Scientifc Informations

• see “cannabinoids“

Prescription Guides of cannabis-based magistral preparations

Practical Informations

for THC >1% , prescribers must submit a request to the Federal Office of Public Health FOPH

SUBJECT: REQUEST FOR EXCEPTIONAL AUTHORISATION FROM THE FOPH FOR THE PRESCRIPTION OF PROHIBITED NARCOTICS (OF THE CANNABIC TYPE) FOR LIMITED MEDICAL USE

Dear Sir/Madam,

I hereby submit an application for authorisation to prescribe medication containing the active substance -9-tetrahydrocannabinol (THC) to the patient named below.

1 APPLICANT PHYSICIAN

Name Telephone
First name E-mail
Street/ No.
Postal code / Place Place/ date

I hereby confirm that

• I have entered the data correctly.
• To draw up and submit to the FOPH an interim report every 6 months on the progress of the treatment and a final report.

Place/ date

Signature of
Attending physician

2 PATIENT

Name Street/ No.
First name Postcode / Place
Date of birth

DECLARATION OF CONSENT BY THE PATIENT
I hereby confirm that I have had an information interview with the doctor, that I have been informed about the financial arrangements and that I agree to the treatment with a cannabis preparation.

Name / First name

Date Signature

3 MEDICAL FILE

Diagnosis

Therapy taken so far (specific medication), course of therapy

Justification for treatment with a cannabis preparation

4 PRESCRIBING

THC: -9-tetrahydrocannabinol, CBD: Cannabidiol

• Isolate “1/0” THC solution, dronabinol 2.5% THC 5% THC 10% THC
• Isolate “1/2” THC/CBD solution: Standardized cannabis oil (~10 mg THC/ ml and ~20 mg CBD/ ml)
• Isolate “1/1” THC/CBD solution*: Standardized cannabis oil (~27 mg THC/ ml and ~25 mg CBD/ ml)
• Full Spectrum THC/CBD solution, 2.5% THC 5% THC 10% THC / CBD 2.5%
• Full Spectrum CBD/THC solution, at 2.5% CBD 5% CBD 10% CBD / THC 2.5%
• Tailor-made: %THC / %CBD (total THC+CBD = max 20%)

5 PHARMACY

Pharmacy Phone
Person responsible E-mail
Street/ No.
Postal code / Place

6 PRODUCTION

Laboratory Name
Street / N°
Postal code / Location

7 ADDITIONAL INFORMATION

Expiry of authorisation: A new application for treatment must be submitted at the latest two weeks before the expiry of the authorisation, accompanied by an interim report on the progress of the treatment.
Interruption/end of treatment: Any interruption of treatment must be announced and briefly justified (death, unsatisfactory effects, side effects, etc.).

Official Website of the Federal Office of Public Health FOPH

Application médicale limitée de stupéfiants interdits (p. ex. le «cannabis», THC)
Beschränkte medizinische Anwendung von verbotenen Betäubungsmitteln (Cannabis, THC)
Applicazione medica limitata di stupefacenti vietati (p. es. canapa, THC)