About medical cannabis

Basic info about


Hemp is an annual plant from the hemp family, which also includes hops. It is a dioecious plant, with the females producing the flowers while the males produce the pollen sacs used to pollinate the female flowers. From a medical point of view, the most interesting are the female flowers, which produce the largest amount of substances with pharmacological effects – so-called cannabinoids, terpenes, flavonoids and others. A total of 1,500 chemically active substances have been identified in cannabis, but only a handful of them have been sufficiently scientifically investigated.

Constituents in cannabis: Cannabinoids and Terpenes

The best-known and most thoroughly researched cannabinoids with medicinal properties are the psychoactive THC (tetrahydrocannabinol) and the non-psychoactive CBD (cannabidiol). The interesting thing about cannabinoids is that they do not occur naturally anywhere else than in the female cannabis flowers. In recent years, the interest of science has increasingly focused on terpenes, which are the substances responsible for the smell and aroma of cannabis, but these substances are also commonly found in other plants.

The cannabis plant contains a variety of different chemicals, including more than 140 cannabinoids. The two most extensively researched and medically used cannabinoids are the psychoactive tetrahydrocannabinol (also known as THC) and the non-psychoactive cannabidiol (also known as CBD). Cannabis for medical use and its preparations can contain both THC and CBD, or often both cannabinoids simultaneously in varying amounts. However, that is not all.


In addition to THC and CBD, cannabinoids that have come to the forefront of science and medicine in recent years include, for example, CBG (cannabigerol), CBN (cannabinol), CBC (cannabichromene), THCV (tetrahydrocannabivarin) or CBDV (cannabidivarin). The interesting thing about cannabinoids is that they do not occur naturally anywhere else than in the female cannabis flowers.

As previously stated, THC is psychoactive, meaning it affects a person’s perception of reality and mental state. It does so by interacting with the CB1 endocannabinoid receptors in our brain. In this way, THC can simultaneously develop a pharmacological activity that leads to a reduction of pain, alleviation of anxiety, reduction of muscle tension or even nausea. At higher levels, or depending on individual patient sensitivity, THC can cause negative effects, including sensory hyperstimulation, paranoia and restlessness, blurred vision, dry mouth, or dizziness. These are the effects associated with so-called intoxication, where it is important to remember that these side effects are not of a permanent nature and do not have a long-term impact on the individual’s health.

In the case of the second most well-known cannabinoid, CBD, the main distinguishing feature is that, unlike THC, it is not psychoactive. This means that it does not cause dizziness and does not affect the perception of the surrounding world or sobriety. In addition, research in recent years shows that CBD can counteract some of the negative effects of THC when the two substances are administered together or within a short time interval. Regarding the therapeutic potential of CBD, clinical research shows a positive effect in the treatment of epilepsy, chronic pain, inflammation or anxiety states.



The spectrum of medical varieties that a doctor can prescribe for you today is really wide - it includes more than six dozen varieties with different contents of active substances. We have prepared an overview for you of what THC and CBD ratios you can expect in cannabis from a pharmacy, what the psychoactivity of these ratios is, and what indications they are typically used for. Of course, cannabis treatment is highly individual and each patient may react differently. The overview is therefore only indicative.


The second most important group of substances that contribute to the complex effects of cannabis are terpenes. They are known as essential oils and are responsible for the specific smell and taste of cannabis. The spectrum of terpenes in cannabis is very broad, however, some aromatic substances appear more often and in greater quantities than others.

In some varieties, fruit terpenes predominate, such as limonene, which gives them a pleasant citrus scent, or linalool with a hint of lavender. However, most often we find the terpene caryophyllene in cannabis, which is also found in nature, for example, in cloves.
Terpenes have their own effects on human health, for example, some have been shown to have significant antibacterial activity, which consists not only in killing bacteria or preventing their growth, but also in suppressing their aggressiveness.

Other substances and synergistic action

The so-called synergy is very important for the complex therapeutic effect of cannabis. Simply put, it is the interaction of different types of substances, mainly cannabinoids and terpenes, with the overall effect exceeding the sum of the effects of the individual components. In addition to terpenes, we also find other groups of substances in smaller amounts in cannabis, which include, among others, flavonoids and alkaloids.

History of cannabis and its medicinal use

The main problem with cannabis and its use in modern medicine is that the plant has been banned worldwide for many decades and all research has focused only on negative properties, while the positive effects on human health have been neglected or completely ignored. This gradually began to change mainly thanks to the work of researchers in Israel, among whom is the world-renowned chemist from Olomouc, Lumír Hanuš. Today, cannabis is being researched in hundreds of research centers around the world, and there is a rapid increase in the number of states where it is legalized for use in conventional medicine. 

