German Survey Finds Many Prescription-Cannabis Patients Report Better Symptoms and Treatment Satisfaction

A survey of 216 German patients receiving prescription cannabinoid therapies found that many reported less pain, improved well-being and greater satisfaction than they recalled experiencing before starting treatment. But the study does not establish that medical cannabis is more effective than conventional therapies: it was a cross-sectional survey based on patients’ retrospective self-reports, not a randomized clinical trial.

The 2023 study published in Frontiers in Medicine was conducted by researchers affiliated with Charité – Universitätsmedizin Berlin and other German institutions. Participants completed an anonymous online questionnaire between May 2021 and June 2022, describing their current experiences with prescription cannabinoids and recalling their health status before beginning treatment.

Chronic pain was the main reason for treatment for 155 participants, or 72% of the sample. Among these patients, average daily pain scores were 3.2 points lower on a 0-to-10 scale than the levels they retrospectively reported before starting cannabinoid therapy. Participants receiving treatment primarily for spasticity also reported less severe symptoms and improved mobility.

Across the full group, participants reported higher scores for treatment effectiveness, side-effect satisfaction, convenience and overall satisfaction on the Treatment Satisfaction Questionnaire for Medication. Their average score on the WHO-5 well-being scale also increased. Patients reported fewer difficulties with physical functioning, anxiety, depression, fatigue, social roles and the effect of pain on daily life. Sleep disturbance showed a smaller improvement.

These findings reflect perceived changes, not an objective comparison between cannabis and a specific conventional medication. Because participants assessed their earlier condition from memory—sometimes recalling a period as far as eight years before the survey—the results may have been affected by recall bias. The design also cannot determine whether cannabinoids caused the reported improvements.

The researchers attempted to reduce stigma and influence from treatment providers by keeping the survey anonymous and online. Participants answered questions about their diagnoses, treatment history, cannabis preparations, side effects, attitudes toward cannabinoids and experiences obtaining prescriptions. Most had been using prescription cannabinoids for one to two years at the time of the survey.

Access and reimbursement remained significant concerns. Although 69% of participants reported no major difficulties with the prescription process, some patients encountered problems with health-insurance coverage. The paper reports that roughly one-quarter of participants with statutory health insurance paid out of pocket for their medication. Patients also reported changing their cannabinoid treatment because of side effects or a desire to improve effectiveness. Reported adverse effects included dry mouth, attention problems, fatigue, dizziness and drowsiness.

Prescription cannabis has been available in Germany since 2017 under rules that allow treatment in individual cases when other options have not provided adequate relief. The German Federal Ministry of Health’s explanation of the 2017 medical-cannabis law describes the framework for prescribing and, in certain circumstances, obtaining reimbursement through statutory health insurance. Medical cannabis remains separately regulated from cannabis intended for nonmedical use; the ministry’s current Cannabis Act FAQ states that medicinal cannabis can still be prescribed under existing social-law requirements.

The survey adds useful information about how patients experience treatment in routine outpatient care, particularly because much earlier German data came from prescribing physicians rather than patients themselves. It also aligns with broader evidence suggesting that some cannabinoid medicines may provide modest short-term benefits for chronic pain, although side effects are more common than with placebo in many studies. The U.S. National Center for Complementary and Integrative Health’s evidence summary notes that the benefits vary by product and condition and that evidence for long-term use remains limited.

The German researchers caution that their sample may not represent all patients using medical cannabinoids. People who experienced meaningful benefits may have been more likely to participate, while those who discontinued treatment or had poor results may have been missed. Recruitment during the COVID-19 pandemic also prevented the study from reaching its intended level of representativeness.

Overall, the results suggest that many surveyed patients perceived prescription cannabinoid therapy as more helpful than their previous treatment and associated it with reduced symptoms and better quality of life. They provide a rationale for more rigorous prospective and randomized studies—but not proof that cannabis is generally superior to conventional pain treatments.