Medical cannabis is a prescription medicine – not a lifestyle product and not a substitute for proper diagnosis. Therapy may be appropriate when a doctor judges that the likely benefit outweighs the risks, and when more suitable standard treatments are insufficient, not tolerated or not applicable.
In Germany, doctors may prescribe cannabis for medical purposes when they consider it clinically indicated. Whether statutory health insurance covers the cost is a separate question with stricter rules. Medical appropriateness and reimbursement are not the same thing.
What “medically appropriate” means here
“Appropriate” does not mean a guarantee, and it is not advice to self-medicate. It means there are recognised or at least plausible medical reasons to consider cannabis or cannabis-based medicines. The strength of evidence differs by condition. Some indications have licensed proprietary medicines; others rely on clinical experience and an individual benefit–risk assessment.
- There is a medically established condition or burdensome symptom – not merely a wish to use cannabis.
- Other, better-supported treatments have been considered, exhausted or are unsuitable.
- Contraindications and interactions have been reviewed.
- Effects, side effects and day-to-day fitness (for example driving) are followed up.
Uses with stronger evidence
Chronic pain
Medical cannabis is most often considered for persistent pain, especially when there is a neuropathic component and usual pain treatments are insufficient or too burdensome. The effect is often relief rather than complete freedom from pain. Whether cannabis will help cannot be predicted with certainty, so a time-limited, doctor-supervised trial with clear goals is common.
Spasticity in multiple sclerosis
For moderate to severe spasticity in multiple sclerosis, nabiximols is a licensed cannabis-based medicine when other antispastic treatments are not enough. This is one of the clearest examples of targeted medical use: a defined condition, after standard therapy, under medical supervision.
Nausea and vomiting during chemotherapy
Certain cannabinoid medicines (such as dronabinol or nabilone) may be used when chemotherapy-induced nausea and vomiting are not adequately controlled with standard antiemetics. Cannabis is usually an add-on option here, not the first step.
Loss of appetite and wasting
In marked loss of appetite and weight loss associated with serious illness – for example advanced cancer or HIV-related wasting – a doctor-supervised cannabinoid therapy may be considered to support appetite and wellbeing. Again, the cause should be clarified and standard measures used first.
Certain epilepsies
Purified cannabidiol (CBD) is licensed as a medicine for selected, hard-to-treat epilepsy syndromes, including Dravet syndrome, Lennox–Gastaut syndrome and seizures in tuberous sclerosis. This is a specialist field – usually paediatric neurology or neurology – and is not the same as over-the-counter CBD oils.
In palliative care, cannabis may also help several symptoms at once, such as pain, nausea and poor appetite. The aim is then quality of life, not cure.
Where the evidence is weaker or mixed
Sleep problems, anxiety, depressive symptoms, inflammatory bowel disease or Tourette syndrome are often linked with cannabis. For some people, doctor-supervised therapy may help in an individual case. The evidence is often limited, mixed, or specific to particular products and doses. THC can also worsen anxiety or mood in some people.
Caution is therefore warranted: weak evidence does not automatically mean “useless”, but it also does not mean “everyone should try it”. The less certain the benefit, the more important the diagnosis, informed consent and a search for better-supported alternatives.
When medical cannabis is usually not appropriate
A prescription is not appropriate merely because cannabis is legally available or feels “natural”. Particular caution – or no therapy at all – is warranted in the following situations:
- No confirmed medical indication, but mainly recreational use or a request for a prescription without a clinical picture.
- As a first measure for mild, non-specific complaints that already have established treatments.
- Past or current psychosis, schizophrenia, or a high risk of these – THC can trigger or worsen psychotic symptoms.
- Pregnancy and breastfeeding, except in a very rare, closely supervised exception.
- Children and adolescents outside specialist indications (for example licensed CBD in certain epilepsies).
- Severe cardiovascular disease without specialist review; cannabis can stress heart rate and circulation.
- As a substitute for a clearly indicated standard therapy only because cannabis is preferred.
- When safe driving or operating machinery is essential and cannot be reconciled with treatment.
A history of substance dependence does not automatically rule out treatment, but it does require a more careful benefit–risk assessment and closer follow-up. Interactions with other medicines, including centrally sedating drugs, must also be considered.
How the medical decision is made
Before a prescription, the doctor reviews the history, existing diagnoses, previous treatments, current medication, mental-health history and day-to-day demands. They choose the preparation, cannabinoid ratio and dose, and plan follow-up. Effects and side effects – such as tiredness, dizziness, dry mouth, reduced concentration or anxiety – are weighed against the intended benefit.
Reimbursement by statutory health insurance follows its own criteria. It often requires a serious disease and that generally recognised treatments are unavailable, cannot be used or have already been exhausted. A medically sound prescription can therefore still make sense if the insurer does not pay – that does not change the need for a medical decision.
In short
Medical cannabis may be appropriate for selected, often hard-to-treat complaints – in particular certain chronic pain, spasticity in multiple sclerosis, chemotherapy-related nausea, marked loss of appetite in serious illness, and specific epilepsies. It is not appropriate as a cure-all, as recreational use with a prescription, or as a first step for mild complaints. The decision always rests with a doctor, not with an article.