Medical Cannabis: Myths and Realities

Medical Cannabis:?Myths and Realities

The cannabis plant has been used in Ancestral Medicine since time immemorial. There are records of therapeutic uses dating back more than 2700 years before Christ, including in Chinese Medicine and in ancient Medicine treatises such as the Avicenna Medicine Cannon written by the renowned Persian doctor Avicenna, discussing the treatment of multiple ailments.

By the 20th century, there were more than 100 publications in scientific medical journals that described the therapeutic properties of cannabinoid therapies; cannabis could be found in different presentations (tinctures, oils, etc.) available in pharmacies. It was not until 1937 that the Marijuana Tax Act was passed, and after this, the prohibition occurred for commercial and racial reasons rather than medical.

Despite this ban, scientists globally continued studying the components of this plant and its therapeutic properties. Prominent scientists such as Professor Raphael Mechoulam from Israel discovered the THC molecule when looking at the parts and properties of this plant in 1964.

In 1988, scientists Allyn Howlett and William Devane discovered the CB1 receptor, one of the main components of our endocannabinoid system.

Many subsequent discoveries have been made, bringing us closer to the knowledge of the complex and complete Endocannabinoid System and the therapeutic applications of Cannabinoid Therapies.

All humans have an Endocannabinoid System (ECS) whose main primary is maintaining balance and homeostasis in our body. This Endocannabinoid system is composed of receptors distributed in the brain and in most of the organs and systems of our body, which is why their therapeutic actions and expressions are so broad.

ECS also encompasses substances produced by our body that is coupled to these receptors and perform essential functions; these substances are produced according to the needs of our body and mimic the action of the components of the cannabis plant; these substances are called Endocannabinoids. In addition, this Endocannabinoid System comprises enzymes that synthesize and degrade these endocannabinoids.

There are different types of Cannabinoids:

1. Our bodies synthesize endocannabinoids (mentioned above). (Anandamide, 2-AG)

2. Phytocannabinoids from the Cannabis plant where are more abundant. (CBD, THC, CBG, etc.)

3. Synthetic Cannabinoids: these are those produced in the laboratory. ( ?Nabilone, Dronabinol).

There is currently an FDA-approved drug derived from the cannabis plant, EPIDIOLEX (purified CBD extract), which has been approved for use in treating patients with refractory epilepsies (Dravet syndrome and Lennox Gastaut syndrome).

Phytocannabinoids are being used for the treatment of various pathologies, considering the levels of scientific evidence for the pathologies that there is scientific evidence of better quality for the treatment of:

-Chronic pain in adults.

-Refractory Epilepsies to treatment (Dravet Syndrome, Lennox-Gastaut Syndrome, Tuberous Sclerosis).

-Treatment of nausea and vomiting induced by chemotherapy.

-Spasticity in patients with Multiple Sclerosis.

Other applications with lower levels of evidence are being studied (anxiety, insomnia, post-traumatic stress disorder, Parkinson's, etc.)

Currently, more than 51 countries worldwide have legalized Medicinal Cannabis due to the growing need of patients for this therapeutic alternative.

Panama took a crucial step and joined this list of countries, legalizing medical cannabis in August 2022. The President of the Republic, Hon. Laurentino Cortizo, signed the Regulation of Law 242, the Medicinal and Therapeutic Use of Medicinal Cannabis in Panama, thus creating a robust and comprehensive regulatory framework.

Panama's framework is one of the most complete regulations in Latin America; it was widely consulted and discussed, where safe access to patients is favored above all, the responsible and controlled prescription is sought through the medical medication and close monitoring of patients by the doctor, under the supervision of the Ministry of Health and other government entities.

Among the most critical points of the regulation, it should be noted that Panama will have a Registry of Medical Cannabis User Patients in which the patients who receive this treatment must be registered.

To access treatment, the patient must have a medical prescription issued by the treating physician, who will certify that the patient has a condition for which cannabinoid therapies are required, with a detailed clinical history and dosage indications, concentrations, etc.

The treating physician and the Ministry of Health will closely monitor the patients using it and watch the proper use of these therapies. The treating physician must have a certification in the Application of Cannabinoid Therapies endorsed by the Ministry of Health.

If the patient does not have a medical prescription and is not in the National Registry of Medical Cannabis User Patients, they will not be able to access this treatment.

The medicine may be imported in the first two years only by those companies that have the quality of licensees certified by the national government; after the first two years, it is expected that there will be national production to be able to meet the needs of patients in Panama.

The production chain, from the cultivation to the development of the final product for the treatment of patients, will follow specific guidelines regarding quality controls and strict security and surveillance protocols monitored by different government entities such as the Ministry of Agriculture, Ministry of Security, Ministry of Industry and Commerce, Customs Authority, Ministry of Health, Pharmacy and Drugs among others. They will ensure that the stipulations of the law are met.

Given the novelty and complexities of creating guidelines, we face significant challenges in implementing this law. Still, there is a clear will from the government to do it in the shortest time possible to ensure that patients benefit as soon as possible from these treatments based on sound scientific evidence.

To promote the wider adoption of cannabis medicine, it is imperative to start educating the medical profession and personnel in the health area as soon as possible to ensure that patients can access these treatments through medical prescription.

Due to the great speculation regarding the therapeutic properties of Cannabinoids, there is much misleading advertising and marketing in the country of products that do not have the Pharmacy and Drugs authorization or the Ministry of Health.

This represents a great danger for the population since products do not have the endorsement of the Pharmacy and Drugs Directorate. The regulatory entities could cause potential damage to health since many of them do not have quality standards, good laboratory practices, etc., and could contain contaminants such as heavy metals, pesticides, bacteria, and fungi that can be deleterious to health.

Therefore, it is essential to refrain from buying this product on the street since once the regulations are implemented, it will be sold exclusively in pharmacies authorized by the Ministry of Health.

Cannabinoid therapies are an important therapeutic alternative for many patients. Still, they are not a miracle cure or first-line treatment. Adverse effects and drug interactions can occur if taken simultaneously with other medications. This is why they should always be used under prescription, and medical monitoring since their indiscriminate use without medical prescription could cause secondary effects.

*Note: The following article is translated from Spanish and appeared in Selecta Magazine on November 11, 2022, Link: https://new.selectamagazine.com.pa/2022/11/10/cannabis-medicinal-mitos-y-realidades/

I welcome your feedback. Please provide suggestions or topics of interest to you in the comments below.

Sandra Carrillo MD, MHSM.

Specialist in Cannabinoid Medicine.

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Medicannips?IPS Medical Cannabis Clinics, Colombia.?https://lnkd.in/guCTjCMM

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