Knowledge Centre
Patient eligibility and prescribing pathway
A practical guide for general practitioners in the Czech Republic. Eight steps from a thirty-second screen to a monitoring schedule, plus how to complete the eRecept.
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Since 1 April 2025, general practitioners holding specialities 001 and 002 may prescribe medical cannabis for diagnosis R52.1, chronic intractable pain, subject to the professional competence requirements of decree 236/2015 Coll.
That change moved medical cannabis out of specialist clinics and into general practice. Most GPs writing a first prescription are not short of willingness. They are short of a starting dose, an escalation interval, and a clear picture of what to check first. This page is that.
Practical guide
Patient suitability for treatment
Does the patient have chronic pain of more than three months with functional limitation?
Yes
Continue to step 2.
No
Stop
Not a candidate today. Do not prescribe.
Chronic intractable, severe or poorly controlled pain.
This is diagnosis R52.1, the indication general practitioners have been able to prescribe for since 1 April 2025.
In practice this covers:
- Neuropathic pain
- Mixed pain (nociceptive and neuropathic)
- Cancer pain and symptom burden
Cancer pain is normally managed in cooperation with the treating specialist.
- Pregnancy or breastfeeding
- Active psychosis
- Uncontrolled severe psychiatric illness
- Severe cardiovascular disease (arrhythmia, unstable angina, recent events)
- History of substance dependence
- Severe anxiety disorders, where high THC may worsen symptoms
Does the patient drive, operate machinery, or do safety-critical work?
Yes
Thorough patient education required
- Do not drive for approximately 6 to 8 hours after taking medical cannabis.
- Do not drive if you still do not feel well.
No
Continue to step 5.
For all new patients, prefer evening dosing, whatever the answer above.
Select the line by THC/CBD profile
Cannabis-naive, older, or anxiety-sensitive
Start with Mota® SILVER, balanced THC:CBD.
Severe pain, or established tolerance
Consider Mota® ROSE, THC-dominant.
Line definitions
SILVER: THC above 5% and CBD above 5%.
ROSE: THC higher than CBD, CBD at or below 5%.
Then select strain dominance
Indica-dominant (night strain)
- Suited to evening use
- Consider for insomnia or night pain
Sativa-dominant (day strain)
- Suited to daytime symptom control
- Prefer where daytime alertness must be preserved
Hybrid (day and night)
- Flexible use
- Suited to mixed symptoms, such as pain with anxiety or pain with sleep disturbance
Vaporised dried flower
- Rapid onset
- Easier dose adjustment by the patient
- More predictable dose-effect relationship than oral in patients without prior experience
Pharmacy-prepared capsules from flower
- Slower onset, 30 to 180 minutes
- Longer duration of effect
- For structured night-time dosing
- Requires slow titration
The route must be stated on the prescription.
Typical range, vaporised flower
- Up to 1 g/day: initiating or low-tolerance patients
- Up to 2 g/day: patients with established tolerance
- Up to 4 g/day: only with careful clinical assessment
Capsules prepared from flower follow the same protocol.
Consider two prescriptions when
- Night pain and daytime functional limitation coexist
- Daytime sedation limits dose escalation
- Higher THC improves pain but disrupts normal daytime function
Sativa-dominant, or hybrid
Indica-dominant, or hybrid
Adjust only one variable per cycle, dose or dominance, not both, so the treatment response can be assessed objectively.
Review schedule
At 2 to 4 weeks, then every 2 to 3 months.
At each review, assess
- Pain intensity
- Function
- Sleep
- Adverse effects
Continue only while benefit outweighs risk.
Step by step
How to prescribe on eRecept
Medical cannabis prescribing requires authorisation through SÚKL.
Already have access
Go to step 2.
Not yet
Apply at pristupy.sukl.cz. Full registration guide.
In your practice software the prescription must be created as a narcotic substance prescription, not a standard one.
Flower
9190000
Cannabis for medicinal use
Extract
9390000
Cannabis extract for medicinal use
Vaporisation or inhalation of flower
Oral administration, capsules prepared in the pharmacy
- Quantity in grams, for example 10.0
- THC % and CBD % with the product name in the note field, for example:
THC 17.9% CBD 0.2% MotaCHEESE 18/1 ROSE - Diagnosis: R52.1, chronic intractable pain
Limits and reimbursement
Flower (9190000)
Max 180 g per month, 540 g over 3 months.
Of that, 30 g per month is reimbursed at 90% of the price by public health insurance; one prescription may cover up to three months, so up to 90 g per prescription.
Extract (9390000)
Counted at a 3:1 ratio against flower.
Max 60 g per month, 180 g over 3 months.
Of that, 10 g per month (30 g per three-month prescription) is reimbursed at 90%.
Maximum permitted content: 25,0% THC and 23,0% CBD, hard upper limits under Decree No. 236/2015 Coll.
This guide is an orientation aid without warranty as to completeness or currency. It does not replace official treatment protocols or the professional judgement of the physician. The decision to treat, and responsibility for the course of treatment, rest entirely with the prescribing doctor.
Reviewed by [name, role], Motagon s.r.o. Last reviewed 10 September 2026. Intended for healthcare professionals.