical marijuana.  Besides Germany, there are provisions for the distribution and use of medical products in Austria, Belgium, Czech Republic, Denmark, Finland, France, Greece, Israel, Italy, Luxembourg, the Netherlands, Norway, Portugal, Spain, Sweden, Switzerland and, the most recent addition, Poland.

This is an interesting list that, again, shows these are historic times here in Europe.

Sadly missing from the list above is the United Kingdom, and that has affected people we know. Our friend Vera Twomey, and her entire family had to leave the U.K. last month just to take care of their young daughter with Dravet’s Syndrome. In the U.K. their daughter suffered from up to 30 grand mal seizures a day while taking a regimen of pharmaceutical drugs.

Think about that for a moment – 30 grand mal ​seizures a day.

Now living as “medical refugees” from their homeland, the Twomey’s and their daughter are now dealing with zero grand mal seizures a day thanks to her medical marijuana.

30 grand mal seizures a day, now zero a day – everyday for the past 3-4 weeks.

The United Kingdom calls medical marijuana illegal. Patients and advocates call that thinking arcane, unjust, and possibly criminal itself. They are now petitioning the Human Rights Commission of the European Union in Brussels for help. I am positive their efforts will be successful – it is just a matter of time.

Vera and her family hope it comes within her daughter’s lifetime. That is all for now. Have a successful rest of the summer, rest up and get ready because I believe that Q-4 of 2017 is going to be a busy one for our industry and your company.

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How Medical Cannabis Could Treat Parkinson’s Disease – by Julie Godard

Over the past two decades, medical cannabis has become an alternative treatment option for many medical patients across the globe.

While medical studies in this area are by no means complete, there have been many promising findings both in the medical lab and outside of it, which may be indicators of future treatments that could be based on medical cannabis. A disease called Parkinson’s disease has recently moved to the forefront of medical investigation involving medical cannabis treatments.

What is Parkinson’s Disease?

Parkinson’s disease is a neurodegenerative brain disorder that occurs when there is a slow reduction in the amount of dopamine produced in the human brain’s nerve cells. Dopamine is the brain chemical that allows coordinated and smooth muscle movements in the body.

Because the disease affects a person’s movements and begins gradually, and because there is no laboratory test for the disease, it can be difficult to spot early on. Through a thorough examination of a patient’s medical history and repeated neurological exams, most cases can be diagnosed. Parkinson’s disease is not generally diagnosed in younger people; age 60 is the age when it usually begins to affect a patient. For the disease to affect a patient noticeably, 60-80 percent of a patient’s nerve cells must be affected. Early warning signs of Parkinson’s disease include:

  • Tremors or shaking
  • Small handwriting
  • Loss of sense of smell
  • Difficulty sleeping
  • Moving or walking issues
  • Constipation
  • Soft or low voice
  • Masked face
  • Dizziness/fainting
  • Stooping

While Parkinson’s disease is not fatal, complications from it can be, and there is no cure. The goal of treatment is to provide the most high-quality life possible once the disease has been diagnosed.

ADHD Cannabis

What are the Symptoms of Parkinson’s Disease?

There are four main stages of Parkinson’s disease, all accompanied by their own symptoms. Stage one involves mild symptoms that do not interfere with normal, everyday activities of patients – tremor and other movement symptoms occur, but only on one side of the body. Changes in posture, walking, and facial expressions may become apparent to friends or family at this stage.

In stage two, tremors and rigidity may appear on both sides of the body, and walking and posture issues are obvious. Daily tasks may become more difficult or take longer, but the patient should still be self-sufficient. Stage three often includes loss of balance and slower movements, possibly with frequent falls. Independence is still possible, but dressing and eating may become more and more difficult at this stage.

In stage four, symptoms of Parkinson’s disease may require help from a walker and help with daily tasks – this usually results in a loss of independence. Help from family, a friend, or a nurse that either visits daily or lives with the patient may now be required. In stage five, leg stiffness may prevent the patient from walking, and require 24-hour nursing care. Although most symptoms of Parkinson’s disease are commonly associated with physical issues, the following non-motor symptoms are also common, particularly in stage five:

  • Depression and anxiety
  • Issues with focused attention, planning, slow thoughts, language and memory
  • Personality changes
  • Dementia, hallucinations, or delusions
  • Orthostatic hypotension
  • Sleep disorders
  • Constipation
  • Lack of appetite
  • Pain and fatigue
  • Vision problems
  • Excessive sweating
  • Sexual issues
  • Weight loss or gain
  • Impulsive control disorders

What Medical Treatments are Available for Parkinson’s Disease?

Among the types of medical treatment that have been shown to decrease symptoms of Parkinson’s disease are surgery, deep brain stimulation (DBS), and various prescribed medications (most common are carbidopa/levodopa, Sinemet, Azilect, Mirapex, ropinirole, and Requip). In DBS, surgically implanted electrodes in the brain block electrical pulses from nerve cells that cause unwanted movements, stopping tremors and other Parkinson’s disease symptoms.

