High hurdles for regulation of cannabis

LSG Darmstadt rejects claim among other things with pure pain
The possibility of prescribing cannabis at the expense of the statutory health insurance companies, which has been in place since March 2017, has high hurdles. According to an express resolution issued by the Hessian State Social Court (LSG) in Darmstadt on Thursday, 16 November 2017, severe pain alone can not justify a claim. After another decision, the same applies to a non-inflammatory pain syndrome (fibromyalgia). On the other hand, a man with chronic abdominal pain had success. (Ref .: L 8 KR 255/17 B ER, L 8 KR 366/17 B ER and L 8 KR 288/17 B ER)

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".

Recently, a new law has come into force that allows seriously ill people to get prescribed cannabis by the doctor. The costs should be taken over by the health insurance companies. These fight against it now. (Image: Africa Studio / fotolia.com)

According to the LSG Darmstadt, thereafter a pure pain syndrome is not sufficient for the prescription of cannabis as a painkiller. Rather, it is necessary that the pain is based on a "serious clinical picture"; this must be "evidenced by medical reports" (express resolution of 4 October 2017, ref .: L 8 KR 255/17 B ER).

Also, the prescription for a patient with fibromyalgia (so-called soft tissue rheumatism, a muscle pain in the vicinity of joints) did not apply the LSG. According to previous studies, cannabis has no alleviating effect here (urgent decision of 16 October 2017, Az: L 8 KR 366/17 B ER). In both cases, the Darmstadt judges also complained that the doctors had not adequately tested conventional medical alternatives.

In the third case, a man suffered from severe chronic abdominal pain, severely limiting his life. The reason for this was repeated inflammation of the pancreas and the operative production of a connection of the pancreas to the small intestine. Even morphine only slightly reduced the pain. The doctor ordered the man a cannabis mouth spray. This brings at least the prospect of relief, there is no conventional alternative medicine, was here the LSG Darmstadt. Therefore, the health insurance company must pay the prescribed cannabis mouth spray (urgent decision of 28 September 2017, ref .: L 8 KR 288/17 B ER).

The LSG Rhineland-Palatinate in Mainz had previously been more generous. Among other things, the plaintiff suffered from psoriasis (psoriatic arthropathy) associated with painful joint changes and stiffening. Similar to the first two cases of the LSG Darmstadt, the health insurance company said that the doctor had not ruled out numerous alternative treatment options. The LSG Mainz nevertheless awarded the patient the cannabis prescribed for pain relief. The doctor has advocated this therapy, the health insurance company may therefore reject this only in exceptional cases (urgent decision of 27 July 2017, ref .: L 5 KR 140/17 B ER, JurAgentur-message of 29 August 2017). mwo