“Today it by no means means that Spain is the last in terms of medical cannabis treatment”

  • Policy Medical cannabis regularization comes back to Congress
  • History A Galician tetraplegic makes the first public request for self-cultivation of medicinal cannabis

Medicinal cannabis regulation means “the difference between life and death for an older patient” The difference between wanting to live or asking for help to die all day. pain doesn’t wait, We want the subcommittee to move at the earliest so that the patient is not left in the hands of drug traffickers, but in the hands of the state, doctors, pharmacies and we have dignity and quality of life. ,

Carola Pérez, president of the Spanish Observatory of Medicinal Cannabis (OECM), which is part of the association—which is made up of researchers and doctors—speaks on behalf of patients after her, said at the gates of the congress yesterday. Intervention at the final session of the health subcommittee to debate the regulation of medicinal cannabis in Congress.

despite the policy debate should be scientific, but the controversy is based on the same premise as there is a tendency to confuse the concepts. What has been discussed in this subcommittee in recent weeks is not to legalize cannabis in general and that anyone can consume cannabis at a time. coffee shopAs in the Netherlands, ie recreational cannabis, to regulate what is proposed medical or medical cannabis For very specific uses and profiles.

“Terminology is very important. Cannabis is a natural substance that has over 200 active ingredients and some of them have been evaluated as potential therapeutic weapons against various problems. Therefore, Cannabis is one thing and cannabis-derived products that can be used medically are another. to relieve some of the symptoms. Logically, everything that is recreational cannabis refers to the consumption of over 200 of these substances, some of them with significant psychoactive effects and conferring addictive potential, etc. When we enter this area – and we must say – with the use of derivatives of cannabis as a therapeutic tool, we already enter medicinal substances, some of which have been evaluated in various studies. is”, explains Joaquim Julie, vice president of the Spanish Society of Medical Palliative Care (SECAPAL), and regional director and head of the palliative care service of the Catalan Institute of Oncology of Badalona (ICO).

For Jess de Santiago, a pain treatment specialist, anesthesiologist at the Quine Hospital Pain Unit in Tenerife and coordinator of the Spanish Pain Society (SED) cannabinoid group, “We are speaking first from ignorance and fear, The first hurdle to overcome is simply this: cannabis is tarnished And when it comes to medical cannabis there is a lot of confusionNot only at the general population level, but within the medical population.”

De Santiago comments that a lot of information is missing. “They don’t really know what they’re talking about and it’s hard to know what they’re doing if you’ve never met them, never treated a patient, and don’t know how. In fact only those who have had that experience could have known.” It has nothing to do with talking about recreational cannabis or medical cannabis and people who have experience dealing with medical cannabis today are above all patient associations such as the Spanish Medicinal Cannabis Observatory or the patients themselves who receive Are these ‘magical threads’ within families or from a friend who told them or from medical professionals who have had the opportunity to be able to treat patients from outside”.

Part of the fear comes from its addictive power, that is the gateway to tobacco use or its psychoactive effects, Some scientific societies such as the Spanish Society of Pulmonology (CEPAR) or the Spanish Society of Psychiatry (SEP) have put forward these arguments. In this sense, de Santiago explains that he is using THC. are against the smoking of cannabis containing high concentrations of [tetrahidrocannabinol, el principal constituyente psicoactivo del cannabis] Or “a product you don’t even know what’s in it”. “We return to ignorance again. Smoking is associated with chronic bronchitis, airway tumors, COPD … that is, no doctor would be in favor of smoking, Medical cannabis must be individualized, it must be adjusted to each individual and the general The chosen one will be oral or sublingual,

With regard to mental disorders, de Santiago indicates that secondary effects of cannabis are known. “There are studies that were conducted among 17,000 young individuals in the US military that looked at cognitive impairment, psychosis problems, and above all, addiction, but once again the terms are confused, which is recreational cannabis and it has nothing to do with cannabis. -Do not give medical cannabis”.

This expert in pain argues that what we see in Spain is that “cannabis is stigmatized, there is a lack of information and Recreational cannabis confused with medicinal, we’re still at that point“There are people who know what they’re talking about because they’ve experienced it, they’ve treated it, and others who don’t know what they’re talking about because they find it amusing.” Confuse with cannabis and fear of course, because psychiatric units are full of cannabis in young people with schizophrenia because recreational cannabis is a gateway to other harder drugs and generates addiction, that’s all true, but it should be Not to be confused with medical cannabis”.