Humans have been using cannabis for thousands of years, as evidenced by historical sources from around the world. One of the main reasons is the medicinal effects of this plant, which were described by all advanced ancient civilizations and were used by respected doctors across Europe and America in the 19th century. It wasn’t until the 20th century that the investigation of possible therapeutic properties was banned. Today, however, everything is different and modern medicine and science are gradually discovering the enormous potential of the substances contained in cannabis.

The traditional place from where cannabis was supposed to gradually spread throughout the world is Central Asia. From there, it quickly spread to all continents (with the exception of the polar regions), which is also confirmed by the linguistic analysis of the word stem cannabis, the basis of which appears in the original Indo-European dialect and has been preserved in a certain form in English, German, Czech, Latin, Greek, Persian and in Sanskrit.

Chinese first

A fundamental breakthrough in the coexistence of humans and cannabis came in the form of the discovery of the medicinal use of various parts of this plant – according to preserved sources, the oldest mentions come from ancient China, specifically from the time of the legendary emperor and healer Shen-nung. He was able to complete traditional methods of natural treatment and knowledge passed down from generation to generation. He is said to have created the first collection of pharmacological recipes and instructions for treatment around 2737 BC. He listed hemp among the best elixirs of immortality and claimed, among other things, the following: “Female plants are recommended for female complaints, rheumatism, beriberi, malaria, constipation, gout, disorders of concentration and other ailments.”

Scientific findings

If we look to the recent past, the second half of the 20th century brought major changes and researches centered mainly in Israel around the pioneer of cannabis science, Raphael Mechoulam, who was the first to isolate THC, CBD and other cannabinoids. Lumír Hanuš, a Czech chemist from the Palacký University, also worked in his team from the end of the eighties, who co-discovered the first endocannabinoid (a cannabinoid that the body makes itself) and called it anandamide.

Thanks to these fundamental and ground-breaking discoveries, research and applications in medicine in other countries could start at a great pace from around the mid-nineties, and we gradually began to get explanations for many questions related to cannabis treatment. Among them, for example, is the key question, how is it possible that substances in cannabis can help with such different health problems? One patient is helped by cannabis with convulsions in multiple sclerosis, another with epileptic seizures. For one it relieves pain, for another it helps with anxiety, for another it stimulates the appetite and for another it can suppress it. Cannabinoids affect not only our brain or heart, but also the entire immune system and also react with skin cells. What role does a receptor system called the endocannabinoid system, which was discovered relatively recently, play in this?
The more information today’s science and medicine gives us in the field of medicinal cannabis, the more questions arise, but what is certain is that cannabis treatment has a strong place in the health care of the 21st century.

A half-forgotten Czech footprint

At the turn of the 1940s and 1950s, research into the medicinal properties of cannabis was carried out on the territory of what was then Czechoslovakia, specifically at the Palacký University in Olomouc, which resulted in the conference Hemp as a Medicine in 1954. The groundbreaking results of the research of professors Krejčí, Šantavý and Kabelík were presented here regarding the antibacterial effects of cannabis, the results of the successful application of the extract in dentistry and in the treatment of otitis media, or the positive effect of consumption of hemp seed in children with tuberculosis. They even identified cannabidiol acid (CBDA) as the first in the world. Even from today’s point of view, these were impressive researches, however, they were carried out under deep communism, and therefore they never reached the world and fell into oblivion. At least the mentioned Lumir Hanuš thus became the successor of an important research tradition,

Endocannabinoid System and Effects of Cannabis

The actual effects of cannabis on humans are complex and very broad. The interaction with the human organism takes place through the endocannabinoid system, which is a relatively recently discovered receptor system that affects a whole range of processes in our body and whose goal is to maintain balance or homeostasis. It is cannabinoids that interact with this system through different mechanisms, which explains the fact that cannabis can help patients with diverse and seemingly completely different health problems – from pain relief to nausea suppression, appetite stimulation to the treatment of inflammation, spasticity or psychological diseases such as post-traumatic stress disorder disorder.

The endocannabinoid receptor system, for which the term endocannabinoid system was used, was discovered in the human body at the turn of the 80s and 90s of the last century. Since then, it has been the focus of both scientists and a growing number of doctors. It turns out that it has a fundamental effect on the functioning of the entire organism and the maintenance of homeostasis (balance) in the body. The existence of this receptor system also clarifies the versatile effects of the substances contained in cannabis, which precisely react with the endocannabinoid system and influence its operation.


After the discovery of the endocannabinoid system, scientists began to come up with other interesting findings – for example, they discovered that so-called cannabinoid receptors are found throughout the body: from the brain to internal and external organs to the immune system. Another important discovery came in 1992, when the Czech chemist Lumir Hanuš, working in Israel, identified the first endocannabinoid together with the American molecular biologist William Devan. They called it anandamide, which in Sanskrit means inner happiness.
In further experiments, it was confirmed that anandamide binds to the same receptors in the brain as the most well-known cannabinoid contained in cannabis – THC.

What can cannabis help with?

It has been scientifically confirmed repeatedly in recent decades that cannabinoids and other substances in cannabis (for example, terpenes) influence a whole range of physiological functions in the human body through the endocannabinoid system. The frequent popular claim that cannabis is a panacea or panacea is of course not true, but the effects of the substances in this plant are really broad.
On the other hand, it is true that each individual can react differently and that the proven health-beneficial effects of cannabis exist primarily in symptomatic treatment. This means that within the framework of official medicine, they treat the manifestations of a whole range of different diseases, but they do not treat the causes of the diseases themselves.
Within the framework of the Czech healthcare system, it is possible to prescribe cannabis for medical use for the following diverse indications:

  • Chronic intractable pain (especially pain associated with oncological disease, pain associated with degenerative disease of the locomotor system, systemic connective tissue disease and immunopathological conditions, neuropathic pain, glaucoma pain).
  • Spasticity and associated pain in multiple sclerosis or spinal cord injury, painless persistent spasticity that fundamentally limits the patient’s movement and mobility or breathing. Involuntary kinesis caused by a neurological disease and other health complications originating from a neurological disease or spinal cord injury or brain injury. Neurological tremor caused by Parkinson’s disease and other neurological problems at the discretion of the attending physician.
  • Nausea, vomiting, appetite stimulation in connection with the treatment of oncological disease or the treatment of HIV disease.
  • Gilles de la Tourette syndrome.
  • Surface treatment of dermatoses and mucosal lesions.

Individual approach

Recently, in connection with cannabis for medical use, there is more and more talk about the need for “individualized” treatment. This means that each patient should be approached individually, both in terms of the content of individual cannabinoids and their mutual ratios in the drug under consideration, and in terms of the method of administration. This is the only way to achieve the best possible effect without side effects.

Ways of use and forms of application

The effects of cannabis can be very diverse and differ based on the content profile of a specific variety, the individual disposition of the patient and the method and form of use. There are varieties that contain a high amount of psychoactive THC, while others contain almost no THC, but you will find a higher CBD content. One strain may work well for one patient for pain relief, while another may work better for another patient with the same problems. Different effects must be expected even in the case of different forms of consumption – inhalation of vapors (smoking or vaporization) has a different effect and for a different time than, for example, oral consumption of oils or food and so on.

Cannabis can be consumed in several different ways, each of which has its own specifics in terms of onset of effects, duration and intensity of therapeutic or side effects. In order to make it not too easy, the form of delivery is also essential for the resulting experience. Below we briefly explain the basic concepts and point out what to watch out for.
There are three basic methods of consuming cannabis and preparations made from it – orally (by mouth), topically (on the skin) and inhalation (vapors from a vaporizer or smoke from burning dry matter).


If we start from the back, in the case of inhalation, it is historically the most used and still the most widespread form of smoking, although it is the least healthy method of consumption. In addition, in the Czech Republic, doctors prescribing cannabis for medical use may not even recommend smoking to their patients. However, a suitable substitute is vaporization, where the plant material is not burned, but only heated, which means that the patient is not forced to inhale harmful substances like when smoking. The advantage of both methods is the rapid onset of action (usually 2–15 minutes), the disadvantage is the shorter duration of action (approx. 2–3 hours). Vaporization is recommended by doctors, and even today there are devices that are approved by the relevant authorities as medical devices designed to inhale cannabis for medical use.

Skin application

Applying gels, ointments, but also tinctures or sprays to the skin is a specific way of administering cannabis, where the active substances are absorbed directly at the problem site. This fact represents the main advantage, when due to precise targeting, there are no “losses”, as when a patient takes, for example, orally an oil with an extract. The disadvantage is the grease remaining on the skin and also the fact that until recently it was not possible to have cannabis ointment prepared in a pharmacy for medical use. However, this has recently changed and soon it should be possible to take away from the pharmacy not only dried flowers or capsules from them, but also extracts and ointments and gels prepared from them.



Under the influence of heat, a molecule of carbon dioxide (CO2) is released from the cannabinoid acid and the neutral form of cannabinoids escapes.


