PHILIPSBURG– Given the current status of evidence-based data from (clinical) research and experiences in several countries, the Inspectorate of the Ministry of Public Health, Social Affairs and Labour VSA is of the opinion that medicinal cannabis may benefit certain patients suffering from specific medical conditions. Therefore, medicinal cannabis should be made available in St. Maarten, Inspector-General Dr. Earl Best stated in the Policy on Medicinal Cannabis and Cannabidiol (CBD) Products, which was published in the National Gazette (Landscourant) of Friday, August 2.
The worldwide trend of permitting the use of medicinal cannabis in a controlled manner in various western countries has not gone unnoticed in St. Maarten, Best is stating in the report.
In the United States, the use of cannabis for medicinal purposes is legal in 29 states, plus the territories of Guam and Puerto Rico and the District of Columbia, as of April 2017.
It was the Health Inspectorate’s objective to establish a policy on procedures aimed at medical doctors and pharmacists in St. Maarten, which takes into consideration the existing legal framework and makes it possible to import, store, distribute, prescribe and dispense medicinal cannabis in a controlled and safe manner.
According to the Inspectorate, patients of St. Maarten should have legal access to affordable, high-quality and safe medicinal cannabis. Through this policy, the Inspectorate creates a means to make this possible.
“There is a considerable need for medicines and therapies that can help and alleviate the painful symptoms of a number of illnesses and diseases. An increasing number of studies suggest that medicinal cannabis in the form of oral extracts, sprays or pills can reduce these symptoms and aid in the treatment of some illnesses. However, as with many other drugs, medicinal cannabis can also cause unwanted side effects, such as difficulty with concentration, dizziness, drowsiness, loss of balance and problems with thinking and memory. Unregulated and illegal herbal cannabis (plant products) should not be used for medical purposes,” the Inspectorate VSA said.
There is activity evidence from systematic reviews of cannabis-based products and cannabinoids for the treatment of chemotherapy-induced nausea and vomiting, epilepsy, multiple sclerosis (MS), chronic non-cancer pain, therapy-resistant glaucoma, tics in Gilles de la Tourette syndrome and use in palliative care in terminal patients. For now, prescription of medicinal cannabis products will be limited to these symptoms and diseases.
Medicinal cannabis is not considered appropriate for people with an active or previous psychotic or active mood or anxiety disorder and for women who are pregnant, planning to become pregnant or breastfeeding or people with an unstable cardiovascular disease.
As more evidence-based data from research becomes available, the policy will be updated as necessary, Inspector-General Best says in the introduction to the policy, which was co-authored by Chief Inspector Pharmaceuticals Ashanti van Heyningen and the Inspectorate’s Senior Legal Advisor Dana Kweekel.
Medicinal cannabis can only be prescribed by a registered medical practitioner with appropriate qualifications and/or expertise for the medical condition requiring treatment. Medical practitioners can submit an application to the Inspectorate VSA to become an Authorized Prescriber (AP) of medicinal cannabis. Approval or authorization may be granted by the Inspectorate VSA after an evaluation of the application.
Before prescribing medicinal cannabis, the doctor will assess each patient to decide if the treatment is appropriate for their condition and individual circumstances. The doctor will take a medical history and a family-health history. The doctor will also consider the patient’s current medications and any problems with drug dependence and substance abuse. Other treating physicians must be consulted prior to prescribing medicinal cannabis. For scientific research purposes, it is important to keep a proper patient file in the case of medicinal cannabis, the Inspectorate said.
As there is limited, scientific evidence to support the use of medicinal cannabis in most conditions and in many cases the evidence is for its use together with other medicines, it should be prescribed only based on informed consent and preferably, when approved treatments have failed to manage conditions and symptoms, it is stated in the policy.
There is not much information available to help doctors determine the most appropriate and safe doses while minimizing potential side-effects. Like all prescription medicines, medicinal cannabis products can have side effects. Cannabinoids (primarily tetrahydrocannabinol – the main psychoactive substance in cannabis (THC)) were associated with a fivefold increase in rates of disorientation and dizziness, compared with placebo or active comparators. The extent of effects of these can vary with the type of medicinal cannabis product and between individuals.
In general, the side effects of CBD-rich products are less than those for high-THC products, but because the required doses for CBD can be quite high in conditions such as paediatric epilepsies, a proportion of patients encounter side-effects with these CBD doses. The known side-effects from medicinal cannabis treatment include fatigue and sedation, vertigo, nausea and vomiting, fever, decreased or increased appetite, dry mouth and diarrhoea.
Patients should not drive or operate machinery while being treated with medicinal cannabis, the Inspectorate says. Measurable concentrations of THC can be detected in urine many days after the last dose. It may take up to five days for 80 to 90 per cent of the dose to be excreted.
As driving under the influence of any substance is a criminal offence, patients should discuss the implications for safe and legal driving with their doctor, the Inspectorate says.
There is no information available on the most effective or safe dose for various conditions and symptoms. For this reason, starting doses should be low and increased over time until patients respond positively or the negative effects outweigh the perceived benefits.
Prescribing doctors should carefully assess elderly and particularly sensitive patients, consult with other treating physicians and specialists, regularly monitor interactions between medicinal cannabis and other treatments and assess their patients’ liver function when deciding to continue or stop treatment.
“Although there may be some evidence to suggest a benefit from medicinal cannabis treatment for one condition or symptom, this does not mean it will have benefits for other conditions, even with the same product and the same dose,” the Inspectorate states.
“There is a significant need for larger, high-quality studies to better explore the potential benefits, limitations and safety issues associated with medicinal-cannabis treatment across a range of health conditions and symptoms,” according to the Inspectorate.
There are various ways in which medicinal cannabis can be administered. The most common route is through inhalation by means of a vaporizer. However, most patients who cannot inhale choose to use it orally.
The Inspectorate does not approve of smoking as a way to administer medicinal cannabis, due to the release of harmful by- products of smoking such as carbon monoxide (CO) and other combustion-generated toxins which pose a health risk.
The Inspectorate approves the administration of medicinal cannabis for therapeutic purposes via vaporizer, extract or tea.
Source: The Daily Herald https://www.thedailyherald.sx/islands/89760-inspectorate-wants-to-make-medicinal-cannabis-available