A sick user shows his herb and medicinal cannabis oil.
A sick user shows his herb and medicinal cannabis oil.Alberto Di Lolli

According to this anesthesiologist, who received the Ulf Lindblom Prize for Best European Pain Treatment Review in 2019, “for being able to speak” There should be study on long-term side effects with medical cannabis, In this situation, we must remember that it is going to be a specialized physician with training who is going to monitor the patient with strict control, with a product that will be considered a drug and supervised, both good at In production and distribution and traceability with practice guide, i.e. People have nothing to fear, nor should psychopathic societies,

The Vice-Chairman of the Secpal emphasized on this lack of education. “There have been many reviews on this topic, systematic reviews and meta-analyses of the medical literature. These studies on studies It has not been shown that these products are effective, there is not enough evidence to recommend their use.And Julie adds: “We’ll always be waiting for new evidence to see whether dronabinol, nabilone, or any of these products can have a place in the therapeutic arsenal. Further investigation is needed to collect the evidence. Which certainly puts them in the respective echelon in that medical arsenal or that really tells us they’re not very useful”.

cannabis for neuropathic pain

“Basically what has been observed is the use of medicinal cannabis for neuropathic pain, that is, pain due to nervous system involvement, For example, patients who may have nerve injury from using chemotherapy or with patients multiple sclerosis That they may have this pain due to degeneration of the nervous system. There are no studies in neuropathic pain that support its use, ie the evidence is very limited,” explains Dr. Julie.

They have also been used for the treatment of loss of appetite, anorexia. “Not anorexia nervosa, which is another issue, but Loss of appetite in patients with advanced AIDS or cancer, which is a symptom that may be common and there is no clear evidence to recommend it. And as it is known that many patients use cannabis at their own risk to treat nausea due to chemotherapy, because cannabis-derived products have no clinical scale status to treat these problems,” said Sekpal vice president They say .

Julia concluded that Evidence from studies is very limited “And at this time it does not allow us to recommend any of these products for use in the day-to-day alleviation of patients’ disease symptoms”.

De Santiago acknowledged that medical evidence on medical cannabis is lacking because “there is a great deal of variability among studies and these meta-analyses do not, in the end, achieve high statistical power because of the high risk involved in making decisions.” bias, but what does exist are several articles at the clinical and observational level. ie, the International Association for the Study of Pain (IASP) issued some recommendations in 2021. First, Continue to study the endocannabinoid system as data is still lacking, The second is that there is no evidence to recommend comprehensive treatment of chronic pain patients with medical cannabis, but He didn’t deny the positive experience that every patient can have with medical cannabis., They recognized that positive personal experience, but due to a lack of medical evidence they could not issue a statement where it would normally be recommended.

In this line, the coordinator of SED’s cannabinoids group explains that In Spain “many patients benefited from pain that was incurable by other means And we’re kicking them out of the health system because there’s no regulation, they have to look for life. so what should we ask ourselves If it is ethical that Spain, today, is the last in terms of medical cannabis treatment and there is no regulation on the subjectWhen the rest of the European countries except Belgium have it”.

That’s exactly what the OECM is demanding: “that it be regulated now, that we in Spain are in legal and health insecurities. In this country Cannabis is being cultivated at pharmaceutical grade and is not reaching the Spanish patientIt reaches patients from other countries,” said Carola Preez at the door of Congress yesterday. And the fact is it is difficult to explain and understand the situation in Spain. There are authorities from the Spanish Medicines Agency (AMPS) Cultivate, manufacture, distribute and export Cannabis sativa and its products, But these products obtained in Spain end up in other countries and here they are not accessible,

like near Israel Medical cannabis is widely used. De Santiago, who was working in a pain unit in that country, stressed that medical guidelines recommend Therapeutic cannabis as a third lineThat is, when the first and second lines of treatment have not been effective, “that is, as a preventive drug when the second has failed, but still not, all patients with cancer pain are being treated.” was commonly used And the doctors were of the opinion that he should go up the ladder, that he should be second in line”.

What emerges from this subcommittee may be the first step in responding to the claims of many patients. Citizens’ opinion in general is favorable to the regulation of medical cannabis. Thus, in April last year in the Barometer of the CIS, this question was asked and 90.1% of Spaniards were in favor of “legalizing the use of marijuana for medical use”., Only 4.5% would oppose this medicinal use and the rest did not know / did not respond. But it has become important to debate this now that The United Nations recognized the medicinal properties of cannabis in December 2020 And it would remove it from List IV of the 1961 Drug Convention, where it possesses the most dangerous property that requires strict controls and without the same medicinal properties as heroin.

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