THC content in relation to
the time and temperature
of decarboxylation

The graph shows the effect of time and temperature of decarboxylation on THC content. The values were measured for hemp extract placed on a glass surface in an open oven.


Source: Journal of Chromatography 520 (1990)



To prevent the resin from sticking to the tray or baking tray, spread baking paper over it. Spread crushed or hand-ground dried hemp on it.

We bake in the classic mode, without using hot air

Depending on the density of the dry matter, a temperature between 100 and 120 °C is recommended. The time required for decarboxylation decreases with increasing temperature (from 60 minutes at 100°C to 20 minutes at 120°C).

Motagon Cannabis logo

Oral application

Cannabis preparations can be taken orally, whether they are extracts dissolved in oil, macerated flowers in alcohol, sweet or salty foods, capsules or tablets. In general, in the case of oral consumption, it takes longer for the patient to feel the first effects (up to two hours). It is also true that the duration before the effects wear off can be six or more hours, depending on the dose. There are also differences between the forms of oral application themselves – oil dropped under the tongue will begin to affect cognition earlier than a swallowed capsule and so on. In general, we can state that orally used preparations are more suitable for the night and for patients who need long-lasting relief. On the other hand, inhalation is sought by patients who need immediate relief even at the cost of the fact that the effects wear off much earlier than in the case of oral consumption.

Other ways

Among the less used, but very promising methods are, for example, nasal sprays and, above all, vaginal and rectal suppositories, the advantage of which should be the rapid onset of effects, high bioavailability and low psychoactivity of THC administered in this way (compared to oral consumption). On the other hand, there is still a lack of sufficiently robust clinical data in this area, so we will have to wait for more mass use of this form of cannabis application for medical use.

The most famous researches and studies

We know exactly what cannabis treats and where it helps, from clinical research, the number of which has been steadily increasing in recent years. From research to date, we know that cannabis treatment is proven to help with chronic pain, muscle spasms, skin diseases or inflammatory bowel diseases. Furthermore, positive effects on appetite and nausea, in patients with glaucoma, and so on, have been demonstrated in cancer patients or HIV/AIDS patients.

Clinical research and relevant studies on cells and animals are being carried out in connection with cannabis with increasing intensity. In the last two decades or so, we have gained a huge amount of knowledge, especially about CBD and THC, the two cannabinoids that are found in the largest amount in most varieties. What are the most interesting results and conclusions of professional papers?

The highest quality clinical studies are conducted mainly in the field of pain treatment, multiple sclerosis and other neurological diseases. The reasons are as follows: pain is by far the most common health problem treated with cannabis, and in the case of neurological diseases such as multiple sclerosis or epilepsy, there are also standardized medicinal products from cannabis that have gone through rigorous approval processes in both America and Europe. These are oz plants extracted from THC and CBD in a 1:1 ratio (Sativex) and pure CBD (Epidiolex). In the United States, it is even possible to officially use Epidiolex for pediatric epileptics.

Synthetic versus natural

A long series of clinical trials have also been conducted with synthetically produced cannabinoids such as dronabinol, for which it was easier for doctors to obtain permission and the material itself. However, in these works we often come across side effects that are not usually observed with herbal cannabis. Nevertheless, research with dronabinol, for example, in patients with HIV/AIDS from the eighties and nineties of the last century became one of the foundations on which patients and doctors based their arguments at a time when cannabis treatment was still prohibited in the vast majority of the world.

Chronic pain

Clinical study: 27 patients from Israel, the results of which were published in 2020 in the European Journal of Pain, showed that inhalation of cannabis with THC leads to a significant reduction in pain intensity. Several recent studies have also shown that the use of cannabis for pain management leads to a reduction in the consumption of opioid drugs (for example American study from Michigan in 2016 with 244 patients, 64% of whom reduced their prescription opioid use; yielded the same results. Canadian study: 1,145 patients from 2021 published in the journal Pain Medicine).

Muscle spasms in neurological diseases

A search for clinical research from 2007 to 2017 published in the professional journal Multiple Sclerosis and Related Disorders concluded that “Sativex is an effective treatment for spasticity and its use also leads to an improvement in quality of life. In addition, only a small incidence of side effects was observed, which confirms the appropriate safety profile and the fact that it is well tolerated by patients.’
Clinical study from 2019, in which the neurology department of the Thomayer Hospital in Prague also participated, investigated the effects of Sativex as an adjunctive therapy to standard antispasmodic treatment in 191 patients with a moderate to severe form of multiple sclerosis (MS). The conclusion reads: “The addition of an oromucosal spray with THC and CBD resulted in better and clinically relevant results than the application of the standard medication alone for the treatment of resistant spasticity in MS patients.”


