Generic placeholder image

Current Bioactive Compounds

Editor-in-Chief

ISSN (Print): 1573-4072
ISSN (Online): 1875-6646

Review Article

Regulation for Prescribing and Dispensing System of Cannabis: the Italian Case

Author(s): Paola Minghetti*, Valentina Marini, Viviana Zaccara and Antonella Casiraghi

Volume 15, Issue 2, 2019

Page: [196 - 200] Pages: 5

DOI: 10.2174/1573407214666181011120031

Price: $65

Abstract

Background: The medicinal properties of cannabis are now recognized. Indeed, in many countries, lawmakers have introduced specific laws and programmes to allow patients to use cannabis preparations in various forms; nevertheless, controversial situations can still be found. In Europe, medicinal- grade cannabis is mainly available as standardized dried flower tops of the cannabis plant used in magistral formulas. These are pharmaceutical preparations compounded in a pharmacy – following Good Compounding Practices - in accordance with a physician’s prescription for an individual patient. Aim of this work is to discuss the available Cannabis based preparations and regulation for prescription and distribution, with reference to Italy.

Methods: We undertook a structured search of Italian laws, ministerial decree and circulars related to therapeutic use of Cannabis, interpreted in light of Italian Society of Compounding Pharmacists’ (SIFAP) position.

Results: Seven documents were analysed. Cannabis can be orally administered to patients - as a dried drug dosed in filter or capsules for infusion or as an extract in olive oil prepared in a pharmacy - or inhaled with a specific vaporizer. Considering the costs and limited availability of Dutch medicinal-grade cannabis, the Italian Government, with the latest Decree of November 9th, 2015, has authorized the production of cannabis in the Military Pharmaceutical Chemical Institute on Florence, describing also the therapeutic use of cannabis and the requirements to be adhered to by physicians and pharmacists.

Conclusion: A well-established national regulation guarantees the proper therapeutic use of Cannabis. Description of preparation method in monograph Pharmacopoeia will be the way to assure quality and therefore the efficacy of these products.

Keywords: Cannabis Sativa, Cannabis preparations, medicine, medicinal products, extemporaneous preparations, psychoactive substances.

