The legalization of medical cannabis is an offer supported by Ulana Suprun about a week ago. It resonated strongly on the network, with thousands of reposts, even more, likes and comments. Everyone seems to like this idea. Or not really? Opinion has found out whether there is really a need to legalize medical cannabis, whether there is an alternative, what the risks are and why the decision has not yet been made.

What and why did Ulana Suprun offer?

On a social network the post of the Deputy Minister for Health, which has already collected more than five thousand reposts, began with the thesis that the use of drugs even for medical purposes is quite a complex topic, which is easy to manipulate. However, Suprun stressed that the use of cannabis in medicine is a normal world practice, and patients’ access to cannabis-based medications is the realization of their right to healthcare.

Легалізація медичного канабісу: про необхідність, ризики, маніпуляції та альтернативи

“The use of drugs for any purpose, even as medications, is a difficult topic. Therefore, it is easy to manipulate, even when it comes to vital care for patients.

Medical cannabis helps to alleviate the suffering of patients and normalize their well-being in case of a number of serious diseases and conditions. Therefore, its use in medicine, of course with certain reservations, is a normal world practice.

In Ukraine, the use of medical cannabis for medical and scientific purposes is completely banned. Although it would help almost two million people who suffer from chronic pain and other disorders.

Patients’ access to cannabis-based medications is the realization of their right to health care. It is important to support the legalization of the medical use of cannabis for scientific and medical purposes,” Ulana Suprun is convinced.

Is there really a need for medical cannabis?

Hennadiy Shabas, the expert of the public organization the Ukrainian Association of Medical Cannabis, noted that there is a scientifically confirmed effect of cannabinoids in the treatment of a number of serious diseases. Consequently, the legalization of medical cannabis can significantly alleviate the suffering of patients.

“By saying ‘medical cannabis’, we mean medications in different pharmaceutical forms that are categorized by the active substance that is used in them – these are cannabinoids and other active components of cannabis. According to the report of WHO, there are about 500 of them discovered. These components, together or separately, interact with cannabinoid receptors in the human body, which causes a therapeutic effect in case of a number of diseases. In our requirements we rely on the scientifically proven effect of cannabinoids in the treatment of chronic pain, epilepsy, anorexia, post-traumatic stress syndrome, immune system diseases, arthritis and rheumatism, asthma, Alzheimer’s disease, Parkinson’s disease, Huntington’s chorea, herpes, ulcers, weight loss from HIV AIDS, diabetic neuropathy, different forms of sclerosis and many other serious diseases.

The legalization of medical cannabis should literally mean the adoption of a law that will establish the rules of its controlled limited circulation for the production of such medications and professional support for their use. The law will provide access to cannabis-based medications for medical patients under the control of doctors” the expert believes.

Легалізація медичного канабісу: про необхідність, ризики, маніпуляції та альтернативи

As Liudmyla Honcharuk, the assistant of the Department of Internal medicine and Infectious Diseases of Higher State Educational Establishment of Ukraine ‘Bukovinian State Medical University’ noted in a commentary for Opinion that nowadays medical cannabis is indeed widely used in many countries. As for Ukraine, the expert notes that there is a need for legalization since the use of medical cannabis can alleviate the suffering of seriously ill Ukrainians and become a step forward towards the civilized standards of other developed countries.

“Nowadays, medical cannabis is successfully used in 29 states of the USA, Uruguay, Canada, Israel, and some European countries (Lithuania, Poland and others). However, it is necessary to remember the UN Convention where cannabis is blacklisted.

What is cannabis? It is a plant, the whole leaves of which are called hemp, and its ground parts are marijuana. The main component of cannabis is tetrahydrocannabinol which has a psychotropic effect on the human brain. In addition to it, there is also cannabidiol, which has a therapeutic effect.

Ukrainian patients today have no legal right to such treatment. The scientists and the medical community have been asking for the legalization of cannabis for years.

There is a well-known practice of the effective use of medical cannabis in the treatment of idiopathic epilepsy, cancer, AIDS and the like.

The introduction of medical cannabis into the list of narcotic medications, the turnover of which is limited, is currently a possible prospect. The use of morphine or amphetamine with a well-developed system of prescriptions of the medications based on these drugs is a relevant example.  This is a necessary condition for alleviating the suffering of seriously ill Ukrainians. This is a significant step forward towards the civilized standards of the developed countries” – the doctor is convinced.

Легалізація медичного канабісу: про необхідність, ризики, маніпуляції та альтернативи

Oleksandr Ihnatiuk, the President of the Association Ukrainian Technological Hemp, on the contrary, believes that the number of patients who require medical cannabis is actually exaggerated.

“The initiators of the appeal to the Verkhovna Rada categorically claim that about 2 million patients need cannabis-based medications in our country. This figure is definitely exaggerated. For the sake of comparison, in Israel (with 8.9 million population), where medical cannabis and medication based on it have been actively used for more than 20 years, the cannabinoid therapy is used only by about 25-30 thousand patients. In the EU countries and Canada, the number of patients who use the therapeutic properties of cannabis or medications based on it corresponds to Israeli figures. But it’s not 2 million people stated in the Ukrainian petition,” Oleksandr Ihnatiuk says.

How to legalize, and were there any attempts before?

According to Hennadiy Shabas, the attempts to legalize medical cannabis have already been made but the initiators of the bill have never finalized their idea, so it is necessary to push this idea once again. But nowadays, the situation is that it is not only illegal to use cannabis-based medications in Ukraine, but also even to conduct scientific researches.

“Nowadays the legal status of cannabis makes it impossible not only to produce and register medications based on it but also to conduct scientific researches. A number of laws and regulations need to be amended to allow for limited turnover and to ensure effective control of such a turnover.

The need for these changes is fixed in the Strategy of state policy on drugs, which refers to the scientific research of cannabinoids as analgesics and other medicines.

The first attempt to implement this point of the state strategy into life took place in 2016 when the bill 4533 was registered. However, it was not developed by people’s deputies in a timely manner, got outdated and needs to be improved” the expert of the Ukrainian Association of Medical Cannabis explained.

But a political scientist Vladyslav Serdiuk is convinced that the legalization of medical cannabis can make life easier for drug importers. In turn, the expert offers not to legalize, but to decriminalize the consumption of medical cannabis.

“I am not a supporter of the legalization of medical cannabis, because I believe that it is not the patients who will be the final beneficiaries of it, but rather people who import drugs to Ukraine. The main task of drug importers is to legalize drugs transportation in any possible form. But our task is not to make a life of importers easier through the legalization of drug supplies to Ukraine, right?

The decriminalization of cannabis use is a more appropriate solution. This will allow the end user (including the patient) to avoid problems with the law, but will not regulate the supply of drugs to Ukraine. Together with the decriminalization, its consumption can be reasoned with medical indications, and therefore everyone but drug dealers will get benefits from it,” Serdiuk said.

Легалізація медичного канабісу: про необхідність, ризики, маніпуляції та альтернативи

Oleksandr Ihnatiuk has a completely different point of view. In his opinion, the issue of the use of cannabis for therapeutic purposes should be treated positively, but this does not mean that it is necessary to change the legal framework to fit the requirements of companies from other countries, since there are enough technical varieties of cannabis in Ukraine, the use of which is not only more affordable but also more effective.

“The issue of amending the legal framework, according to which the therapeutic properties of hemp will be used not only for industrial, but also for scientific and medical purposes, should be treated positively. But there is no need to change the legal framework to fit the interests of foreign companies that lobby for the opening of the market for products of dubious quality. There are technical varieties of therapeutic hemp created in Ukraine, the use of which gives a better result at a much lower price in comparison to pharmaceuticals, which are imposed on us from abroad.

How successful is the practice of cannabis treatment? If we talk about the national practice of treatment with the leaves and inflorescence of technical hemp of therapeutic orientation, it is extremely effective. There is no need to buy very expensive foreign medications based on the hemp extract. One can buy oils, juices, condiments, cosmetics, or independently get a permit to grow non-hashish varieties of therapeutic orientation and get treatment on a regular basis. In addition, there is an experience in Ukraine when the appropriate conductors and catalysts are added to the ‘green mass’ of the plant and a substance that excludes extraction (currently prohibited by law) is obtained. It is extremely effective in the treatment of very severe, including chronic diseases. There are documented examples of treatment of inoperable forms of cancer and persons with the fourth (terminal) stage of cancer in Ukraine.”

Are there any risks in legalizing medical cannabis?

Hennadiy Shabas stressed in his comment on this issue that most of the concerns and reservations arise from a banal lack of understanding of the mechanism of the legal cannabis turnover establishment.

