Concerns about cannabis

As with so many of the President’s mispronouncements, his recent admission to using marijuana — whether it was a joke or not — was terribly unfunny. Regardless of its harms and benefits, marijuana or cannabis is currently illegal in the Philippines, and Mr. Duterte’s words are just more flippant insult added to serious injury for the thousands who have been devastated by the drug war. If nothing else, though, these “jokes” are a springboard for discussion and education, particularly as the issue of legalizing medical marijuana is still prominent in the public consciousness.

Marijuana derives from the cannabis plant, and tetrahydrocannabinol (THC) is its main psychoactive component. Smoked, eaten or vaporized, it creates an elevated mood, increased appetite and altered perception. It isn’t quite the best stimulant to keep one alert during international conferences, as Mr. Duterte’s joke may suggest. It is the most commonly used illegal drug in the world and is considered dangerous in large part because of its risks, like addiction, decreased cognitive ability for users who start in their teens, and short-term effects like psychotic episodes and an increased risk of vehicular accidents.

Still, the legalization of marijuana use for medicinal purposes is gaining traction worldwide. It is considered by many to be useful in the management of chronic pain particularly as replacement for opiates, as well as of epilepsy and muscle spasms. While US federal law still holds the use of cannabis as illegal for any purpose, 33 states allow its medicinal use, and 10 allow for its recreational use.

In the Philippines, House Bill No. 6517, or the Compassionate Use of Medical Cannabis Act, advocates the legalization of medical marijuana and describes stringent measures to assure restricted and qualified access. One recalls that even before his presidency, Mr. Duterte himself said that he doesn’t oppose the medical use of marijuana, and some senatorial candidates share his opinion; in a CNN Philippines senatorial forum last week, four out of eight candidates agreed with the legalization of medical cannabis.

It continues to be a hotly debated topic even among health and academic circles. The University of the Philippines Manila, considered to be the health sciences center of the UP system, released a strongly worded opposing statement last year created by its Technical Working Group on Medical Cannabis Legalization. Calling the move “a serious threat to public health,” it echoed concerns of many that the current evidence for medical cannabis use doesn’t yet fulfill the stringent requirements for drug approval. It also cited the evidence that even medicinal use can be diverted to recreational use, and that legal cultivation of cannabis can still pave the way toward easier access for recreational use.

I would add to their hesitations the legitimate fear that cannabis is possibly a “gateway” drug that facilitates the exposure to and eventual use of other, more dangerous illicit drugs. This remains debatable. There is currently some correlational, but no causal, evidence that marijuana precedes or correlates with the use of other harder drugs, and some have even proposed that it acts like a “filter” that prevents users from seeking out other drugs. Regardless, this is no clear-cut medical issue, and the risks should be enough to give a public health policymaker some pause.

The legalization of medical marijuana is no doubt well-intentioned and there are several groups and patients who will benefit, but we all know how well-intentioned laws have the tendency to be abused or poorly enforced given our farce of a criminal justice system. This brings us to the drug war, where thousands have been summarily killed for possession of drugs including marijuana. Some have been killed without possessing anything at all. It would truly be a tone-deaf move to approve the medicinal use of something which has up to now been included in the country’s list of dangerous drugs, without appropriate redress for those who have been harmed in the pursuit of such users.

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