“For which disorders Medical Cannabis is most indicated”, “not just CBD” are some of the points treated in this interview with Marco Ternelli, pharmacist, head of a galenic laboratory e founder of the web portal that groups information on galenic preparations: farmagalenica.it.
Since January 1, 2017 in Italy it is possible to find the so-called “Cannabis of the State”. After almost 5 months, can Dr. Ternelli give us a first evaluation, from his point of view, in terms of distribution of cannabis, quality of the product and customer feedback? This is possible even though it is obviously rather early.
In any case, the production seems to be proceeding in spite of some supplying issues to pharmacies which had to wait longer than expected for the availability of the production batches; on the other hand, as I understood, the requests for FM2 have been lower than forecasted, in a particular way those coming from the Regions.
Medical Cannabis, in which cases can a physician issue a prescription and which role has the pharmacist in this process?
We have to distinguish between cannabis paid for by the patient (with a so-called “white prescription”) and cannabis supplied without costs by the Regional Healthcare System (SSR – Sistema Sanitario Regionale) with a “red prescription”, a treatment plan or an electronical prescription.
In the first case the physician can prescribe cannabis for any therapeutic indications for which we can find accredited scientific documentation in magazines of international renown. This ensures a uniformity in medical approach throughout the Italian territory.
In the second case, however, each Region can decide autonomously for which diseases dispense cannabis without costs; usually multiple sclerosis, (chronical, oncological, neuropathic) pain, glaucoma, Tourette Syndrome, nausea/vomit/cachexia, cancer or anorexia.
This causes differences in approach from one Region to the other. The Pharmacist often has to sustain the patient and/or the physician in obtaining information on the situation in the Region where the patient resides and has to help the physician to correctly fill out the medical prescription.
You’ve created the web portal Farmagalenica.it, what is it and what is its mission?
The portal was created at the beginning of 2013 to spread information about the Art of Pharmaceutical Formulations (Galenics), which is the preparation of any medicine by the pharmacist in his own Galenic Laboratory. The actual situation is that almost 99% of the products sold by pharmacies are industrial preparations, but each time the need of a medicine made by the Pharmacist occurs (i.e. cannabis, but not only), no list or tools exist which enable the patient or the physician to learn where to get the medicine, and I mean with this: which pharmacy is able to make the preparation. Farmagalenica, through the search engine Cercagalenico.it, has resolved this issue, for cannabis and any other galenic preparation.
From your point of view, are there any dysfunctions which respond better to Medical Cannabis than others? What kind of feedback do you receive from your patients?
In my experience of almost four years of interaction with patients using medical cannabis, dysfunctions and diseases like pain, cancer, nausea from chemotherapy, epilepsy and multiple sclerosis respond best. Like all pharmaceuticals, in some cases cannabis works excellently, in others cases it works less and in some does not work at all. The major part of the patients are satisfied as they obtain great results or in any case satisfying improvements; on the other hand, some patients are disappointed due to the very high expectations and hopes they had regarding cannabis.
What is your opinion about products for therapeutic use containing only CBD? Are there cases or situations for which these products are more indicated than for others?
Various studies show that isolate CBD is less efficient than CBD-rich whole plant cannabis extracts and for this reason the latter should be preferred. The use of isolate CBD avoids the problem THC has (being psychotropic) and with this offers products which are completely THC-free or (best solution) can be added to cannabis extracts to increase the contents of CBD and reach specific concentrations of this compound. I am however convinced that shortly these products will be strictly regulated as true medicines (Great Britain already did), maybe allowing free sales of low dosage products as nutritional supplements.
Italy is gradually opening up to the world of Medical Cannabis, at least that’s what it looks like; are there any role models to follow from outside the country?
Regarding medicinal use, in Europe Italy was second (to Holland) in 2013 and with excellent regulations which apparently provided easy access to medical cannabis (at least when the patient pays for it). The problems regard information and cultural aspects, especially when it comes to health professionals, who are the only reference for accessing medical cannabis, but are often reluctant or completely against its use. I can’t really say whether there are any European role models (like Germany, Denmark, the Netherlands, Ireland, etc.) where cannabis for medicinal use is legal, but more restricted.
Which are the weak points of the sector to be improved majorly?
What is lacking very much is the education of both physicians and pharmacists who prepare cannabis pharmaceuticals (everybody is able to do it, but not all of them know how to).
Patients with dysfunctions treatable with cannabis should have free access to cannabis or to some of its pharmaceutic forms (capsules for oral use, suppositories, ointments etc.)
Which kind of requests do you mainly receive from patients?
Many many questions on how to obtain it legally, for which diseases and dysfunctions it can be used, what a medical prescription of cannabis should look like and which physicians are allowed to issue a prescription (I remember it still: if paid for any physician member of the Order of Physicians). Other information requested frequently by patients with the product in hand: how to prepare it (as a herbal infusion), how to take it and how to lower the psychotropic effects, if present.