“I personally would like to hear arguments against it, but so far I have not been lucky to hear them. I only hear warnings and fears – usually, the reason for them is that people do not fully understand the mechanism of creating a legal cannabis turnover. The warnings mainly concern the circle of patients who will have access to treatment. And fears are all about the doubts about whether the state will be able to control this process. But this is the task of the law – to establish adequate restrictions and effective control,” the expert said.

Dmytro Sinchenko, the Chairman of the public organization the Association of Political Sciences, is convinced that there are no risks in fact. According to him, the legalization will only allow patients to get the necessary medications, but those who use cannabis for non-medical purposes will continue to do so, regardless of the decisions of the authorities.

“In my opinion, there are no risks. Patients will receive effective medications, and those who used cannabis for non-medical purposes will continue to do so, regardless of the legalization of medical cannabis. And the fact that marijuana, by the way, unlike tobacco and alcohol, not to mention other drugs, is not addictive, gives confidence that the risks of ‘turning Ukrainians into drug addicts’ do not exist,” the expert adds.

What manipulations should be expected?

Reflecting on the legalization of medical cannabis, Ulana Suprun assured that a lot of manipulations may arise in the context of this issue. But Hennadiy Shabas told Opinion that a certain manipulation arises from the mere understanding of the term ‘drugs’, because in fact – it is not only what kills, but also what heals people.

“Drug is a word that in the last century has become a kind of trigger, which is used to scare and which we are supposed to be scared of because drugs kill people. But drugs also save people, if they are in legal circulation, as vital medications. The illegal drug turnover is fought, and the legal drug turnover ensures access to drugs to those who need it.  The essence of an effective state drug policy is to ensure a balance between these things, but this is an area for expert discussion. There is no sense in putting it for public discussion. The question of whether it is humane to give the patient painkillers is not solved by referendums,” the expert believes.

But Dmytro Sinchenko does not exclude manipulation against Ulana Suprun herself, particularly in the form of accusations of the alleged ‘hooking the Ukrainians on drugs’. Despite the international experience and the fact that Suprun has become a symbol of one of the most successful reforms in the country.

“Manipulations are not difficult to predict – obviously, Ms. Ulana will be accused of the desire to hook the Ukrainians on drugs and finally break their ‘spiritual bonds’. And when emotions will speak – the logic will be silent. And no one will care that medical cannabis is allowed in Canada, in Israel and in Lithuania, and even in a very conservative Poland. Just like no one cares about the benefits of medical reform implemented by Ulana Suprun, which nowadays has become, without exaggeration, a symbol of one of the most successful Ukrainian reforms,” Sinchenko said.

So why hasn’t the issue been resolved yet?

According to Dmytro Sinchenko, the continuation of discussions around this topic is due to several reasons. In particular, the traditions of Soviet times, the shadow drug business and the conservatism of the Ukrainians themselves are considered.

“Several factors are at play here. First, it is a tradition, or even inertia, since Soviet times. And we began to abandon most of the Soviet traditions only after 2014, and this process is not only incomplete but is merely gaining its momentum. Our state inherited too many Soviet things, and our government was too conservative.

Secondly, the shadow drug business is not interested in state intervention into its sphere. And the ‘law enforces’ who protect illegal turnover of drugs in Ukraine, including marijuana, aren’t interested in it even more.

Thirdly, the Ukrainian electorate is extremely conservative. They do not see any problem in smoking tobacco or drinking alcohol, which is much more dangerous to health than smoking marijuana, but they have a sharply negative attitude to cannabis and to all other illicit drugs,” said the Chairman of the public organization the Association of Political Sciences.

But Hennadiy Shabas is convinced that the issue is not really debatable, there has long been a scientific consensus on it. Moreover, Suprun is not the first head of the Ministry with such a position. According to the expert, a lack of public demand and discussion of the algorithm for solving the problem is standing in the way of the legalization.

“I would say that there has been a consensus on this issue for a long time. There is a scientific consensus. The scientists have been seeking the order of scientific research from the government for two years. There is a consensus among doctors. It exists even at the level of heads of the Ministry of Health of different years. At least two predecessors of Ulana Suprun share her attitude to medical cannabis. The solution has so far been hampered by the excessive sensitivity of the issue and the lack of a clear request from civil society.

The algorithm for solving this problem can be debatable: how exactly the law will solve the problem of patients’ access to medications, what will be the conditions for the use of plants in medical and scientific activities, who and how quickly will be able to obtain licenses and the like,” the comment states.

By Dmytro Zhuravel

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