Still difficult: THC in medicine

From 2012 to 2018, 12,000 exemptions were granted (limited to 6 to 12 months). Since the end of 2022, exemptions are no longer required, only a doctor's prescription is needed.

A doctor must determine that a sick person could be helped with THC therapy and issue a prescription for this. On the one hand, synthetic products such as Dronabinol, also known as Marinol, can be prescribed. On the other hand, products such as Sativex or specially produced tinctures (so-called magistral formulations), which are made from natural cannabis, can also be prescribed. The preparations often contain 2.5 to 5 % THC. Cannabis flowers can now also be prescribed.

Dronabinol, for example, is used in Switzerland for the following symptoms, among others: Nausea and vomiting, loss of appetite and emaciation, anorexia and weight loss, spasticity, muscle cramps and muscle hardening, pain conditions, asthma, glaucoma, epilepsy, sleep disorders and anxiety as well as movement disorders. Patients with these symptoms suffer from multiple sclerosis, cancer, AIDS, Alzheimer's, hepatitis C, anorexia or other serious illnesses, for example. In Switzerland, most exemptions used to be granted for cancer, followed by multiple sclerosis.

There has been no boom in prescriptions since THC was made easier to use for medical purposes. Even though doctors no longer have to apply for an exemption permit and therefore have less work to do, they still have to record prescriptions in a FOPH database. Over the years, this data should be used to develop guidelines as to which dosages and forms of application are recommended for which diseases.

However, the main problem is that most doctors have no experience with cannabis as a medicine and only very rarely prescribe such preparations. In most cases, they only prescribe them when all other treatments have failed, i.e. when the patient has reached the end of their therapy.

The entire chain of activities that lead to the end product “hemp-based medicine” and have something to do with its distribution to patients are strictly regulated. This includes the cultivation of hemp, the production of remedies, the treatment and the trade in cannabis as medicine. The costs for these remedies are therefore very high. As health insurance companies rarely reimburse these remedies, patients usually have to bear the costs themselves. However, many are unable to do so, meaning that the black market continues to play a major role here.

If the medicine is to be dispensed by a pharmacy, it requires an operating license for controlled substances in accordance with Article 11 of the Narcotics Control Ordinance. Such a license is also required if a pharmacy wishes to produce a medicine itself from the prohibited cannabis, such as a hemp tincture.

The cultivation of hemp (from 1 % THC) for the production of medicines is also regulated by law. In principle, the “grower” requires an operating license or must act on behalf of a licensed company. An application for an operating license must contain the following: adequate protection against theft; a written contract with an authorized company; precise information on the type and quantity of cultivation; a guarantee that the entire quantity of cultivation will be delivered to the client.

The bureaucratic effort involved discourages most potential producers of medicinal hemp from growing legally. The costs incurred due to the various licensing requirements mean that a medicine that has cleared all the hurdles to be approved for treatment is not cheap. The costs can quickly amount to hundreds of francs per month.

It seems to us that it has not yet been conclusively clarified whether someone with THC-containing medication is allowed to drive or not. What is certain is that the detection limit of 1.5 micrograms per liter of blood, which otherwise applies to everyone, does not apply here.

However, this does not mean that those affected are on the safe side when driving a motor vehicle. This only means that the ability to drive cannot be proven by the THC content in the blood. The statements of the police and the medical examination are decisive here. This does not always seem to be clearly communicated to us by doctors.

It would also be possible to undergo a fitness to drive test to clarify whether the prescribed THC drug generally impairs driving or not. However, such an investigation is expensive and the outcome is uncertain.

The facilitations for medicinal hemp came into force on August 1, 2022 and a new era has begun. Doctors can prescribe hemp containing THC without having to apply for a special permit. But this does not mean that medicinal hemp is simply released. The following documents give an impression of this: