Cannabis – Positionspapier der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin e.V. (DGP)

Zusammenfassung

In diesem Positionspapier werden auf Grundlage der aktuellen wissenschaftlichen Literatur die Gesundheitsrisiken von Cannabis aufgezeigt, zusätzlich werden die bei einigen Krankheiten potenziell symptommindernden Wirkungen diskutiert. Cannabis ist die in Deutschland am weitesten verbreitete illegale Droge. Schätzungsweise 600 000 erwachsene Personen weisen einen missbräuchlichen oder abhängigen Cannabiskonsum auf. Der Cannabiskonsum in der Gruppe der 12- bis 17-jährigen Jugendlichen erhöhte sich von 2011 bis 2014 von 2,8 auf 6,4 %, die Verbreitung des regelmäßigen Konsums von 0,2 auf 1,5 %.

Derzeit wird in Politik und Öffentlichkeit über den Umgang mit Cannabinoiden debattiert. In die Debatte müssen auch gesundheitliche Aspekte einfließen. Neben den psychischen und neurologischen wird in diesem Positionspapier besonders auf die bronchopulmonalen und kardialen Nebenwirkungen eingegangen. Als fast gesichert kann die Induktion einer chronischen Bronchitis gelten. Auch allergische Reaktionen einschließlich Asthma sind beschrieben. Assoziationen mit anderen Krankheiten wie Lungenemphysem, Lungenkrebs und Pneumonien sind nur unzureichend belegt, aber auch nicht ausgeschlossen. Im Zusammenhang mit dem Konsum von Cannabis sind auch kardiovaskuläre Ereignisse wie akute Koronar-Syndrome, periphere Gefäßerkrankungen und zerebrale Komplikationen bekannt. Oft reicht die Datenlage aus verschiedenen Gründen nicht aus, um feste Aussagen zu machen, vor allem kann in den meisten Veröffentlichungen nicht oder nur unzureichend zwischen den sich überlappenden Effekten des Tabakkonsums und des Cannabiskonsums differenziert werden. Empirisch ist u. a. mittlerweile sehr gut belegt, dass ein im Leben früher, hochdosierter, langjähriger und regelmäßiger Cannabisgebrauch das Risiko für unterschiedliche Störungen der psychischen und körperlichen Gesundheit und der altersgerechten Entwicklung erhöht. Sorge bereitet deshalb speziell der Cannabiskonsum bei Kindern und Jugendlichen.

Die wissenschaftliche Datenlage zum medizinischen Nutzen von Cannabis als Heilmittel ist nur gering, systematische wissenschaftliche Forschung guter Qualität, insbesondere prospektive, randomisierte, Placebo-kontrollierte doppeltblinde Studien liegen kaum vor.

Aus Sicht der an diesem Positionspapier beteiligten Fachgesellschaften ist festzustellen, dass der Konsum von Cannabis mit gesundheitlichen Risiken verbunden ist, die in der Debatte um den gesellschaftlichen Umgang mit Cannabinoiden zu berücksichtigen sind. Die beteiligten Gesellschaften stimmen darin überein, dass noch viele Aspekte hinsichtlich der gesundheitlichen Auswirkungen von Cannabis offen sind und möglichst mittels kontrollierter Studien geklärt werden sollten.

Abstract

In this position paper, the adverse health effects of cannabis are reviewed based on the existing scientific literature; in addition possible symptom-relieving effects on some diseases are depicted. In Germany, cannabis is the most widely used illicit drug. Approximately 600 000 adult persons show abusive or addictive cannabis consumption. In 12 to 17 year old adolescents, cannabis use increased from 2011 to 2014 from 2.8 to 6.4 %, and the frequency of regular use from 0.2 to 1.5 %.

Currently, handling of cannabinoids is much debated in politics as well as in general public. Health aspects have to be incorporated into this debate. Besides analysing mental and neurological side effects, this position paper will mainly focus on the influences on the bronchopulmonary and cardiovascular system. There is strong evidence for the induction of chronic bronchitis. Allergic reactions including asthma are known, too. Associations with other diseases like pulmonary emphysema, lung cancer and pneumonia are not sufficiently proven, however cannot be excluded either. In connection with the use of cannabis cardiovascular events such as coronary syndromes, peripheral vascular diseases and cerebral complications have been noted. Often, the evidence is insufficient due to various reasons; most notably, the overlapping effects of tobacco and cannabis use can frequently not be separated adequately. Empirically, early beginning, high-dosed, long-lasting and regular cannabis consumption increase the risk of various psychological and physical impairments and negatively affect age-based development. Concerns therefore relate especially to children and adolescents.

There is only little scientific evidence for medical benefits through cannabis as a remedy; systematic research of good quality, in particular prospective, randomised, placebo-controlled double-blinded studies are rare.

The medical societies signing this position paper conclude that cannabis consumption is linked to adverse health effects which have to be taken into consideration in the debate about the social attitude towards cannabinoids. The societies agree that many aspects regarding health effects of cannabis are still uncertain and need clarification, preferably through research provided by controlled studies.

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