Extract of Medical Cannabis Now Available for Czech Patients. What Benefits Does It Bring?
At the end of 2022, a new drug based on cannabis extract Naxiva Panaxol by Neuraxpharm was approved in the Czech Republic. It can be prescribed by specialists treating patients with chronic intractable pain. The treatment is covered by public health insurance.
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Simplified Preparation
The extract from cannabis for medical use is intended for individually prepared medicinal products. The innovation of the drug lies in its liquid form. Compared to existing capsules, it is prepared from a cannabis extract, which is more accurate and allows for individualized dosing. It also simplifies the preparation of other dosage forms such as ointments, suppositories, or gels for pharmacists.
Medical cannabis has been successfully used for pain relief for several years. However, pharmacists previously had to prepare it from plant material, which was time-consuming and required the patient to order the medication in advance. With preparation from the extract, it can now be available within minutes. The new drug in the form of an extract is welcomed by experts from the Society for the Study and Treatment of Pain ČLS JEP and the patient association for cannabis treatment KOPAC.
Unmet Needs in Pain Treatment
About one-fifth of the European population suffers from chronic pain. Of these, more than a third suffer from severe pain, and almost half are not adequately treated. Chronic pain manifests with physical and psychological symptoms that significantly reduce the quality of life of patients and increase healthcare costs. Inadequate pain control leads to overuse of analgesics and increases the risk of their side effects, including addiction. The main goal of pain treatment is long-term effective therapeutic management.
Mechanism of Action of Cannabinoids in the Endocannabinoid System
The endocannabinoid system plays a significant role in the human body. It is involved, among other things, in the modulation of activities of other neurotransmitter systems. The system consists of endocannabinoids and cannabinoid receptors. The best-studied cannabinoid receptors are CB1 and CB2.
CB2 receptors are found in the skin, bones, and immune system, where they trigger an immune response to inflammation when activated. CB1 receptors are primarily found in the central and peripheral nervous systems and can reduce sensitivity to pain. This is one of the main reasons why cannabis is effective in pain relief.
Pain relief occurs when cannabinoids bind to cannabinoid receptors. The main cannabinoids in cannabis are cannabidiol (CBD) and tetrahydrocannabinol (THC). Both substances have similar chemical structures but different physiological and pharmacological effects. By mutually acting on endocannabinoid receptors, their analgesic effect can be enhanced. Additionally, medical cannabis positively affects other functions in the body, related to sleep quality, memory, mood, appetite, and immunity.
Advantages of Cannabis Extract
The Naxiva Panoxol medical cannabis extract contains a mixture of substances (cannabinoids, terpenes, flavonoids, etc.) that, through synergistic effects, enable the maximum effect of cannabinoids, known as the entourage effect. The extract has a clearly defined THC content. The production of the extract involves decarboxylation under controlled conditions. This is a process where the acidic precursors from cannabis (THCA and CBDA) are converted into the active ingredients THC and CBD. Decarboxylation requires heat and time – all of which are eliminated during the preparation of the extract in a pharmacy, unlike the preparation and dispensing of cannabis in capsules. Additionally, the contained vitamin E (tocopherol) prevents the degradation of THC upon opening the extract.
Who Can Benefit from This Modality
Medical cannabis in the form of an extract is a suitable solution for patients with chronic pain who need effective therapy to improve their quality of life. It is also suitable for patients who have difficulty swallowing and for polymorbid patients.
The dose of medical cannabis is determined individually. The extract is available in 2 forms: THC 50 mg/CBD 10 mg or THC 100 mg/CBD 20 mg. When indicating, it is necessary to consider comorbidities, concurrent medications (due to possible interactions with other drugs), the patient's age, and weight.
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