St. Anne’s University Hospital in Brno, Czech Republic, is proud of an interesting fact: It’s number one in the country in terms of how many patients they treat legally with medical cannabis. Credit for this goes mainly to Dr. Radovan Hřib, head doctor at the hospital’s Center for Pain Treatment, who does not only prescribe cannabis to patients suffering from pain, but is also a tireless lecturer on the subject, helping to educate other health workers.
What is the range of your patients in terms of age and diagnosis?
Very broad. Our youngest patient is twenty years old, and on the opposite spectrum I treat many seniors of advanced age. In terms of diagnoses and conditions, roughly ten percent of our patients are cancer patients, then comes osteoarthritis and rheumatoid arthritis. In cooperation with a gastroenterologist, we also help a lot of patients – at present about twenty – with Crohn’s disease and ulcerative colitis. These patients often suffer from painful joints and ligaments, on which they cannot use standard anti-arthritis treatments.
Under current laws you’re not allowed to prescribe cannabis for Crohn’s disease or ulcerative colitis, is that right?
No, we’re not. We treat those patients for pain. Their doctors from gastroenterology send them to us because they have problems with mitigating the above-described pain, which often moves around the body, wherever the disease manifests itself. And cannabis does a very good job on such pain.
Cannabis and opioids can work very well together to help patients with pain.
Salves should work well on joint pain, but you can’t find ones with high cannabinoid content in pharmacies, unlike capsules.
The problem with salves in this country is that at present they can’t be prepared properly, since we do not have extract at our disposal. By the time we macerate cannabis buds for example in lard or Vaseline, the prescription has just about expired. In other words, it’s not possible to make good salves in two weeks. As a supplement to treatment I therefore advise patients to buy some kind of commercial hemp ointments in the pharmacy, if they are not able to make their own at home. I often learn a lot from my patients in such cases.
Are most of your patients new to cannabis, or have they had prior experience?
My guess is that nine out of ten new patients are virgins when it comes to cannabis. In fact, many of them have deeply rooted “cannaphobia”. The rest have had some kind of therapeutic experience; with the younger generation, sometimes even recreational use.
How popular is the vaporization station you opened last spring, in comparison to oral capsule use?
The capsules are very popular, which is the reason why the number of patients in the vaporization station is lower at present than we had expected. It’s also a question of when the insurance companies are going to at least partially subsidize vaporizers – once that happens, people would be interested in trying something new. But we’ve all been quite surprised how effective and popular the oral form has been.
What has been your experience with the psychoactivity of the oral capsules which the hospital pharmacy prepares for your patients? The 19% THC content could be quite strong for some.
It can be a problem sometimes for older people, but they’re not that psychoactive – I’d compare them to getting a bit tipsy on alcohol. We’ve had rare reports of hallucinations and such. When we started, we gave the first patient a quarter-gram, which hit him hard, so now we start with a sixteenth of a gram or even smaller amounts.
There are lots of revolutionaries around cannabis who’d like to have it all now, but some changes take time.
Do you have the support of the hospital administration for cannabis treatment?
Our director, Dr. Pavlík, has been very open from the start regarding cannabis treatment, and still is. In that respect I truly have maximum support.
Are you afraid of negative coverage from the media?
Not at all. I do keep an eye out personally for one thing – that I never express anything in public about the recreational use of cannabis, because I don’t want people to confuse the two. Also, I’m not an expert in addictology nor other social sciences. As a private citizen, of course I do have an opinion – just like I don’t have a problem with recreational use of alcohol, I also don’t have a problem with recreational use of cannabis – but I’m not going to make a big fuss about it in the newspapers, because I don’t want it to interfere with medical cannabis. That is to say, cannabis intended for medical treatment, which is sold in pharmacies. That’s a more exact term than “medical cannabis”, although it’s one and the same plant.
“Medical cannabis” is a kind of artificial concept, is that right?
I suppose it has to be categorized that way, but I don’t consider that phrase as the best solution.
We’ve all been quite surprised at how effective and popular the capsules have been.
You’ve co-authored a chapter on cannabis treatment in the new book Opioids. Do you have any practical experience with the simultaneous prescription of these drugs against pain compared to cannabis?
We prescribe them both together, without a problem, although the majority of patients who are starting with cannabis have already been using opioids. Thanks to having a constant supply of cannabis and not being threatened with shortages as in the past, I’ve recently begun to reduce the dosages of opioids for several patients. At present I don’t have any data, because these patients haven’t yet come in for a check-up. Nevertheless, what is important is that I don’t have any negative data – because if patients had experienced discomfort, they would have called. None of the patients in the group has called yet.
So what is your opinion now on mutually supplementing the effects of cannabis and opioids on pain – and the future of this treatment?
Absolutely positive. I think that cannabis and opioids can work well together to benefit patients in pain.
Author: Luke Hurt
The full version of this article will be published in the CANNABIS THERAPY Magazine No.1, available online for free by June 2019.
Radovan Hřib (b. 1970)
He graduated in general medicine from the Masaryk University Faculty of Medicine in Brno. Since 1996 he has been working at the Anesthesiology and Resuscitation Department of St. Anne’s University Hospital in Brno, now in the position of head doctor at the Center for Pain Treatment. He specializes in treating chronic and acute pain, both oncological and non-oncological, in the wide spectrum of possibilities: from basic and advanced pharmacological treatment to rehabilitative treatment after implantation of highly sophisticated neuro-modular equipment. In recent years he has concerned himself with practical questions of using cannabis in medicine. He combines this natural form of treatment with classical medicine to take advantage of the best of what both have to offer. Especially due to his efforts, St. Anne’s University Hospital became the first state healthcare facility in the Czech Republic where doctors began to prescribe cannabis for medical use.