A team from the Center for Pain Management at St. Anne's University Hospital Brno in Czechia recently introduced a unique method for administration of medical cannabis using vaporizers. This initiative, which was headed by Radovan Hrib MD, and developed in cooperation with Ethan Russo MD, Director of Research and Development at ICCI, provides medical cannabis patients with access to Storz & Bickel Volcano Medic medical vaporizers donated by Bedrocan . The Center for Pain Management in Brno has been prescribing medical cannabis for the treatment of pain since 2016, but until the launch of the vaporizer program in April 2018, was mainly employing capsules for oral administration. Medical cannabis taken orally poses titration challenges as the first effects appear in 30 to 60 minutes, peak in two to three hours, and fall off in approximately four to eight hours. Inhalation of vaporized medical cannabis allows the many therapeutic substances in cannabis to enter the lungs where they are quickly absorbed and travel throughout the body. The first effects of vaporized cannabis occur within a few minutes and gradually disappear within three to four hours. This quick onset of effects makes titration more manageable. Employing vaporized cannabis in pain management has underscored the importance of focusing on delivery methods which maximize the synergistic effect of all the complex bioactive substances in the cannabis plant, or so called "entourage effect", first reported by Shimon Ben-Shabat PhD and Raphael Machoulam PhD in their seminal 1998 study (Ben-Shabat S et al.: An entourage effect: inactive endogenous fatty acid glycerol esters enhance 2-arachidonoyl-glycerol cannabinoid activity. Eur J Pharmacol, 1998, 17, 353(1), 23-31).
The Center for Pain Management's use of medical cannabis and interest in utilizing new tools for optimizing the method of its administration to patients is a great example of patient-focused medicine and using innovation to improve patient outcomes. The prescription of medical cannabis in the Czech Republic is regulated by Decree No. 236/2015 Coll., which imposes restrictions on both who is permitted to prescribe and what conditions are eligible for prescription of medical cannabis. The legislation permits only physicians with a specialization in clinical oncology, radiation oncology, neurology, palliative medicine, pain management, rheumatology, orthopedics, infectious medicine, internal medicine, ophthalmology, dermatovenerology, geriatrics, and psychiatry to prescribe medical cannabis, and specifies a list of approved conditions for which it can be prescribed (e.g. chronic pain, spasticity, nausea and others).
Alexandra Šulcová, M.D., Ph.D,
Professor of Pharmacology, FCMA, FECNP, FCINP