Puff away pain

An employee checks cannabis plants at a medical marijuana plantation in northern Israel. pHOTO: REUTERS / Nir Elias

Marijuana is a two-sided plant. Despite its medicinal benefits especially for severe pain management, marijuana — or weed — is known to be one of the most abused drugs in the world, giving a euphoric high, and even delusions and hallucinations if smoked too much.

The unwanted psychoactive side effects of the drug makes it divisive, particularly when it comes to the issue regarding marijuana legalisation not just here in Thailand but across the globe. Since earlier this year the cabinet has approved, as proposed by the Office of the Narcotics Control Board, farmers to grow industrial hemp, or Cannabis sativa — the herbaceous plant of the same family as marijuana, or Cannabis indica — across 15 districts of six provinces namely Chiang Mai, Chiang Rai, Nan, Tak, Phetchabun and Mae Hong Son. Raw materials processed from hemp can be used for the manufacturing of clothes, bulletproof vests, building materials, food supplements, pharmaceuticals and cosmetics.

But as for marijuana, the decriminalisation has been and will still be under long, long discussion.

While Thailand still lags behind, many other countries have legalised marijuana at least for medical purposes. Argentina, for example, legalised medical cannabis only two months ago. Germany legalised medical cannabis in 2016, which took effect in March this year. Chile is the latest nation to have shown successful movements in medical marijuana as pharmacies in the capital city of Santiago began selling cannabis-based medicines earlier this month, the first time such treatments have been offered by drugstores in Latin America.

Supaporn Pitiporn, a herb expert and chief pharmacist of the Chao Phraya Abhaibhubejhr Hospital in Prachin Buri province, said marijuana has been in Thailand for hundreds of years and is even mentioned in ancient Thai literature like Khun Chang Khun Paen. What the country needs when it comes to medical cannabis legalisation is proper management.

“Thailand is moving at a very slow pace when it comes to the decriminalisation of medical marijuana,” she said.

“Weed has been part of Thai people’s lives since the old days. And we should not have looked at it as a mere narcotic drug. We should instead learn how to handle and properly control the use of it in a way that we can also benefit from it. The world has long awoken to the medicinal benefits of this plant.”

The medicinal benefits of cannabis have been proven and reported by various groups of researchers around the world. The US National Academy of Sciences — a private, non-profit organisation of America’s leading researchers — earlier this year published its research paper The Health Effects Of Cannabis And Cannabinoids. The paper lists cannabis as being able to significantly reduce symptoms among adults suffering chronic pain. This is not to mention other medicinal properties such as lessening chemotherapy-induced nausea and vomiting in adults and alleviating spasticity in adults with multiple sclerosis (MS), a disabling disease of the central nervous system.

Churanya Onlom, a PhD graduate from Naresuan University’s Faculty of Pharmacy and postdoctoral researcher at the University of Alberta in Canada who studied medical cannabis, reaffirms the medicinal advantages of marijuana. The main chemical compound in cannabis, Churanya explained, is tetrahydrocannabinol, or THC, which has been studied, reported on and used in various countries as an effective relief for severe pain as well as nausea in patients falling prey to the side effects of chemotherapy.

“THC has been studied by researchers for quite some time and it is proven to be very effective for pain relief,” said Churanya. “As far as I understand, there are so far around three THC-based medicinal products in the [global] market.”

But while THC is likely to come with some psychoactive consequences that affect a person’s memory, pleasure, movements, thinking, concentration, co-ordination, and time perception, researchers have also been interested in another active chemical compound in cannabis called cannabidiol, or CBD. Possessing an ability to reduce pain and act as an anti-inflammatory agent, CBD is reported to cause no psychoactive effects. In recent years, scientists have therefore focused more on studying CBD as well as the combined use of CBD and THC for therapeutic purposes.

Smoking pot, added Churanya, actually triggers four types of reactions: a good mood, emotional sensitivity, drowsiness, and confusion plus memory loss. These reactions vary from one person to the next. But in clinical trials of medical cannabis, patients are not reported to have these psychological upshots.

