Medical marijuana gains ground in South America

[Buenos Aires] Three South American countries have issued policies to regulate cannabis use for medical or recreational purposes. In recent weeks, firm steps have been taken to legalise the controversial plant in the region.

This also opens new opportunities for research into its therapeutic and pharmacological properties. But the measures are still the subject of debate among scientists, who have mixed views about legalisation and the need for clinical trials as well as control measures.

To date, research has shown that at least 45 different pathologies do not respond to conventional medicine, but they respond to cannabis.

Colombia and Argentina have issued policies to regulate the cultivation and marketing of the plant, as well as the manufacture of derived products. Uruguay’s policies cover recreational use of the plant — after more than three years of study, the government announced last month (April 6) that as of July, it will enable the sale of cannabis in pharmacies.

Chile, Jamaica and Puerto Rico have also approved medicinal use of the plant in recent years, while in Mexico a congressional debate on the issue is still pending.

Rules in three countries

People who want to buy cannabis in Uruguay must register, from May 2^nd, at the offices of Uruguayan Mail. Anyone can buy up to 10 grams per week, with a limit of 40 grams per month, at a cost of US$ 1.30 per gram. Users will be identified by their fingerprints, with a device showing the pharmacist if the buyer is authorised and how much they can buy.
It is estimated that, initially, around 30 pharmacies will participate in the system.

In Colombia, the government issued an order on April 10 to regulate the management of cannabis seeds and their derivatives for medical and scientific purposes. It established four types of licence, all with a validity period of five years: for manufacture of derivatives, use of seeds for planting, cultivation of psychoactive cannabis plants, and cultivation of non-psychoactive cannabis plants. The order states that “drugs may only be advertised or promoted in scientific or technical publications, addressed to the medical and / or veterinary body.”

In Argentina, a law that incorporates the use of cannabis-based medicines to the National Public Health System was made official on April 19. This law was promoted more than a year ago by groups of mothers of children with diseases and neurological disorders, especially epilepsies, that do not respond to conventional treatments.

For now, cannabis will be used to treat refractory epilepsy, cancer, chronic pain, fibromyalgia, glaucoma, multiple sclerosis, and others that the Argentine Ministry of Health deems appropriate.

The same regulation also applies to research, cultivation and production of cannabis by the State. It also guarantees the free supply — initially through the import of cannabis oil — to registered patients.

Debate over the science

But not everyone agrees with these developments. Marcelo Merello, director of the neurosciences department of the Foundation for the Fight against Neurological Diseases of Children (FLENI) in Argentina, highlights an enormous discrepancy between the lack of scientific data showing the usefulness of cannabis, the new regulation and the increasing demand for its use.

“Science and research in this case go far behind regulations and that is a real problem, primarily for patients, and for doctors as well,” Merello said in a statement posted on FLENI’s website.

But Carlos Magdalena, a neurologist at the Children's Hospital Dr. Ricardo Gutierrez in Buenos Aires, questions this argument. “We have [only] been able to do research for a very short period of time, because it was forbidden,” Magdalena says. “When some colleagues ask us for longitudinal studies we understand that they seek to devalue the evidence; it’s a way to avoid a possibility of therapeutic alternatives, to improve the quality of life that would be very imprudent to generate.”

“We should move forward in constructing a network that includes care, boosts teacher training, and institutionalizes the subject [of cannabis use] in health organisations, it’s the only way to make up for time lost.”

Carlos Magdalena, Children's Hospital Dr. Ricardo Gutierrez, Buenos Aires

A dozen case studies were presented at the last Congress in 2014, of the Argentine Society of Neurology — and Magdalena confesses they had to be done “in secret, with a little shame”.

He emphasizes that, for the first time, the traditional doctor-patient relationship, “in which traditionally the first has the know-how and the latter is a passive being”, is being reversed as a result of the recent policies.

For Merello, the benefit of approving cannabis oil is not so much for its use, but for the great door it opens to advancing scientific research. “Science should be allowed to make a pronouncement on its usefulness and safety in the most expeditious way possible so that patients, if there are benefits, can take advantage of them quickly”, he argues.

Policies that work for patients

Valeria Salech is president of the Chilean NGO Mama Cultiva, and mother of a 10-year-old boy with epilepsy and autism, conditions that she treats with oil from a cannabis plant she grows in her house. “Very traditional and prejudiced doctors shut the doors for us saying that cannabis was not going to work,” she says. “We have even been expelled from the clinics for daring to challenge the doctor's authority.”

María Laura Alasi, founder of Cannabis Medicinal Argentina, says there is a way to address concerns over addiction. “Sometimes a single variety of oil does not cover all the needs, so it is necessary to rotate the type of cannabis so that there is no habit,” she explains.

Because of these needs, and in order to avoid a regulatory approach based on provision of the oil by the laboratories, Salech and Alasi argue that it is necessary to legalize self-cultivation.

“First world countries have incorporated it as a medicine into the therapeutic chain, creating a multimillion dollar industry”, says biologist Marcelo Rubinstein, a researcher at the Research Institute in Genetic and Molecular Biology Engineering ‘Dr. Héctor N. Torres’ (INGEBI) in Argentina.

“We should move forward in constructing a network that includes care, boosts teacher training, and institutionalizes the subject [of cannabis use] in health organisations,” says Magdalena, adding that it’s the only way to make up for time lost.

With additional reporting of Daniela Hirschfeld, from Uruguay.

This piece was originally published by the Latin America and Caribbean desk.