European patients seek access to medical cannabis

Dr. Michael Verbora was invited to the Estonian parliament earlier this month to present on Canada's world-leading medical cannabis system

Access to regulated cannabis that has controls in place is important if it is being used as a medicine and being prescribed properly by a physician. While North America has been experiencing a green rush, many other patients across the globe still do not have access to regulated medical cannabis. Dr. Michael Verbora (medical director of Canabo Medical Corp and physician lead of the Toronto Cannabinoid Medical Clinic) was invited to the Estonian parliament (Riigikogu) earlier this month to present on Canada's world leading medical cannabis system after an online petition in Estonia garnered more than 1000 signatures to address cannabis.  

In the end of July, 2016, two petitions regarding medical cannabis garnered enough signatures to trigger government evaluation. One of the petitions, initiated by Aleksander Laane of the Estonian Green Party, focused on the medical side of cannabis regulation only, and demanded five things: 1) that the government develop guidelines for medical cannabis growing, preparing/processing, and sale in pharmacies based on the best examples from abroad; 2) that herbal cannabis be removed from Schedule I of narcotic drugs to Schedule III of the same, and that additional regulations be developed to allow for use of medicinal cannabis that do not mimic similar regulations set in place for medical use of opium and opioids; 3) that the process of prescribing both herbal cannabis as well as cannabinoid preparations be simplified in a manner similar to how Canada, Germany, the US, Israel and other countries have done it or are planning to do; 4) that herbal cannabis as well as cannabinoid preparations be made instantly available to patients with relevant prescriptions; and 5) that the state stop penalizing people for simple possession and use of cannabis.

The second petition, by private citizen Elver Loho, consisted of three standalone proposals. The petition, titled “Suggestions to the Parliament for better regulation of the cannabis market,” proposed that: 1) Estonian enterprises be allowed to produce cannabinoid medicines for export, in the same way they are allowed to produce mainstream psychoactive medicines and precursors, to be sold on the international market; 2) that the Minister of Health should decree that THC be moved from Schedule I of Narcotic Drugs to Schedule II to make it easier for doctors to prescribe THC-based medicines; 3) that the government initiate a pilot study into a heavily controlled and regulated recreational cannabis market model, whereby doctor-approved adult citizens would be allowed to buy and consume strictly tracked limited amounts of recreational cannabis on the premises of heavily regulated and screened cannabis consumption facilities.

While the petitions were gathering signatures, the Estonian Medical Cannabis Association (MTÜ Ravikanep) compiled a concise compendium of evidence-based information on cannabinoid medicine and medical cannabis regulation, containing a piece of original research—results of an anonymous survey into the unlicensed medical use of cannabis in Estonia—which was published in the fall of 2016, at the same time as both petitions reached the necessary minimum amount of signatures, but before the dates for the first session of the parliamentary commission were set. The evidence of effectiveness of medical use of cannabinoids cited in the compendium is mostly based on the Health Canada medical cannabis monograph of 2011.

The Parliamentary Commission on Social Affairs first gathered to discuss the medical cannabis related proposals of both petitions in February of 2016. The petitioners met with stern resistance to any liberalization of the procedures for prescribing medical cannabis and cannabinoids, especially on the part of the Estonian Doctors’ Association. The main objections by Estonian doctors to easing regulation, or even to simply starting to prescribe cannabinoid medicines in the legal framework that’s currently in place, are that: they don’t know enough about cannabinoid medicines and their nonconventional routes of administration, especially with regards to cannabis flos (Bedrocan’s herbal preparations), to confidently prescribe them; that the medications available on the market, especially Sativex, are prohibitively expensive; and that doctors don’t want to be “keepers of the key to the narcotics vault.”

In order to assuage these fears, and to demonstrate that safe, efficient, evidence-based cannabinoid treatments are actually feasible and in many cases preferable to other treatments, the petitioners, in tandem with the Medical Cannabis Association, started looking for a foreign expert. I was contacted and agreed to travel to Estonia to present to the Parliamentary Commission. The Medical Cannabis Association was able to crowdfund over 3000 euros in less than one week to support this visit.

While in Estonia, I met with patients to answer questions about my practice and cannabinoid medicine in general. One of the national commercial TV broadcasters, Kanal 2, made an hour-long in-depth feature for a current issues program Radar, which will be aired in the beginning of May 2017, featuring interviews with myself, the petitioners, some patients and commission members. Patients with brain cancers (or other cancers), patients on chemotherapy, and people living with chronic pain attended a meet and greet and shared their stories and how Cannabis helped ease their pain and suffering.

I attended the Estonian Parliamentary Commission on April 11, 2017 to present on the Canadian Cannabis system and the expertise of Cannabinoid Medical clinic physician, and demonstrated patient outcomes and medical evidence supporting the use of cannabis.

To date, the Social Affairs Commission has yet to make any definitive decisions regarding medical cannabis in Estonia, but the head of the Commission, Mrs. Helmen Kütt, said to a reporter that they have asked the State Medical Board to explain the reasons for the current double classification of THC/dronabinol into Schedules of Narcotic Drugs I and III, and will look into simplifying the process of prescribing and acquiring not just cannabinoid-based medications, but all medicines that aren’t licensed to be sold in Estonia.

Unfortunately, patients using medical cannabis in Estonia are not getting proper medical advice, expertise or supervision on the use of cannabinoid medicines. Their government often views them as criminals rather than patients trying to heal their suffering. Hopefully, countries like Estonia will develop evidence-based approaches to prescribing cannabinoids and consider changing regulations so patients can palliate their symptoms with peace of mind.

Featured image by Pöllö.

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