– When I had the strongest pain, I had suicidal thoughts. That’s what Julie Welde (28) says about the pain she experienced due to the diagnoses. She has, among other things, endometriosis and migraines. Because of the pain, she is disabled. After an operation in 2014, she started on morphine. The doses gradually became stronger. – I changed my personality as the doses of opioids were stepped up. I was very angry and upset and could sit for several hours by myself and just laugh, says Welde. Welde experienced that the pain medication she was on led to changes in her personality. Photo: Marthe Svendsen / news Significantly reduced morphine use Finally, she was tipped off by an acquaintance with endometriosis about the possibility of getting medical cannabis at a pain clinic in Copenhagen. She started on cannabis oil for the pain. – It worked very well and has made a big difference. I still get bouts of pain, but not to the point where I think ‘now that’s enough’, she says. The cannabis oil Welde uses. Photo: Marthe Svendsen / news Welde says she has stopped taking three medications and reduced her opioid use by 80 percent, after she started using medical cannabis. Previously, she was admitted to hospital several times a month due to pain. The 28-year-old has not had a single hospitalization due to chronic pain since she started taking her new medicine, according to herself. She has asked to get medical cannabis on prescription from the pain clinic at St. Olav. There she was flatly refused. – I got the impression that it was superior to his personal opinion. He said that cannabis is not medicine, she says. Medical cannabis in hospitals Medical cannabis is classified as experimental treatment in Norway. It is the patient’s local healthcare organization that must decide whether a patient can start trial treatment and who must pay for the treatment. The health authority prescribes a prescription for the patient, which is then sent to the Norwegian Medicines Agency for approval. The Norwegian Medicines Agency does not check prescriptions from multidisciplinary pain clinics. Thus, in practice, it is the hospitals that decide whether a patient can start medical cannabis. Several Norwegians receive a prescription from a private clinic abroad and collect medical cannabis in foreign pharmacies. Due to the Schengen Agreement for medicinal products, the patient can take one month’s worth of the medicine home to Norway. Criticizes St. Olav for not knowing the routines. St. Olav contacted the University Hospital in Oslo to get a second-hand opinion. The chief physician in Oslo believed that Welde had a so-called “indication for using medical cannabis”. This means that they believe she qualifies to receive medical cannabis, based on the factors they have assessed. They have not taken a decision on contraindications, i.e. conditions that militate against her getting it. Such an assessment must be made by St. Olav. The doctor writes in a letter to St. Olav that she has documented a good response to medical cannabis, both through less pain and reduced drug use. St. Olav still said no to Welde. Oslo University Hospital believes Welde has an “indication for medical cannabis”. Photo: Marthe Svendsen / news In a meeting with four senior doctors at the pain clinic at Oslo University Hospital, the answer they receive from St. Olav is discussed. One senior doctor writes the following in a journal note, which is also sent to the patient: “Here they write that our second opinion does not change their position in relation to the patient not being prescribed medical cannabis. Furthermore, it is written that our department, as the one with probably the most experience with medical cannabis and pain, should apply for approval exemption from the Norwegian Medicines Agency”. The head doctor further writes that “it is also clear that they (journal. note: St. Olav) do not know the process, or have familiarized themselves with it, as regards the prescription of medical cannabis on prescription”. The note ends with the following: “Since St. Olav’s hospital does not want to follow the recommendations we make, without them medically arguing for it, it is reasonable to interpret this as a fundamental disagreement”. St. Olavs has declined an interview. Read their answers further down in the case. Good cooperation Audun Stubhaug, professor and head of the department for pain management at Oslo University Hospital, says he cannot comment on the case to Welde, due to confidentiality. Stubhaug emphasizes that there is close and good cooperation between the pain clinics in Norway, and that there is absolutely no conflict between Oslo University Hospital and St. Olav. Regarding the journal note, Stubhaug says that it does not refer to the relationship between the hospitals, but to a difference in the view of what is the correct procedure when it comes to prescribing certain drugs. He says doctors can write prescriptions for medicines that are not approved in Norway, and the Norwegian Medicines Agency will then usually approve the prescription within 1-2 days. – I think perhaps not everyone is aware of it, that it is so easy to prescribe and apply to the Norwegian Medicines Agency, says Stubhaug. Audun Stubhaug is professor and head of the pain management department at Oslo University Hospital Photo: ES Gjerde / OUS The professional community is skeptical Stubhaug points out that the entire international pain community is very skeptical of medical cannabis as a pain medicine, because there is little documentation that it is effective. There are 500 patients a year who receive the cannabis preparation Sativex, and between 130-140 patients who receive cannabis products containing THC. Stubhaug says he does not have figures for how many patients are prescribed medical cannabis from Ous. The manager says the hospital rarely receives requests for second-hand assessments related to medical cannabis. – We do not get many requests for second opinions. I can only remember one other case on the fly, he says. The hospital has not given an individual assessment After Welde was refused medical cannabis from St. Olav, she sent a complaint to the State Administrator. They concluded that St. Olav has not given her an individual assessment in the matter. The hospitals are obliged to provide this. Now St. Olav must once again decide whether Welde should receive medical cannabis for his pain. – The doctors’ personal opinion should have no say in what treatment the patients receive. So I’m quite skeptical about that. That’s what Welde says about St. Olav’s handling of the case. Welde is disappointed with St. Olav’s handling of the case. Photo: Marthe Svendsen / news Intended for a small number of patients St. Olav’s hospital has declined to be interviewed. They send over a written response from subject director Runa Heimstad. The subject director writes that approval exemptions for the use of medical cannabis are intended for a small number of particularly serious pain conditions, according to the Norwegian Medicines Agency. Thus, cannabis preparations can be considered for patients with such conditions. – In neurology, for example, cannabis preparations have been tried in recent years for patients with spasticity and particular pain problems, but few stay on such preparations over time due to varying and sometimes weak effects, writes Heimstad. As of August 2022, there are less than 5 patients receiving medical cannabis on prescription at St. Olav. – Regarding the case from the State Administrator, we apologize that this has not yet been fully processed. We cannot therefore go into more detail about the questions that are asked, writes the subject director. Runa Heimstad is subject director at St. Olav. She says medical cannabis is intended for a small number of patients. Photo: St. Olav’s Hosptial Expensive to go to Denmark Welde now has to travel to Denmark once a month to collect the cannabis. This costs her between NOK 10,000-15,000. When well over half of her salary goes to medicine, she cannot afford an apartment. She therefore has to live in her parents’ basement flat, she says. Welde hopes that she can be prescribed cannabis from St. Olav. Photo: Marthe Svendsen / news – What would it mean to you to be prescribed medical cannabis in Trøndelag? – That would have changed a lot of the situation. It is very expensive, it is an expensive medicine. It would have enabled me to move on my own and be more independent. Nor would I have had to spend so much time and energy fighting for the medicine, says Welde.
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Julie wants medical cannabis – St. Olav and OUS consider differently – news Trøndelag
