Legalizing medical marijuana in the Philippines: A pharmacist’s perspective
In the past few days, Sen. Robinhood Padilla has been making headlines for pushing the legalization of medical marijuana for compassionate use in the Philippines.
This news is not new to me since I’ve been following its legalization process since 2017 when the House of Representatives granted the medical marijuana bill, a step forward to becoming law despite the Duterte administration’s war on drugs.
Marijuana or cannabis is legal in some countries like Uruguay and Canada, and in some US states like Colorado. Thailand is the first Southeast Asian nation to decriminalize the growing and selling of cannabis. Thais even celebrate a cannabis festival that undoubtedly attracts tourists and helps boost their economy, especially in the post-pandemic era.
Like marijuana, some of the substances that we are consuming can be habit-forming. These include alcohol, tobacco, and coffee. They are “gateway drugs” whose use can lead to the dependence on a harder drug such as cocaine or heroin.
The oldest evidence of marijuana use can be traced back to a 2,500-year-old cemetery in China. Even old texts such as “Ebers Papyrus” from Ancient Egypt and “De Materia Medica” by Greek physician Dioscorides described medical cannabis. Cannabis was also used in religious practices such as in India and is allegedly used as a component of holy anointing oil mentioned in some parts of the Bible like Exodus.
It is important to note that marijuana contains the principal mind-altering constituent called tetrahydrocannabinol (THC). This is the cannabinoid responsible for the “high” feeling and can interrupt critical tasks such as driving and machine operation. However, there are existing drug forms of THC, such as dronabinol, used to treat nausea and vomiting caused by cancer chemotherapy and to increase appetite in people with HIV/AIDS.
Aside from THC, cannabidiol (CBD) is also a prevalent cannabinoid and is essential in medical marijuana. In humans, CBD exhibits no effects indicative of any addiction and some clinical studies suggest that CBD has broad therapeutic uses, including rare forms of epilepsy and chronic pain.
Currently, marijuana in the country is classified as a dangerous drug under the Republic Act No. 9165 or the Comprehensive Dangerous Drugs Act of 2002. Despite this, terminally ill patients may apply for a special permit from the Food and Drug Administration (FDA) for compassionate purposes.
By account, marijuana is not the only medicinal plant that has a history of addiction. Opium poppy is the plant source of the powerful painkiller, morphine, especially used for cancer-related pain. Another is the coca plant, which is the source of the psychoactive stimulant, cocaine, that was once used for anesthesia. Before it was banned, cocaine was, in fact, the main ingredient in soft drinks.
While marijuana will only be used for medical purposes, the problem when it is legalized is the implementation of the law. Unfortunately, the Philippines is excellent at making a law, but not at implementing it. It could be prone to regulatory oversight. The ways in which medical marijuana has to be approved, prescribed, dosed, stored, and made available to the public will be very different from other prescription drugs. This will require a series of research and validations. Even though there is an enormous amount of research about marijuana from other countries like the US, these studies cannot be deemed similar to the marijuana grown on Philippine soil. Marijuana plants that are not cultivated in the same soil and environment would have a different plant chemistry and will not produce similar compounds even though they look morphologically the same. Because of this variation, results might have different safety profiles and might not exert the same therapeutic effects. There will still be a long journey before we see definite results.
Although the training of medical cannabis physicians and pharmacists is part of the bill, it is also critical that marijuana use should be taught in detail in medical and pharmacy schools, especially on treatment, dose, and route of administration.
Nevertheless, let us be open to the potential wonders of this disputed plant. If legalized, I hope it will be patient-oriented and research-oriented, with proper regulation and taxation.
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