Great dispute over therapy sovereignty in cannabis

LSG Mainz and SG Dusseldorf provide different lines
After cannabis can be prescribed as a medical treatment under certain circumstances at the expense of statutory health insurance since March 2017, the courts are now also arguing with patients, doctors and health insurances about it. According to an express resolution of the Social Court (SG) Düsseldorf, published on 24 August 2017, cannabis can only be prescribed as a last resort at the expense of the statutory health insurance (ref .: S 27 KR 698/17 ER). In contrast, the Landessozialgericht (LSG) Rhineland-Palatinate in Mainz in a decision published on 22 August 2017 gives physicians significantly more freedom of treatment (Ref .: L 5 KR 140/17 B ER).

In Germany, around 1,000 people have an exemption to buy marijuana for medical self-therapy in a pharmacy. (Image: rgbspace / fotolia.com)

As of 10 March 2017, a new provision has been added to the Social Security Code, which allows for the prescription of cannabis at the expense of the statutory health insurance funds. The prerequisite is that this at least promises relief for a "serious illness". In addition, there must be no traditional medical alternatives or these may not be reasonable for the patient in the opinion of the doctor, for example because of strong side effects. However, a suitably justified request may then be rejected by the health insurance fund "only in justified exceptional cases".

In the Düsseldorf case, the patient suffers from polyarthritis (inflammatory pain in various joints) and ankylosing spondylitis (inflammatory and progressive stiffening and curvature of the spine).

Since 2008, the now 67-year-old and severely disabled man is being treated with cannabis. Before that, the standard therapy had serious side effects. Since the cannabis therapy, he had no more relapses, pain and side effects had fallen sharply.

However, the man could not or did not want to bear the cost of just over 1,000 euros per month. Exactly on March 10, 2017, he therefore submitted a cost transfer request to his health insurance.

This refused - after conviction of the SG Dusseldorf rightly. Although there is a serious illness, alternative therapies are available. His last standard therapy was already 16 years back. In the light of medical progress, it can not be assumed that even newer treatment options - such as drugs that suppress the immune system - have unacceptable side effects, according to the SG in its decision of 8 August 2017.

While SG Düsseldorf imposes very high duties on doctors and patients, the LSG Mainz grants them much more freedom of decision and treatment.

Here, the 34-year-old plaintiff suffers, among other things, from psoriasis associated with painful joint changes (psoriatic arthropathy). According to the doctor, the disease now affects almost all joints and leads to a "morning stiffness" of 60 minutes. The results of other treatments have so far been unsatisfactory.

Again, the health insurance refused. The doctor has ruled out numerous alternative treatment options not justified.

Nevertheless, in this case - as was previously the case with the SG Koblenz - the LSG Mainz was right for the patient by a decision of 27 July 2017. His doctor had advocated the treatment and thereby clearly named the pain relief as a goal. By law, the health insurance funds are likely to reject such an application only in exceptional cases. Here, moreover, the doctor has a addiction medicine additional qualification, so that "his professional advocacy" particular importance. According to the credible statements of the employer, the patient without cannabis suffers from severe pain and is unable to work.

Both the Düsseldorfer and the decision of Mainz took immediate action. They are therefore only valid until a final judgment in the skin matter. mwo / fle