Medical Marijuana: A Case Study

The first record of cannabis for medicinal use dates back in 2700 BCE for treating over 100 ailments. In the last 25 years, this controversial plant is making headlines for its potential therapeutic and medicinal properties, particularly its Δ-9- tetrahydrocannabinol (THC) and cannabidiol (CBD) compounds.

Numerous studies have pointed CBD as a compound with great potential in treating various diseases, including sleep disorder, pain and anxiety control, neurodegenerative conditions and cardiovascular regulation. CBD has been shown to have potent antioxidative effects and aids in vasorelaxation and myocardial contraction, making it a promising therapy for chronic conditions, such heart failure.

However, our understanding of the health effects of cannabis has been limited by decades of worldwide illegality and stigma around the drug.

Professor A is a medical lecturer from the United Kingdom and he reflected on an incident whereby he collaborated with Professor C from Thailand to run a clinical research on CBD to treat heart disease. Professor C is renowned for his ground-breaking study in cannabis and has won many awards for it. This has led him to open up the first ever cannabis clinic in the region, which now extends throughout the whole country. This is an impressive feat, considering that Thailand has some of the strictest drug laws in the world. His prominent cannabis research has gained attention from many scientists globally, and as a result, he was offered a job in a prestigious university of a neighbouring country.

Professor C intends to continue his research in cannabis as that is where his interest lies. However, his plans were met by strong resistance from his colleagues and higher authorities. This was partly because cannabis is highly stigmatised in the country and is subjected to the Poison Act and is under Schedule 1 of the Dangerous Drugs Act, alongside heroine and LSD. This also means it has the tightest regulation under federal law for its highest potential for abuse and is currently unaccepted for medical use, although other drugs in lower categories such as opioids are proven to be more potent and dangerous based on clinical studies. This is made worse for the fact that cannabis possession of more than 200g is deemed to be drug trafficking by the Dangerous Drugs Act and punishable by death.

Professor C realized the national stigma surrounding cannabis stemmed from the notion that cannabis is usually linked to criminals being “stoned” or “high” due to the drug’s psychedelic and psychoactive effects. Its use for recreational purposes has also led to abuse and dependence. Many, however, do not realize that these types of cannabis are usually not in its purest form and extract, and are mixed with other impurities to render them more addictive to generate sales.

Professor A recounts how Professor C struggled to win the approval he needed just so he could get his research study off the ground. He had to encounter multiple layers of administrative authorities, namely the university itself, the Ministry of Health and the National Pharmaceutical Regulatory Agency (NPRA) on a national level in order to use a restricted drug as an intervention in hospitals. However, his efforts were in vain as his request were most of the time turned down.

A recent news by the deputy health minister stated that local research had to be conducted as proof that the drug is safe and effective for medical purpose, including the dosages and preparation methods.

Without local study evidence, the import and prescription of cannabis is illegal and strictly prohibited. He goes on claiming that even drugs such as paracetamol and other medicines have been accepted based on evidence of local studies done, and not studies from other countries.

Professor C questioned the validity of the minister’s claims since local studies on paracetamol actually has never even been done in the first place. There were no proper randomised controlled trial conducted, other than a collection of real world data which shows paracetamol as harmless, and subsequently licensed all over the world. Secondly, many other drugs including the latest COVID-19 vaccines such as Pfizer, Astra-Zeneca and Sinovac had only studies and data taken from European or third world countries with no local studies done. Nevertheless, they were imported, distributed and prescribed freely nationwide.

Hope was found when a medical cannabis company successfully achieved temporary registration for compassionate use from the NPRA to treat muscle spasms in Multiple Sclerosis patients. However, the lack of demand among the small group of patients in the country and poor turnover rate eventually led the business to be financially unviable which drove them to stop supply.

Despite having numerous offers from industrial collaborators to work on cannabis research, Professor C found it impossible as he could not even get pass the first hurdle, which is approval to initiate his research in the first place. In the end, Professor C had to refocus on research that he could at the very least conduct, albeit with significantly less funding and industrial collaborators in other research areas.

His intentions to do cannabis research never materialized, and every night he would go to bed feeling disheartened, thinking how he could have made his dreams come to fruition.

Little did he know that the cannabis landscape is experiencing a major positive shift worldwide.

During the Tokyo Olympics 2020, CBD was allowed among elite athletes as it is no longer prohibited by the World Anti-Doping Agency and appears to be safe and well-tolerated in humans. It helps athletes deal with pain management, sleep problems and anxiety.

In December 4, 2020, the United States House of Representatives approved a bill on decriminalising marijuana. The landmark legislation would ultimately lead to the removal of non-violent marijuana-related convictions. Meanwhile, the United Nations Commission on Narcotic Drugs (CDN) removed marijuana from the strictest control schedule listing, in recognising its medical and therapeutic benefits.

Over recent years, the CBD market has exploded, especially in Europe. By 2023, Europe’s CBD market is set to rise by 400 per cent. The Asian Cannabis Report estimates that Asia’s medical marijuana market will be worth more than US$5.8 billion. Thailand alone is projected to generate US$661 million by 2024.

This is largely due to CBD becoming more socially accepted and is being touted for its medical and well-being properties. This massive change in policy and use has forced clinicians to critically evaluate the safety and efficacy of cannabis. Governments are also contemplating to review the national drug policy to take a step towards decriminalizing marijuana for educative and rehabilitative purposes.

Despite numerous failures and rejection, the gradual change in perception towards cannabis has created awareness among local authorities, and as an optimist, Professor C remains hopeful for what the future has to bring.

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QUESTIONS

1. Most of the time, laws are formed based on old dogmas and moral perceptions of the norm. However, not all these laws are necessarily congruent with scientific-based evidence. How can we bridge this gap?
2. What are the ways we can do to make CBD research legal?
3. Is it important to conduct cannabis research? Why? Why not?
4. Should we change society’s perceptions towards cannabis? Why and how?

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REFERENCES

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Garza-Cervantes, J. A., Ramos-González, M., Lozano, O., Jerjes-Sánchez, C., & García-Rivas, G. (2020). Therapeutic Applications of Cannabinoids in Cardiomyopathy and Heart Failure. Oxidative Medicine and Cellular Longevity, 2020, 1–17. https://doi.org/10.1155/2020/4587024

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