LEGISLATION

Legislation for Physicians

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.

What should be taken into account when prescribing medicinal cannabis?

 

As mentioned above, a prescription for medical cannabis should not be an alibi for recreational purposes. That is why it is very important that your patient is thoroughly screened. This means that Cannabis Patient Care analyzes the following points:

 

  • Monitoring the patient's suffering pressure via certain measuring methods. We use the VAS scale (measure the patient's pressure of suffering), the ADL (influence of suffering on daily life) and WPI pain index (extent of suffering). 

 

 

  • Medical history of the patient and inquiries on the treatments already used. If this check shows that the treatments obtained have given insufficient results or too many side effects, this is also stated in the advisory report. Particular attention is given to the position of "late-line treatment". This means that the patient has already gone through all possible conventional therapies without satisfactory results.

 

  •  Only if all these items are correctly documented in a full patient record, it is possible for the doctor to start a treatment based on medicinal cannabis. It is therefore essential for the physician to thoroughly screen the medical situation of the patient and to compile a dossier about this before making a prescription of medicinal cannabis.

 

 

Physicians have a very busy schedule and that is why it is not always easy to compile a comprehensive file. However, this dossier is important to protect the physician when prescribing medicinal cannabis and to use his therapeutic freedom. Cannabis Patient Care is a solution to help the physician. We give a reaching hand to both the patient and the physician. We act as a kind of safety net and provide supportive guidance to both. By drawing up such a file and advice report, we take a lot of administrative work out of the hands of the physician. This advisory report contains all important and fundamental data to start a treatment based on medicinal cannabis. We also give an opinion on what appears to us to be the most appropriate treatment. Nevertheless, it is always the prescribing physician who makes the decision about how and whether or not to prescribe a treatment based on medicinal cannabis.

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