Cannabis: the comeback of a banned medicine

In what used to be a bicycle storage room, there is a flurry of activity. Like every afternoon, Manfred Fankhauser and his assistants are preparing the parcels for dispatch. The post office closes in a few hours and there is no time to lose. 

Cannabis medicines are lined up on a shelf, 24 boxes for the same number of patients throughout Switzerland. Most contain a THC-based solution, dronabinol, a medicine which Fankhauser prepares directly in his pharmacy in Langnau, canton Bern. Then there are the natural tinctures made by Markus Lüdi, his business partner.

Cannabis acts against nausea and vomiting in patients undergoing chemotherapy. It stimulates the appetite in AIDS patients and relieves spasms in multiple sclerosis. “Patients come to me when other medicines have failed to produce results,” he says.

In 2007, when he started working with cannabis, there were five patients; today there are about 600. With new requests coming in every week, Fankhauser has taken on an assistant just to field calls. And the place where he used to keep bicycles in his family home has been transformed into a “cannabis depot” under video surveillance and alarm. His raw material, pure THC in glass vials, is kept in a safe.

Vaney, 63, is consulted not only by multiple sclerosis patients, who have an incurable disease that affects 8,000 people in Switzerland. There are also people suffering from spinal cord injuries (caused by road accidents or falls), fibromyalgia and severe migraines.

“I tell them to start with a small dose, taken in the presence of another person, and see how it works. I always emphasise one thing: cannabis relieves pain, it won’t cure the disease.”

The doctor from Lausanne has no illusions: cannabis is not a panacea. In his experience, it helps in 30-40% of cases. “Its potential is not fully known at all,” he points out. He believes that growing knowledge about the receptors of THC and other cannabinoids in the human body may lead to the discovery of unrealised therapeutic potential.

Rudolf Brenneisen has spent 30 years studying psychotropic plants and the active constituents of cannabis. Head of the Swiss task force on cannabinoids in medicine and a one-time consultant to the United Nations Narcotics Laboratory, he believes the plant has a lot more to offer. “I know of no other with its potential,” he says.

Like the grower and the pharmacist, Vaney needs a special authorisation from the health authorities. In the eyes of the law, he has to take full responsibility for prescribing cannabis.

Doctors prescribing cannabis are a growing number (350 in the first five months of 2015 compared with 250 over the same period in 2014) but remain “a minority”, says Gert Printzen, who is on the steering committee of the Swiss Medical Association. The use of cannabis for particular purposes is not in dispute and there are excellent scientific publications to back it up, he told swissinfo.ch by email.

The reticence, he notes, is more on the side of public opinion and the politicians. When you talk about therapeutic use of cannabis, it is always a political issue, he says, but narcotics and medicine need to be distinguished.

To relieve the pain, she has tried everything: pain-killers in ever larger doses, opiates and experimental treatments. All in vain. At some point the initial relief always disappeared and the side effects became more and more burdensome.

One day a friend showed her a pamphlet. “It talked about a medicine with cannabis, dronabinol. I found it interesting and had the urge to try it.” Three years later, cannabis is her “life saver”, she says. She still takes her daily cocktail of seven medicines. She cannot do otherwise. But since she discovered Manfred Fankhauser’s drops, she has reduced consumption of opiates and sleeping pills.

Twelve drops a day, usually in the evening, are not sufficient, and Koella would like to increase her dose – not to increase the effect, but to spread the drops over the day so that she always has some THC in her bloodstream.

But every drop is precious. Her little bottle of medicine, which lasts her less than two months, costs CHF900. This cost is covered by her health insurance – for now. She is afraid that the insurance company may stop paying; it would have that right under current law. About half such requests to health insurance companies are accepted, says the Federal Office of Public Health.

For Margrit Kessler from the centrist Liberal Green Party, this is not sufficient. As president of the Swiss Patients Organisation, she wants to see automatic and easy approval of medicines using cannabis. The approval procedure is complex and the prices of natural medicines are too high, she has stated in a parliamentary motion.

Under the current system, she believes, many patients dealing with chronic pain prefer to self-medicate – illegally. In June, a substantial majority of the House of Representatives accepted her motion, and the government now favours the idea of a study “to clear up the scientific, methodological and legal questions regarding the use of cannabis flowers”.

In the meantime, Koella prefers to take her drops accurately. Sometimes not even the dronabinol has an effect. But living without her “miraculous” little bottle of medicine would be unthinkable. “It has given me back part of my life,” she says.

Calling cannabis “the aspirin of the 21st century”, as some do, is an exaggeration, Fankhauser thinks. “For almost all the situations where it can be used, there are other medicines too.” But he hopes that patients will be able to get access to cannabis in a timely manner and not as a last resort.

It is only a question of time before cannabis returns for good to pharmacy shelves, Brenneisen believes. “It is enough to look at what is happening in a number of American states or in Uruguay.”

Equally optimistic, Vaney expects that in five to ten years, use of cannabis in Switzerland will be widespread. “Free sale of cannabis for therapeutic purposes could help [patients] live better.”