Individual application patterns of Cannabis-based medicines in Germany – descriptive evaluation of a patient survey and discussion from a forensic perspective

Abstract

Background: An increasing number of countries have legalised cannabis for medicinal purposes in recent years leading to tensions with other regulatory frameworks. Some countries grant a medical defence according to their drug driving legislations. This may lead to specific medico-legal assessments relating to the participation of cannabis patients in road traffic. In Germany, these enquiries for expert opinions are opposed by incomplete statistics on medicinal cannabis patients, which limits the assessment of individual cases. Methods: A cross-sectional, anonymous patient survey was carried out nationwide in the first quarter of 2022 using an online questionnaire. The overall collective (n = 1030) was analysed with regard to application patterns of cannabis-based medicines. In particular, a detailed evaluation of the cannabis flower sub-collective was carried out. Results: Taking into account patients with health insurance prescription and, for the first time, self-payers, a high proportion of cannabis flower patients was observed (89.9 %). On average, the intake of cannabis flowers is associated with substantially higher daily THC doses (336 mg) compared to the usage of other cannabis-based medicines (≤ 17 mg). In addition, 16.2 % of patients reported complex usage patterns consisting of combina tions of different types of cannabis-based medicines. Over a quarter (28.4 %) of respondents stated a smoking intake of cannabis flowers which is not recommended from a medicinal point of view. Conclusions: Descriptive information on individual application patterns of cannabis-based medicines provide a valuable source of information for medico-legal expert statements as well as a basis for further research projects.