And for those who are concerned medical cannabis will eventually lead to drug abuse, Churanya assured that smoking marijuana for pleasure and using it for medicinal purposes are two completely different stories.

“When you smoke weed, you use crude marijuana. You burn it and it releases several cannabinoids [chemical compounds from cannabis] that lead to various degrees of psychoactive reactions. But when making medicine, cannabis is extracted until we only get purified THC, which is considered medicine,” said Churanya, adding that based on clinical trials, some patients are reported to develop unwanted psychological side effects after depending on THC-based medication but the conditions improve after six weeks, which means those on cannabis-based medicine require a certain period of time for adjustment.

THC is best used in the form of an inhaler, the researcher explained, given quick rates of absorption. In countries that legalise medical cannabis, the drug so far requires a doctor’s prescription and is yet to be available over-the-counter.

“Cannabis is just like every other medication,” she commented. “Dosage varies according to each individual and needs to be adjusted based on the severity of symptoms. This explains why medical cannabis requires a prescription.

“There have been efforts to replace opioid pain relievers with cannabis-based pain medication as the side effects of the former are much worse.”

Despite the said medicinal benefits of cannabis, the legalisation of it in Thailand still needs a proper debate from various concerned parties particularly as to how to prevent as much unwanted psychoactive results as possible. Niyada Kiatying-Angsulee of Chulalongkorn University’s Drug System Monitoring Mechanism Development Centre under the Faculty of Pharmacy commented that for medical marijuana to be decriminalised, people need to first thoroughly understand what the plant really is so that we come to know how to use it to its maximum potential.

“First we must accept that there is such thing as marijuana abuse. What the country is in desperate need of therefore is a round-table discussion among researchers, medical practitioners and everybody involved on how best to use it for medical reasons.

“Risks and benefits should be thoroughly discussed. Many countries are able to eventually legalise medical cannabis because they have implemented a proper control protocol.”

Given the fact that cannabis is a high-quality plant and that Thailand has an ideal climate for growing it, Churanya strongly hopes that in the not-so-distant future, the country will be able to produce its own cannabis-based medication, for export even, under the authority’s caring yet watchful eyes.

“A tropical country like Thailand is definitely able to grow cannabis. So if the medical use of it is finally allowed and encouraged, we will be able to significantly reduce the production cost in the long run. Thailand already has perfect weather and terrain. We only need our own team of researchers and of course support from parties involved.”

Medical marijuana by country

Australia

Australia legalised medical cannabis in August 2014, allowing patients with a prescription to purchase cannabis from authorised sellers.

Canada

Canada implemented a national medical cannabis law in 2001, allowing patients to grow their own cannabis at home and caregivers to produce their own cannabis. Last month, Prime Minister Justin Trudeau introduced legislation to legalise the recreational use of marijuana in the country. When the bill is passed, Canada will become the second nation to completely legalise marijuana as a consumer product after Uruguay.

Israel

One of the leading countries with medical marijuana research, Israel’s government announced in 2016 plans to make medical cannabis prescriptions available for patients through pharmacies across the nation. Earlier this year, Israeli ministers endorsed a draft bill to legalise export of cannabis for approved medical use. However, the recreational use of weed is currently illegal in the Jewish state.

Italy

Italy allowed medical marijuana in 2013.

Switzerland

Since 2011, cannabis can be sold and consumed legally in the wealthy Alpine country.

The Netherlands

The country started allowing medical cannabis products to be sold at pharmacies to patients with a doctor’s prescription in 2003.

The United States

California was the first US state to legalise medical cannabis for qualifying patients in 1996. After that, 28 other states followed suit. The latest is West Virginia, which has legalised medical marijuana this year.

Dried flower buds of legal cannabis in Lausanne, Switzerland. Photo: AFP / Fabrice COFFRINI

A pharmacist prepares a prescription of marijuana produced by the Italian military’s Cannabis Project Team in a pharmacy in Florence. Photo: AFP / FILIPPO MONTEFORTE