At the rate of the discussions in the House of Representatives, in which a bill that allows the use of cannabis (marijuana) derivatives for medical indications is gaining more adherents, some say the Philippines might be the first country in Southeast Asia to legalize this substance.
The proposed bill (Medical Cannabis Act) has recently hurdled the House health committee and is due to be passed on to the plenary for final debates.
We’ve tackled this issue before in this column (“Are we ready for medical marijuana?,” PDI, 10/04/14); “Another take on medical marijuana,” PDI, 10/11/14). At the time, there was also a House bill proposing its legalization, and we were grateful that solons saw the merits in the arguments presented by all the health experts, who found many more disturbing questions rather than positive arguments on the effective and safe use of cannabis derivatives for medical indications.
Junked, resurrected
The House bill was junked then at the health committee level. But to our chagrin, it was resurrected sometime last year and is gaining supporters by the day.
In a recent exchange of text messages with Dr. Tony Leachon, a past president of the Philippine College of Physicians and one of the staunchest health advocates in the country, we’re still pinning hopes that legislators will look at current scientific data more objectively before deciding if the potential risks of product abuse to the general population can be outweighed by the symptomatic, not curative, benefits to a few.
Some of the intended indications are for infants and children suffering from cerebral palsy and severe spasms. Certainly, we don’t think we’re giving these infants and children good prospects of a bright future by relieving them partially of their symptoms but making them addicted to a cannabis product. The long-term harm on the various endocrine (hormonal systems) and other organs of a growing body also show alarming safety red flags.
If the bill becomes law, it will be a great paradox of President Duterte’s administration, which is currently waging a war on drugs.
Legal restrictions
If one scans the literature, one can find close to a thousand studies on the benefits and risks of cannabis derivatives. But most, if not all, are saddled with limitations.
Expert bodies have scrutinized all these published data, and their succinct bottom line was that there are not enough data to support a more liberal use of the product.
The National Academies of Sciences, Engineering and Medicine (Nasem) published in January this year a report on all studies evaluating the health effects of marijuana and its derivative products. An objective appraisal of all the current evidence on both therapeutic effects and harmful effects was done, and the Nasem recommended that further research be done “to develop a comprehensive understanding of the health effects of marijuana.”
In short, the Nasem acknowledged that despite the numerous published data, we’re still facing a blank wall in determining if it’s more beneficial or harmful when used for medical indications.
It also recommended that regulatory barriers be eased on qualified researchers who wished to conduct properly designed studies on marijuana’s health effects.
That is what we should first do: cut the haste in legalizing medical marijuana, and instead encourage and fund research on its short- and long-term health benefits and side-effects.
Safety requirements
We highlighted the importance of these types of research on medical marijuana in our previous columns. Through e-mail conversations with then Food and Drug Administration (FDA) director general, Dr. Kenneth “Ken” Hartigan-Go, he was quite supportive of granting approval for such research, provided statutory requirements on safety are met.
Another highly respected institution in the United States, the National Institutes of Health-National Cancer Institute, updated its report on the health effects and risks of cannabis products and derivatives on April 13. Its conclusion: “At this time, there is not enough evidence to recommend that patients inhale or ingest cannabis as a treatment for cancer-related symptoms or side effects of cancer therapy.”
If the experts are telling us that they’re not sure if cannabis derivatives can do more good than harm, we respectfully recommend to our legislators that we temper over-enthusiasm to make these products legally available. We should heed as many qualified expert opinions and recommendations.
If we have a legal problem, it’s right that we should heed the lawyer’s advice more than that of our family physician.
In the same vein, if we have a medical issue, it’s just proper that we heed the medical expert’s advice, rather than that of lawyers, businessmen or prospective patient-users.
Despite safety nets that are intended to restrict marijuana use, the ingenuity of Filipinos can always find ways and means to access it for nonindicated and abusive purposes.
Likewise, knowing the propensity of Filipinos to self-medicate in terms of adjusting the dose of the medicines prescribed by their doctors, the risk of substance abuse gives healthcare experts cause for worry.
‘Good for all’
Through e-mail a few years ago, Ken—who was subsequently appointed undersecretary of the Department of Health—emphasized that any policy on any medicinal substance must be dictated by the “good of all and equity, and reality of implementability.”
This is a good insight for our legislators to reflect on—is the bill seeking to legalize medical marijuana not compromising the “good of all” for the benefit of a small minority, and how confident are we that we can implement safeguards against illegal use and abuse?
It seems not quite right that the initiative to approve marijuana derivatives should come from Congress. Our legislators should have deferred to the mandate and competence of the FDA in evaluating the potential benefits and harms of such products.
Ken explained, when he was FDA director general, that his office was a scientific regulatory agency and had the capability to closely scrutinize and validate the efficacy and safety of any product based on well-designed studies in humans. However, it could be a lot more complicated for a medicinal product derived from marijuana.
“We cannot dissociate legit use from the potential for recreational abuse and misuse,” he wrote in his e-mail.
Independent agency
He added that the FDA must first protect society, specifically patients/consumers, as well as doctor-prescribers, from making wrong choices. “The FDA’s decision is based on science, numbers and evidence. It balances innovation with sound regulations, but it also respects risk-benefit and precautionary principle,” Ken explained.
Because of the crucial nature of the FDA’s mandate, Tony (Dr. Leachon), who also currently sits in PhilHealth as an independent director, proposes that the FDA should be empowered to become an independent agency, “so it will not be pressured politically to approve medicines without scientific evidence of efficacy and safety.”
We appreciate the sincerity of lay advocates and some of our solons in pushing for the legalization of medical marijuana for specific indications. We agree that there are some valid indications for the minority of these patients, like in those whose pains and muscle spasms could not be relieved with available mainstream medicines.
For these patients, they can avail of the cannabis product by the provision of “compassionate usage,” which the FDA has already allowed.
It may need a little more paper work than simply scribbling a quick prescription. But it affords the physician a little more time to think if prescribing a cannabis product is really to the patient’s best interest.
‘Compassionate usage’
We believe that making cannabis products available to patients by “compassionate usage” is a reasonable middle-ground that can possibly benefit a small number of patients who really need them, without compromising the safety of the general population to a possible opening of the gates wide open for substance abuse.
I join Tony and all our concerned health advocates in appealing to President Duterte, and Rep. Helen Tan, who is the chair of the House committee on health, and Rep. Rodito Albano III, the bill’s main proponent, that as we prepare for plenary debates on this proposed bill, we step back a little bit and look at the big picture of this issue in its entirety.
In this manner, we may discern dispassionately and objectively the short- and long-term harm to the general population vis-à-vis the potential benefits to a minority of patients, should we legalize the availability and usage of cannabis products for medical indications.
Rumors have it that the House bill on medical marijuana is almost good as approved.
We refuse to believe it, and we still maintain our full trust and confidence on our President and our legislators that after debating and pondering on the pros and cons of this issue, they will still follow the dictates of their conscience, though this may mean turning back on their previous pronouncements.
Some may call this change of mind flip-flopping, but in my book, this is a patriotic flip-flop.