A doctor may use magnetic resonance imaging (MRI) or computed tomography (CT) scans to identify parts of the brain producing unwanted movements prior to surgery. DBS uses surgical insertion of a neurostimulator (similar in size to a stopwatch or heart pacemaker) which delivers to electrical stimulation to targeted brain areas. DBS usually involves the thalamus, subthalamic nucleus, and the globus pallidus. DBS is used only for patients who do not respond to other medications and treatments, and is an invasive procedure. Medical cannabis could help prevent such a procedure, and provide an option that Parkinson’s disease patients could use in the privacy of their own homes.

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Image credit- Strong CBD Oil

How Can Medical Cannabis Help Parkinson’s Disease Patients?

The National Parkinson’s Foundation acknowledges the current medical cannabis investigations occurring for Parkinson’s disease patients, noting that several anecdotal reports show reduced tremors in Parkinson’s patients. “Ride with Larry” is a three-part documentary involving Larry, a man with severe Parkinson’s disease who chose to consume medical cannabis to help with his tremors and other symptoms. Because medical cannabis can interact with neurological cannabinoid receptors (CB1 and CB2), it affects the brain and can calm tremors in some patients.

In general, people with Parkinson’s disease have fewer CB1 receptors than people without it; boosting CB1 receptors with medical cannabis seems to alleviate dyskinesia and reduce tremors. The difficulty of conducting medical cannabis trials for Parkinson’s disease has been and is still affected by national and international laws regarding the use of medical cannabis, as well as the difficulty of conducting a double-blind, placebo controlled trial with medical cannabis. However, some patients are positive that medical cannabis helps their tremors, and have posted videos of the treatment working on websites such as YouTube. In one pilot study, nabilone (a cannabinoid receptor agonist) significantly reduced dyskinesia in seven patients with Parkinson’s disease. Several other studies have shown different results, including tic benefits but no dyskinesia benefits.

A more recent study conducted in Europe has demonstrated that some Parkinson’s patients enjoy both pain relief and improved motor function following medical cannabis treatments. Parkinson’s disease patients in areas of the world where medical cannabis is legal have the option to discuss this form of treatment with their doctors or healthcare professionals if they are not responding to medications or DBS, but more clinical trials are needed to find reliable results for this treatment.

 

How Medical Cannabis Could Treat Parkinson’s Disease

 

 

 

 

 


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Is There a Medical Cannabis Crisis Brewing in Germany? By Marguerite Arnold

A looming product shortage, regulatory bureaucracy and insurance issues create a maelstrom of woes for German medical cannabis patients.

There is a great deal to be happy about with medical cannabis legalization in Germany. This is the first country that has mandated insurance coverage of the drug – at least at the federal legislative level.

However, as the government evaluates the finalists in the first tender bidfor domestically grown and regulated cannabis, a real crisis is brewing for patients on the ground. And further one that the industry not only sees but is trying to respond to.

Spektrum Cannabis GmbH, formerly MedCann GmbH began trying to address this problem when they obtained the first import license for Canadian cannabis last year. They are also one of the apparent five finalists in the pending government bid to grow the plant domestically for medical purposes. According to Dr. Sebastian Schulz, head of communications for Spektrum, “Shortly after the new cannabis law was reformed we experienced a huge increase in demand from the side of patients. We had prepared for that. The German population is very curious about cannabis as a medicine and in general very open to natural remedies.”

People are curious here. But like other places, the law in Germany has evolved slowly. Much like Israel, the government has allowed a trickle of patients to have access to cannabis by jumping through multiple, time consuming hoops. The process of getting cannabis prescribed, much less getting a pharmacy to stock it, was difficult. Patients had to pay out of pocket – a monthly cost of about $1,700. While that is expensive by American standards, to Germans, this is unheard of. The vast majority of the population – 90% – is on public health insurance. That means that most Germans get medications for $12 a month, no matter what they are. Allegedly, German patients were supposed to get about 5oz a month for this price. At least that is what the law says.

People are curious here. But like other places, the law in Germany has evolved slowlyAs in other countries, no matter what Germans think about recreational reform, the clear majority of them at this point support medical use. And at this point, both legislatively and via the courts, the government has said and been required to provide the drug to Germans patients at low cost.

Unintended Effects & Consequences

Since the law went into effect in March of this year however, things have suddenly turned very dire for patients.

The handful of people who had the right to grow at home – established under lawsuits several years ago – were suddenly told they could no longer do so. They had to go to a doctor and regular pharmacy. Even regular patients in the system found that their insurance companies, allegedly now required to pay, are refusing to reimburse claims. Doctors who prescribed the drug were abruptly informed that they would be financially responsible for every patient’s drug cost for the next two years (about $50,000 per patient).

Photo: Ian McWilliams, Flickr

To add a final blow to an already dire situation, German pharmacies that carried the drug, then announced an additional fee. It is about $9 extra per gram, added at the pharmacy, pushing the price of legitimate cannabis north of $20 dollars per gram. This is justified as a “preparation fee.” Cannabis bud is technically marked as an “unprocessed drug.” This means the pharmacies can charge extra for “processing” the same. In reality this might be a little bud trimming. If that. The current distributors in the market already prep and pre-package the drug.

