"Today it makes no sense for Spain to be last in terms of treatment with medical cannabis"

• Politics The regularization of medical cannabis comes to Congress again

• History A Galician quadriplegic makes the first public request for self-cultivation of medicinal cannabis

The regulation of medical cannabis "for a chronic patient means the difference between life and death, it means

. We ask that the subcommittee move forward as soon as possible to not leave the patient in the hands of the drug trafficker, but in the hands of the State, the doctors, the pharmacies and that we have dignity and quality of life".

This is what Carola Pérez, president of the Spanish Observatory of Medicinal Cannabis (OECM), said yesterday at the gates of the Congress, speaking on behalf of the patients who are part of this association -also made up of researchers and doctors- after her intervention in the last session of the Health Subcommittee to debate the regulation of medicinal cannabis in Congress.

Despite the politics,

, but the controversy starts from the same base since it tends to confuse concepts.

What has been discussed in this subcommittee in recent weeks is not that cannabis in general be legalized and that anyone can consume cannabis in a

, as in the Netherlands, that is,

.

What is proposed is to regulate

for very specific uses and profiles.

"The terminology is very important. Cannabis is a natural substance that has more than 200 active ingredients and some of them have been evaluated as possible therapeutic weapons against different problems. Therefore,

to relieve some symptoms.

Logically, everything that is recreational cannabis implies the consumption of these more than 200 substances, some of them with important psychotropic effects and that give it addictive potential, etc.

When we enter the field -and we should call it that- of the use of cannabis derivatives as a therapeutic tool, we already enter medicinal substances, some of which have been evaluated in different studies", explains Joaquim Julià, vice-president of the Spanish Society of Medical Palliative Care (Secpal), and regional director and head of the Palliative Care Service of the Catalan Institute of Oncology of Badalona (ICO).

For Jesús de Santiago, specialist in the treatment of pain, anesthesiologist at the Pain Unit of the Quirón Hospital in Tenerife and coordinator of the cannabinoid group of the Spanish Pain Society (SED), "

. The first hurdle to overcome is precisely that:

and when it comes to medical cannabis

, not only at the general population level, but also 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 up to if you've never met them, you've never treated any patients and you don't know how they're doing. Really only those who have had that experience can know." which has nothing to do with talking about recreational cannabis or medical cannabis and today those who have experience dealing with medical cannabis are above all patient associations such as the Spanish Observatory of Medicinal Cannabis or the patients themselves who have been obtaining these 'magic formulas' within families or from a friend who has told them or from medical professionals who have had the opportunity to be able to treat patients outside".

Part of the fear stems from its addictive power, from

.

Some scientific societies such as the Spanish Society of Pulmonology (Separ) or the Spanish Society of Psychiatry (SEP) have argued these arguments.

In this sense, De Santiago points out that he is against smoking cannabis with high concentrations of THC [tetrahydrocannabinol, the main psychoactive constituent of cannabis] or "a product that is not even known what it contains."

"We return again to ignorance. Smoking is associated with chronic bronchitis, airway tumors, COPD... In other words,

. Medical cannabis has to be personalized, it has to be adjust to each individual and normally

".

Regarding mental disorders, De Santiago indicates that the secondary effects of cannabis are known.

"There are studies like the one that was done in the US Army among 17,000 young individuals where cognitive impairment, psychosis problems and especially addiction were seen, but once again terms are confused, that is recreational cannabis and has nothing to do with medical cannabis".

What we see in Spain, argues this specialist in pain, is that "cannabis is stigmatized, there is a lack of information and

".

“There are people who know what they are talking about because they have experienced it, have treated it, and other people who do not know what they are talking about because they confuse it with recreational cannabis and are afraid, of course, because psychiatry units are full of schizophrenias. in young people produced by cannabis because the recreational one is the entrance to other harder drugs and generates addiction, all this is true, but it should not be confused with medical cannabis".

A patient and user shows her medicinal cannabis herb and oils. ALBERTO DI LOLLI

According to this anesthesiologist, who received the Ulf Lindblom award for the best European pain treatment review in 2019, "in order to speak,

. In this situation, let us remember that he is going to be a specialized doctor with training, the one who will monitor the patient, with strict control, with a product that will be considered a medicine and will be supervised, with good practice guides both in production and distribution and in traceability, that is, that

."

The vice president of Secpal emphasizes this lack of studies.

"Several reviews have come out on the subject, systematic reviews of the medical literature and meta-analyses. These studies on the studies

. "

will always be waiting for new evidence to appear to see if dronabinol, nabilone or any of these products can have a place in the therapeutic arsenal

. that corresponds in that therapeutic arsenal or that really tells us that they are not very useful".

Cannabis for neuropathic pain

dropdown

"Basically what has been looked at is the use of medical cannabis for neuropathic pain, that is,

. For example, patients who may have nerve damage due to the use of

or patients with

who, due to the degeneration of the nervous system, may have this pain. In neuropathic pain there is no study that supports its use, that is, the evidence that exists is very, very limited," explains Dr. Julià.

They have also been used for the treatment of loss of appetite, anorexia.

"Not anorexia nervosa, which is another issue, but

, which is a symptom that can be common and there is also no clear evidence to recommend. And just as it is known that many patients they use cannabis at their own risk for the treatment of nausea due to chemotherapy, since cannabis-derived products do not have any position on the therapeutic scale to treat these problems, "adds the vice president of Secpal.

Julià concludes that

"and at this time it does not allow us to recommend any of these products for use in day-to-day palliation of the symptoms of the patients' diseases".

De Santiago acknowledges that there is a lack of medical evidence on medicinal cannabis because "there is a lot of variability in the studies and from these meta-analyses, in the end, high statistical power is not achieved since there is a high risk of bias in making decisions, but what do exist are many articles at a clinical and observational level. That is, the International Association for the Study of Pain (IASP) issued some recommendations in 2021. The first is

; the second is that There is no evidence to recommend the generalized treatment of patients with chronic pain with medical cannabis, but

.

They recognized this positive personalized experience, but due to a lack of medical evidence, they could not issue a statement recommending it widely."

Along these lines, the coordinator of the SED cannabinoids group points out that

and we are excluding them from the health system for not having regulations, they have to seek life So what we should ask ourselves is

, when the rest of the European countries, except Belgium, they have it".

Precisely that is what the OECM is demanding: "That it be regulated now, that we are in legal and health insecurity in Spain.

, it reaches patients from other countries ", Carola Pérez said yesterday at the door of the Congress.

And it is that the situation in Spain is difficult to explain and understand.

There are authorizations from the Spanish Medicines Agency (Aemps) to

.

But these products obtained in Spain end up in other countries and

.

In countries like

, medical cannabis is widely used.

De Santiago, who was in that country working in a pain unit, stresses that medical guidelines recommend

, that is, when the first and second lines of treatment have not been effective, "that is, as a rescue drug when the other has failed, but in spite of that it is not like that, there treating especially patients with cancer pain

and the opinion of the doctors was that it should go up the ladder, that it should be second line".

What comes out of this Subcommittee could be a first step to respond to the claims of many patients.

The opinion of citizens in general is favorable to the regulation of therapeutic cannabis.

Thus, in the CIS barometer in April last year, this question was asked and

.

Only 4.5% would oppose this medicinal use and the rest did not know/did not answer.

But for this to be debated now, it has been key that

and remove it from List IV of the 1961 Drug Convention, where it places the most dangerous assets that require stricter control and without medicinal properties, such as heroin.

Conforms to The Trust Project criteria

Know more

• cannabis

• Health