Leading national and international experts and activists discussed barriers and opportunities at the first conference on medical cannabis in Hungary.
Professor Lumir Hanus is an analytic chemist, and a leading authority in the field of cannabis research. He was invited to Budapest by the Hungarian Civil Liberties Union to talk about the long history of cannabis use in medicine – from the dawn of human civilisation to the present day. He said one of the reasons why cannabis is so useful in medicine is that it contains 144 active compounds (cannabinoids) that are not present in any other known plants, with two types of receptors in the human body to which these cannabinoids connect. These receptors are distributed very broadly in the body, and thus can influence several diseases. Professor Hanus works with Professor Mechoulam at the Hebrew University in Jerusalem, the researcher who discovered THC, the best known psychoactive cannabinoid. He said there is a long way to go before we can properly understand the intricate relationships between the various strains of cannabis and their effects. One of the barriers to research is illegality. Dr. Ilya Reznik was a general practicioner who believed cannabis to be a very dangerous narcotic substance with no medicinal applications. It took him several years and scientific fellowships to learn that cannabis can be an incredibly useful medication for people suffering from neurodegenerative diseases, such as sclerosis multiplex, Tourette's, Alzheimer's and Parkinson's. Now he is a medical cannabis specialist who treats many people in Israel. He emphasised that doctors should be educated about cannabis, in order to counter the brainwashing to which they have been exposed.
Dr. Anna Kelemen, a Hungarian neurologist specialising in children with epilepsy, said, with regret, that doctors don’t use cannabis in medicine in Hungary, so she has very little personal experience. She is, howver, currently doing research into the use of CBD in treating children. She said cannabis should be subjected to placebo-controlled, double-blind clinical trials before it can be licensed by the state for use as a medicine. There is, she said, very good evidence on the use of cannabis in the treatment of sclerosis multiplex. In the treatment of other diseases, evidence is limited. The problem is that there are very few research projects in this field, because of political pressures. She mentioned that she was threatened not to attend the conference herself, because of the harm it could do to her career. There is a good deal of anecdotal evidence for the usefulness of cannabis in the treatment of epilepsy, with CBD probably having the most beneficial effect. A survey of 19 patients showed that 11% of patients could achieve zero seizures – which is better than the best mainstream medicines surveyed have achieved so far.
Pavel Pachta spoke about the dilemma of how to regulate access to medical cannabis in light of the international drug control treaties. He pointed out that a significant minority of cannabis users self-medicate, and are criminalised for doing so. There is an increasing number of patients obtaining cannabis legally (Israel: 25,000 patients, Canada: 45,000 patients, Holland: 4,500 patients, USA 1.246 million patients). There are 8.1 patients per 1000 people who are treated with cannabis in the US, which may seem a lot. But if you consider that 50 patients per 1000 people are treated with opiates, access to cannabis still seems low. Governments are less concerned about the use of more dangerous medications, on a much larger scale, than about the limited access to cannabis. Medical cannabis is not a Trojan horse for the legalisation of recreational cannabis, nor is its use a violation of the UN conventions. Current scheduling of cannabis is based on a scientific study produced in 1935. The cannabis herb is not an approved medicine – but there are registered cannabis-based medicines, such as Sativex and Marinol. “Special treatment” and “compassionate use“ programs make it possible to use the cannabis herb even if it is not registered as medicine. A good example is Israel. The Ministry of Health in Israel has acknowledged that there is limited evidence, but still the government is committed to provide limited access to cannabis because it could help many patients.
Tomas Zabransky, a professor at Charles University in Prague and adviser to the Ministry of Health, described the evolution of the regulation of cannabis for medical use in the Czech Republic. Mr. Josef Ponikelsky came out as a patient of Parkinson's disease in 1997 and helped a lot to educate the public about the issue. In 2010, Charles University organised a parliamentary seminar on the issue, which reached a consensus on the need to provide a legal supply of cannabis for patients who have been diagnosed as suitable to use it in accordance with the rules relating to evidence-based medicine. But the Ministry of Health has made no practical efforts to move the issue forward, claiming that, “No interest has been shown by medical experts”. Later, a special committee was set up to prepare new legislation, headed by Professor Tomas Zima, the rector of Charles University. Two subgroups were created, one medical, the other legal, to review best practice. In 2013, the proposal was sent to the parliament, which discussed it and established the National Medical Cannabis Agency, with an exclusive right to buy, sell, and to provide licences. The Ministry of Health produced a bylaw (MoH order 221/2013) which replaced legal prohibition with economic prohibition: it set the maximum amount at 30 grams per person per month and created further barriers, establishing a cannabis sales monopoly for the Dutch company, Bedrocan. When a new government was elected, it hired Zabransky to lead the agency. A domestic grower was selected who produces cannabis much more cheaply than the Dutch company. The wholesale price is 3 euro per gramme. The government provides research grants for clinical trials. In October 2015, the bylaw was amended, so that now 180 grams of dried herb can be obtained per person, and most of the barriers to medical care were removed. The minimum age limit is still 18, however, which Dr. Zabransky considers controversial. He emphasised that without the direct impact of patients it is impossible to make good policy – patient activism is a sine qua non. It is also important to make full use of the political window of opportunity.
Steph Sherer, the founder and director of Americans for Safe Access, explained how her NGO advocates for safe and legal access to cannabis for therapeutic use. ASA has succeeded in getting laws passed at local, state, and federal level, educates doctors, and creates safe product standards. When the federal government tried to block the enforcement of state laws regulating access to medical marijuana, ASA organised several civil disobedience actions – educating activists to knowingly break the law by responding to DEA raids. Apart from radical action, ASA consults with elected officials and carries out direct lobbying and a lot of media work and public education. They are working on a monograph on cannabis.
Rita Pálffyné Poór, from the National Institute of Pharmacy and Nutrition, emphasised that according to the official position of her institute, there is too little research evidence to register cannabis as a medicine in Hungary. Since 2008, however, a legal framework has been in place, allowing doctors to order cannabis-based medicines registered in other countries. Unfortunately, no such order has yet been submitted.
Miklós Szelestei, the head of the newly founded Hungarian Medical Cannabis Association, said patients can’t wait until official medications are registered – they need compassion and help now. There is enough evidence to show that cannabis can be safely used in the treatment of many incurable diseases. He suggested that the government should create a new regulatory system to allow the domestic production of cannabis medication and make it possible for patients to cultivate it themselves.
Cintia Ripszám, the mother of a child suffering from Dravet syndrome, a rare form of epilepsy, made a very moving and powerful speech in support of legal access to cannabis concentrates for therapeutic use. She said her daughter, along with other children living with epilepsy, benefited greatly from the use of high-concentrate cannabinoid oils. After trying so many registered medications whose side-effects outweighed the benefits, parents are desperate for new ways to treat their children. They are not irresponsible, they would like to use this drug safely, but there is not enough information available, and they fear arrest.
At the closing round-table session, professionals and activists discussed the future direction of medical cannabis advocacy in Hungary. Participants emphasised how important it is to maintain a dialogue among stakeholders. It was suggested that the next step should be to educate medical professionals about the benefits of cannabis, as well as to motivate them to import medication from abroad. If there is enough interest from the medical profession and patients, if a large number of import requests are submitted, the government will feel pressured to create a new regulatory system and allow domestic cultivation for therapeutic use.
Peter Sarosi