In the study from 2015, 214 pediatric patients with seizures of various origins who did not respond to conventional treatment methods (Dravet syndrome, Lennox-Gastaut syndrome, etc.) were examined in more than ten American pediatric hospitals. The findings were published in the journal The Lancet Neurology and read: “Our findings suggest that CBD has the potential to reduce seizure frequency and has an adequate safety profile in children and young adults with drug-resistant forms of epilepsy.”
In a double-blind, placebo-controlled study clinical study from 2017, American doctors looked at the effects of CBD on 120 children and young adults with Dravet syndrome, who suffer from seizures that are not helped by conventional drugs. At the conclusion of the paper, we read: “The use of cannabidiol by patients with Dravet syndrome led to a greater reduction in the number of seizures compared to placebo, but at the same time more side effects were observed than with placebo.”

Skin problems

Unequivocal proof that cannabis, or in this case CBD of plant origin, is an effective means of treating skin problems is inclusion of this substance to the European Commission’s official CosIng database in 2021. Specifically, it is written about CBD in this database that it has “antioxidant, protective and moisturizing effects and acts against sebum production” on the skin.

Who can prescribe and to whom

In the Czech environment, doctors prescribing cannabis must meet certain requirements and there are also restrictions on the patients for whom cannabis can be prescribed for medicinal use. Everything is strictly defined by law and only applies to the territory of this country, abroad the rules can be quite different and, for example, travelling with cannabis across borders can be problematic for official patients.

According to a 2013 law, there is a list of medical specialities that can prescribe cannabis for medicinal use in the Czech Republic. This does not include GPs, for example, which slows down the whole system from the start. Similarly, it is not possible to prescribe cannabis to patients under the age of 18, which is not in line with standards and clinical experience from around the world.

Who prescribes

From the website of the State Agency for Cannabis for Medicinal Use (www.sakl.cz) we read that doctors of the following specialties can prescribe: clinical oncology, radiation oncology, neurology, palliative medicine, pain management, rheumatology, orthopedics, infectious medicine, internal medicine, ophthalmology, dermatovenerology, geriatrics and psychiatry. It should be noted that, for example, psychiatrists or ophthalmologists in the Czech Republic practically do not prescribe.

Neurologists and algesiologists (doctors who treat pain) prescribe the most cannabis for medical use. A smaller number are oncologists, orthopedists and rheumatologists. With the possibility of preparing ointments from January 1 this year, it can be expected that the number of prescribing dermatologists will also begin to rise.

To whom it can be prescribed

Unlike other countries, in the Czech Republic we do not have a defined list of diagnoses, but so-called indications or conditions (so they do not prescribe directly, for example, for multiple sclerosis, but for spasticity associated with it). In practice, this gives doctors somewhat more latitude than in states where diagnoses are fixed. Again on the website of the State Agency for Cannabis for Medicinal Use (www.sakl.cz) you will find the following list of indications for the mitigation of which it is possible to prescribe cannabis for medical use:

  • Chronic intractable pain (especially pain associated with oncological disease, pain associated with degenerative disease of the locomotor system, systemic connective tissue disease and immunopathological conditions, neuropathic pain, glaucoma pain).
  • Spasticity and associated pain in multiple sclerosis or spinal cord injury, painless intractable spasticity that fundamentally limits the patient’s movement and mobility or breathing, involuntary kinesis caused by neurological disease and other health complications originating from neurological disease or spinal cord injury with spinal cord damage, or brain injury, neurological tremor caused by Parkinson’s disease and other neurological problems at the discretion of the attending physician.
  • Nausea, vomiting, appetite stimulation in connection with the treatment of oncological disease or the treatment of HIV disease.
  • Gilles de la Tourette syndrome.
  • Surface treatment of dermatoses and mucosal lesions

Details and limitations

As we have already stated, in the Czech Republic it is not possible to prescribe cannabis for medical use to persons under the age of eighteen. The amount for adults is limited to 180 grams of dry matter per month (in the case of extracts, a 7:1 conversion was established), however, health insurance companies reimburse 90 percent of amounts up to 30 grams per month. If, in the opinion of the doctor, the patient needs more than 30 grams per month and does not have the financial means, he can apply for individual reimbursement, which must be approved by the reviewing doctor.

As for traveling with cannabis for medicinal use abroad, it should be possible within the European Union countries in which cannabis treatment is also legal. In practice, however, lawyers dealing with this issue do not recommend it very much and draw attention to the different interpretations of the relevant laws at the level of individual states.