‘Throw away your bias, your preconceptions and try’
In Italy, access to cannabis-based products is complicated because of the ‘excess of bureaucracy’, according to Dr Marco Bertolotto, an Italian pain specialist. Dr Bertolotto is an experienced prescriber of medicinal cannabis, having already treated more than 2500 patients. While other Italian doctors do not even consider prescribing. Dr Bertolotto points out: “Every step is complex and insidious. A serious error can be punishable by law. Every step has a trap inside.” Limited prescribing means few patients access medicines they could benefit from. “It is a recurrent story. Patients suffer from the disease and from the lack of therapy.”
Dr Bertolotto runs a regional pain clinic and palliative care centre ASL2 in Liguria, Italy. At the end of 2018 he launched a personal website with information about the use of cannabinoids as a medicine. Due to a special Bedrocan cannabis Masterclass in December 2015 in the Netherlands, Dr Bertolotto and a small group of Italian medical experts were trained in depth on the use of medicinal cannabis according to Bedrocan standards. He now considers himself an expert and an Italian pioneer in the field. “My experience started five years ago, at the start of the Italian medical cannabis programme. I found out that there was a group of patients that were suffering and had tried so many drugs, without efficacy. They were looking for an alternative and an expert doctor who could help them.”
‘Throw away your bias’
Despite the maze of rules, Bertolotto’s motto to doctors starting out prescribing is ‘not to be afraid. Throw away your bias, your preconceptions and try. Choose the dosage by starting low, and continue going slow. Follow the patient day by day.” Bertolotto also provides advice with regards to which administration form to use. “It depends of the patient and the disease. I normally prefer to use oil, because the titration with drops is easy, but I also prescribe cannabis dried flower by vaporization.” As Western medicine is entirely based on scientific evidence that requires randomised, double-blind studies there is unfortunately still not enough evidence. Bertolotto about this issue: “This is a big problem as doctors are therefore reluctant to prescribe. Evidence based medicine is not adapted to studying cannabis-based medicine. We need a different approach. My personal approach, that I will present later this week at the Italian Cannabis Business conference, is called Personalised Medicine. We collect and analyse a lot of data until we have an algorithm to help doctors.”
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