What this bodes for a future dominated by infused products, oils and concentrates is unclear. However the impact now is large, immediate and expensive in a country where patients also must still go to the pharmacy in person for all prescription drugs.

There is no mail order here, by federal law. Online pharmacies are a luxury for Auslanders.

At minimum, this could mean that without some relief, German patients will go right back into the black market and home grow.While nobody has challenged this situation yet en masse, it is already a sore point not only for patients but across the industry. It means that an already expensive drug has gotten even more expensive. It also means that the government regulations are not working as planned.

At least not yet. For the large Canadian companies now coming into the market with multimillion-dollar investments already sunk in hard costs, Germany will be a loss-leader until the system sorts itself out.

According to Schulz, whose company is now in the thick of it, the new law is very vague. “Currently, there are almost no cannabis flowers available in German pharmacies because companies like us are not allowed to sell them,” says Schulz. “Various different regulatory demands come up that seemed to change on a monthly basis. We are ready to deliver even large amounts of cannabis for a market that might well explode soon – but we first need to overcome the regulatory nightmare that leads to the suffering of so many patients here these days.”

At minimum, this could mean that without some relief, German patients will go right back into the black market and home grow. Black market costs for cannabis are about $10-15 a gram. In other words, exactly the situation the government was hoping to avoid.

What Is Causing The Situation?

The intended effect of the legislation was twofold, according to industry insiders: To legalize cannabis in such a way to meet a rising public demand and, in the face of a court decision, to limit the home grow movement. The latter of which, despite federal regulations, is thriving here. Germans like to grow things, and cannabis is a rewarding plant to nurture.

High attendance at the Mary Jane Grow Expo in Berlin in June is just one sign that the genie is out of this particular bottle. BfArM – the federal agency in charge of regulating narcotics and medical devices – cannot stuff it back.Patients are going back to the way things were

However home grow does not build a professional, high volume cannabis market, much less a highly regulated medical one make. The government also made clear that it is going to have strict inspections and quality controls, and will technically buy all the cannabis produced, per the terms of the bid application process.

However, it is not entirely clear when the government will start actually doing the buying. And why the buying has not started yet. If insurance companies are refusing to pay, this means the government is not reimbursing them. The same government, which has also agreed to do so, as of March 2017.

What Gives On Good Old German Efficiency?

On the streets, patients are going back to the way things were. Many are used to fighting for the only drug that makes them feel better. The euphoria in May, for example, has been replaced with weary acceptance that things might get a bit worse before they really improve.

That said, there is also a realization that more activism and lobbying are required on just about every front. If an extrapolation of data from say Colorado or California is applied to Germany, there are already at least a million eligible patients here, based on the qualifying conditions. The government is planning for an annual increase in medical patients of about 5-10,000 a year, including in the amount of cannabis they are planning on buying from the licensed producers they choose. The numbers, however, are already not matching.Even existing patients are literally being forced into the black market again.

Added to this wrinkle is the other reality that is also looming, particularly now.

With one exception, all of the firms now apparently in contention as finalists for the German government bid will also be supplying a domestic market in Canada that is going rec next summer. One year, in other words, before the German companies even begin producing.

What Is The Upshot For Patients?

Guenther Weiglein is one of the five patients who sued for home grow rights in 2014. He is now suing again for the right to extend home grow privileges until the government figures out its process. He is not the only one. Earlier this year he was told he had to stop his home grow and integrate into the “mainstream” system. So far, he, along with other patients who are suing, including for insurance coverage, have not been able to get cannabis easily through the system, although they are starting to make progress.

Weiglein’s situation is made even more frustrating by the fluidity of the situation. As of late July, he had finally gotten agreement from his insurance company to cover the drug. But now he cannot find a doctor willing to accept the financial risk of prescribing it to him. And in the meantime he has no access to medication.

Talk to any group of advocates right now, and there is one ongoing story. Even existing patients are literally being forced into the black market again.

And those that can’t afford it? They are out of luck. Some patients say a tragedy like someone dying will create the impetus to move this into public eye. A hunger strike here by a leading cannabis doctor earlier this summer has so far not had much impact on policy. There is a great deal of pessimism here, as promised change earlier this year has turned into a long and drawn out multiyear question mark.

If this sounds like a bubbling and untenable situation, especially before a national election, it is. The prospect of another four years of Angela Merkel does not bode well for fast cannabis reform.

That said, the German government is now in an interesting situation. The law has now clearly changed to say that sick Germans are allowed to use cannabis as a drug of choice for chronic diseases when all else fails. Further, the national government has bound the insurance industry to cover it. So far, every patient who has sued for coverage has won. That has not, however, moved the insurance industry altogether. Nor has it solved the problem with doctors prescribing the drug.

Many now ask what will? It is clear, however, that it will change. The question is when, how fast, and in what situations.

The problem will undoubtedly ease by 2019, when the first German crops are finally ready, although it will be far from completely solved.

https://www.cannabisindustryjournal.com/news_article/is-there-a-medical-cannabis-crisis-brewing-in-germany/#comment-300