Cannabis-based medicines for chronic pain: indications, selection of drugs, effectiveness and safety. Experiences of pain physicians in Saarland

Background. There are uncertainties among physicians with respect to the indications, selection of drugs, effectiveness and safety of cannabis-basedmedicines for chronic pain. Methods. All statutory health insurance pain physicians in Saarland were asked to complete a self-developed questionnaire assessing their experiences with cannabisbased medicines, which they prescribed between 10 March 2017 and 30 November 2018 for adult patients with chronic cancer and non-cancer pain. Results. All statutory health insurance pain physicians participated in the survey and 13 out of 20 reported having prescribed cannabis-basedmedicines. Themost frequent reasons for prescriptions in 136 patients (1.9% of the patients of the institutions) were failure of established treatment (73%) and desire of the patient (63%). In 35% of patients the type of pain was nociceptive, in 34% neuropathic, in 29% nociceptive and neuropathic and in 13% nociplastic. Dronabinol was prescribed for 95% of the patients and 71% were responders (clinically relevant reduction of pain or of other symptoms). In 29% of patients treatmentwas terminated due to either a lack of efficacy or adverse events. Conclusion. Statutory health insurance pain physicians in Saarland were reluctant to prescribe cannabis-basedmedicines. Dronabinol was effective and well-tolerated in themajority of the highly selected patients.