The prescription of medicinal cannabis is still not evident to most doctors. This is even more in a country, such as Belgium, where medicinal cannabis has not yet been legalized.
In Belgium, a Royal Decree was published in June 2015 that made it possible for the authorization of cannabis-based medicines. Since then, the registered medicine Sativex® has been on the market. This medicine, in the form of a mouth spray, was licensed by the FAMHP (Federal Agency for Medicines and Health Products) for the following indications: as treatment for the relief of symptoms in adult patients with moderate to severe spasticity due to multiple sclerosis (MS) that have not responded adequately to other anti-spasticity medications and showed a clinically significant improvement in spasticity-related symptoms during a first trial treatment period.
The questions most physicians wrestle with are: Can I prescribe it and do I not violate the legislation? And how do I start?
The therapeutic freedom of a doctor: In many European countries, the physician has the therapeutic freedom to prescribe medical therapies if this is to the benefit of his patient. In Belgian law it is formally mentioned in Article 11 of the Royal Decree No.78 of 10 November 1967 concerning the exercise of the health professions.
Art.11 The practitioners referred to [2 in Articles 2, § 1, 3, 4, 21noviesdecies, 21quatervicies and 21quinquiesv] 2 may not be subject to regulatory restrictions on the choice of the means to be used, either for the establishment of the diagnosis, either for setting up and carrying out the treatment or for carrying out magistral preparations.
In short: A doctor has the therapeutic right* to prescribe medicinal cannabis if this is for the benefit of his patient. A prescription of medicinal cannabis must under no circumstances be an alibi for recreational cannabis use.
*this therapeutic freedom does have its limitations and in case of abuse the doctor can get sanctions from the Order of Physicians.
Medicinal cannabis is therefore prescribed in practice as a last-line drug; if all conventional therapies do not help or give too many side effects.