Graphical Abstract

[1]
Bifulco, M.; Pisanti, S. Medicinal use of cannabis in Europe: the fact that more countries legalize the medicinal use of cannabis should not become an argument for unfettered and uncontrolled use. EMBO Rep., 2015, 16(2), 130-132.
[2]
Karst, M.; Wippermann, S. Cannabinoids against pain. Efficacy and strategies to reduce psychoactivity: a clinical perspective. Expert Opin. Investig. Drugs, 2009, 18(2), 125-133.
[3]
Lercker, G.; Bocci, F.; Frega, N.; Bortolomeazzi, R. Cannabinoid acids analysis. Farmaco, 1992, 47(3), 367-378.
[4]
Perrotin-Brunel, H.; Buijs, W.; Van Spronsen, J.; Van Roosmalenb, M.J.E.; Petersa, C.J.; Verpoorted, R.; Witkampa, G-J. Decarboxylation of Delta(9)-tetrahydrocannabinol: Kinetics and molecular modelling. J. Mol. Struct., 2011, 987(1-3), 67-73.
[5]
Veress, T.; Szanto, J.I.; Leisztner, L. Determination of cannabinoid acids by high-performance liquid chromatography of their neutral derivatives formed by thermal decarboxylation: I. Study of the decarboxylation process in open reactors. J. Chromatogr. A, 1990, 520, 339-347.
[6]
Russo, E.B. History of cannabis and its preparations in saga, science, and sobriquet. Chem. Biodivers., 2007, 4(8), 1614-1648.
[7]
Tashkin, D.P. Smoked marijuana as a cause of lung injury. Monaldi Arch. Chest Dis., 2005, 63(2), 93-100.
[8]
Dussy, F.E.; Hamberg, C.; Luginbühl, M.; Schwerzmann, T.; Briellmann, T.A. Isolation of Δ9-THCA-A from hemp and analytical aspects concerning the determination of Δ9-THC in cannabis products. Forensic Sci. Int., 2005, 149(1), 3-10.
[9]
Huestis, M.A.; Henningfield, J.E.; Cone, E.J. Blood cannabinoids. I. Absorption of THC and formation of 11-OH-THC and THCCOOH during and after smoking marijuana. J. Anal. Toxicol., 1992, 16(5), 276-282.
[10]
Agurell, S.; Halldin, M.; Lindgren, J.E.; Ohlsson, A.; Widman, M.; Gillespie, H.; Hollister, L. Pharmacokinetics and metabolism of delta 1-tetrahydrocannabinol and other cannabinoids with emphasis on man. Pharmacol. Rev., 1986, 38(1), 21-43.
[11]
Gieringer, D.; St. Laurent, J.; Goodrich, S. Cannabis vaporizer combines efficient delivery of THC with effective suppression of pyrolytic compounds. J. Cannabis Ther., 2004, 4(1), 7-27.
[12]
Lanz, C.; Mattsson, J.; Soydaner, U.; Brenneisen, R. Medicinal Cannabis: In Vitro Validation of Vaporizers for the Smoke-Free Inhalation of Cannabis. PLoS One, 2016, 11(1), e0147286.
[13]
Wall, M.E.; Sadler, B.M.; Brine, D.; Taylor, H.; Perez-Reyes, M. Metabolism, disposition, and kinetics of delta-9-tetrahydrocannabinol in men and women. Clin. Pharmacol. Ther., 1983, 34(3), 352-363.
[14]
Harvey, D.J. Metabolism and pharmacokinetics of the cannabinoids. Biochemistry and physiology of substance abuse. 1991, Vol. III, 279-365.
[15]
Politi, M.; Peschel, W.; Wilson, N.; Zloh, M.; Prieto, J.M.; Heinrich, M. Direct NMR analysis of cannabis water extracts and tinctures and semi-quantitative data on delta9-THC and delta9-THC-acid. Phytochemistry, 2008, 69(2), 562-570.
[16]
Hazekamp, A.; Bastola, K.; Rashidi, H.; Bender, J.; Verpoorte, R. Cannabis tea revisited: a systematic evaluation of the cannabinoid composition of cannabis tea. J. Ethnopharmacol., 2007, 113(1), 85-90.
[17]
Law of the Italian Parliament on April 8th 1998, n. 94, “Conversione in legge, con modificazioni, del decreto-legge 17 febbraio 1998, n. 23, recante disposizioni in materia di sperimentazioni cliniche in campo oncologico e altre misure in materia sanitaria” published on Gazzetta Ufficiale Italiana n.86 1998. [Accessed January 2018].
[18]
Decree of the Italian Ministry of Health on November 9th 2015, “Organismo statale per la cannabis previsto dagli articoli 23 e 28 della convenzione unica sugli stupefacenti del 1961, come modificata nel 1972”, published on Gazzetta Ufficiale Italiana n.279 2015. [Accessed January 2018].
[19]
Trasmissione del documento recante raccomandazioni ai medici prescrittori di Cannabis FM-2 prodotta dallo Stabilimento Chimico Farmaceutico Militare di Firenze secondo le normative dell'UE in materia di sostanze attive, certificata GMP secondo le Good manufacturing practices dell'UE 2017. [Accessed January 2018].
[20]
Italian Society of Compounding Pharmacists (SIFAP). Mem-bers area: procedures. www.sifap.org/area-soci/procedure/142-estrazione-oleosa-di-inf [Accessed February 2, 2017].
[21]
United Nation. Single Convention on Narcotic Drugs, 1961, as amended by the 1972 Protocol Amending the Single Conven-tion on Narcotic Drugs 1961. [Accessed January 2018].
[22]
Law of the President of Italian Republic on June 5th 1974, n.412, “Ratifica ed esecuzione della convenzione unica sugli stupefacenti, adottata a New York il 30 marzo 1961 e del protocollo di emendamento, adottato a Ginevra il 25 marzo 1972”, published on Gazzetta Ufficiale Italiana n. 236, September 10, 1974 – Ordinary Supplement 1974. [Accessed January 2018].
[23]
Decree of the Italian Ministry of Health on April 18th 2007, “Aggiornamento e completamento delle tabelle contenenti l’indicazione delle sostanze stupefacenti e psicotrope e relative composizioni medicinali, di cui al decreto del Presidente della Repubblica del 9 ottobre 1990, n. 309 e successive modificazioniottobre 1990, n. 309 e successive modificazioni ed integrazioni, recante il testo unico delle leggi in materia di disciplina degli stupefacenti e sostanze psicotrope e di prevenzione, cura e riabilitazione dei relativi stati di tossicodipendenza” 2007. [Accessed January 2018].
[24]
Decree of the Italian Ministry of Health on January 23rd 2013, “Aggiornamento delle tabelle contenenti l’indicazione delle sostanze stupefacenti e psicotrope, di cui al decreto del Presidente della Repubblica 9 ottobre 1990, n.309 e successive modifiche e integrazioni. Inserimento nella Tabella II, Sezione B, dei medicinali di origine vegetale a base di Cannabis (sostanze e preparazioni vegetali, inclusi estratti e tinture), published on Gazzetta Ufficiale Italiana n.33 2013. [Accessed January 2018].
[25]
Directive 2001/83/EC of the European Parliament and of the Council of 6 November 2001 on the Community code relating to medicinal products for human use, published on Official Journal of the European Communities L 311, November 28 2001, 67. [Accessed January 2018].
[26]
Circular of the Italian Ministry of Health on March 22 2017, n.18469, “Applicazione del DM 9/11/2015” [Accessed January 2018].

Rights & Permissions Print Cite
© 2024 Bentham Science Publishers | Privacy Policy