German patients say medical cannabis is effective

Germany made cannabinoid medicine available by prescription in 2017. This study wanted to learn more about how these patients feel about its effectiveness. It was published in the journal Frontiers in Medicine in December 2023.

Unlike in the U.S., all licensed physicians in Germany can prescribe THC-containing cannabinoids. No special permission is required, however the insurance coverage rejection rate for cannabinoid prescriptions is about 40%. This will obviously impact the use of cannabinoid medicine.

Between June 2021 and June 2022, 216 patients with an average age of 52 (48% women) were surveyed and asked about:

  1. medical history
  2. diagnoses
  3. attitudes toward cannabinoids
  4. physical symptoms
  5. emotional states

On average these patients had been using cannabinoid medicine for about 2.4 years. Patients completed two anonymous questionnaires during one session: one for the current point in time, and one for the point in time before they started cannabinoid treatment.

The survey questions were quite comprehensive and consisted of at least 9 different accepted medical self-rating models, including some diagnosis-specific scales.

The breakdown of their conditions:

  1. Pain (72%)
  2. Spasticity (8%)
  3. Depression (8%)
  4. ADHD (2%)
  5. Other (15%)

The prescriptions were distributed among the following product types, although they were allowed to choose (and use) more than one:

  1. Cannabis flower (45%)
  2. Cannabis extracts (24%)
  3. THC Isolate in the form of dronabinol/marinol (20%)
  4. Combined THC + CBD isolates in the form of nabiximols (13%)



After the start of their cannabinoid treatment, most participants (n = 204, 94%) reported a positive attitude toward cannabinoids.

Across all diagnoses and symptom groups, participants in this sample reported positive effects on emotional states and quality of life. 

Patients suffering primarily from pain (72%, n = 155) reported a reduction of daily pain (NRS: −3.2 ± 2.0, p < 0.001)

During their therapy, most of the participants’ cannabinoid therapy was modified at least once 


Significant "takeaways": Pain patients reported an average of a 3.2 point reduction in pain on a 10 point scale. Overall, patients reported that their quality of life as measured by the WHO-5 Index improved by 7.8 points (out of 25 possible).

Note that most of the patients changed or modified their therapy at least once - which reflects the challenges facing patients in choosing one of many available product types, cannabinoid mixes, and doses.

The reported side effects in order of prevalence were: dry mouth (7%), attention-deficit (5%), fatigue (5%), dizziness (5%) and somnolence (4%).


Authors' conclusions: 

Most participants experienced their therapy with cannabinoids as more effective than their previous therapy. 

Effect sizes observed for pain reduction, quality of life, social participation, and other outcomes suggest a therapeutic potential, particularly in the treatment of chronic pain.


The main limitation of this study (mentioned by the author) was representativeness of the participants, partly due to a large portion of them being privately insured or self-paying.

This type of study is NOT intended to determine causal relationships. It is intended simply to collect and report on patient perceptions of their cannabinoid medicine treatment. The authors state: "The presented exploratory significance levels and effect sizes must therefore be interpreted with appropriate caution and due restraint and no causal attributions are being derived from this exploratory observational data set".


The full text article is here at



Fischer Jan Moritz, Kandil Farid I., Katsarova Ekaterina, Zager Laura Sophie, Jeitler Michael, Kugler Felix, Fitzner Franziska, Murthy Vijayendra, Hanslian Etienne, Wendelmuth Christoph, Michalsen Andreas, Karst Matthias, Kessler Christian S., Patients’ perspectives on prescription cannabinoid therapies: a cross-sectional, exploratory, anonymous, one-time web-based survey among German patients, Frontiers in Medicine, VOLUME 10, 2023,  DOI: 10.3389/fmed.2023.1196160, ISSN: 2296-858X