Cannabis for medical and scientific purposes: the Colombian landscape
Abstract
The Colombian government, through Law 1787 of 2016, has created a regulatory framework that allows its citizens to have a safe and informed access to cannabis and its derivatives for medical and scientific purposes. Our country joins others in their efforts to legalize cannabis-derived substances for therapeutic purposes, as many jurisdictions have recognized the potential these products have in the treatment of certain medical conditions. This paper describes the current medical cannabis outlook in Colombia, compares the different medical cannabis supply systems in other parts of the world, summarizes the evidence related to the potential therapeutic benefits and potential risks of using cannabis for medical purposes.
References
Medicinal use of cannabis: History and current status [Internet]. [cited 2018 jun 27]. Disponible en: https://sencanada.ca/content/sen/committee/371/ille/presentation/kalant-e.htm
Li H-L. An archaeological and historical ac- count of cannabis in China [Internet]. Economic Botany. 1973;28:437-48. doi: http://dx.doi.org/10.1007/bf02862859
Zuardi AW. History of cannabis as a medicine: a review [Internet]. Revista Brasileira de Psiquiatria. 2006;28:153-7. doi: http://dx.doi.org/10.1590/s1516-44462006000200015.
Jiang H, Wang L, Merlin MD, Clarke RC, Pan Y, Zhang Y, et al. Ancient cannabis burial shroud in a central eurasian cemetery [Internet]. Economic Botany. 2016;70:213-21. doi: http://dx.doi.org/10.1007/s12231-016-9351-1.
Mahdizadeh S, Khaleghi Ghadiri M, Gorji A. Avicenna’s Canon of Medicine: a review of analgesics and antiinflammatory substances. Avicenna J Phytomed. 2015;5(3):182-202.
O’Shaughnessy WB. On the preparations of the Indian Hemp, or Gunjah: Cannabis Indica theireffects on the animal system in health, and their utility in the treatment of tetanus and other convulsive diseases. Prov Med J Retrosp Med Sci. 1843;5(123):363. doi: https://doi.org/10.1136/bmj.s1-5.123.363
Holland J. The Pot Book-A Complete Guide to Cannabis: Its role in medicine, politics. Science, and Culture Park Street Press, Rochester, NY, USA. 2010;45.
Section 812 [Internet]. [citado: 2018 jun 27]. Disponible en: https://www.deadiversion.us-doj.gov/21cfr/21usc/812.htm
Drug Enforcement Administration, Department of Justice. Schedules of controlled substances: temporary placement of three synthetic cannabinoids into schedule I. Final order. Fed Regist. 2015;80(20):5042-7.
Maccarrone M, Bab I, Bíró T, Cabral GA, Dey SK, Di Marzo V, et al. Endocannabinoid signaling at the periphery: 50 years after THC. Trends Pharmacol Sci. 2015;36(5):277-96. doi: https://doi.org/10.1016/j.tips.2015.02.008
Matsuda LA, Lolait SJ, Brownstein MJ, Young AC, Bonner TI. Structure of a cannabinoid re- ceptor and functional expression of the clo- ned cDNA. Nature. 1990;346(6284):561-4. doi: https://doi.org/10.1038/346561a0
Munro S, Thomas KL, Abu-Shaar M. Molecular characterization of a peripheral receptor for cannabinoids. Nature. 1993;365(6441):61-5. doi: https://doi.org/10.1038/365061a0
Sáenz Rovner E. La “prehistoria” de la marihuana en Colombia: consumo y cultivos entre los años 30 y 60. Cuad Econ. 2007;26(47):205-22.
Stringer RJ, Maggard SR. Reefer madness to marijuana legalization: Media exposure and American attitudes toward marijuana (1975- 2012). J Drug Issues. 2016;46(4):428-45. doi: https://doi.org/10.1177/0022042616659762
Cohen PJ. Medical marijuana: the conflict between scientific evidence and political ideology. Part one of two. J Pain Palliat Care Pharmacother. 2009;23(1):4-25. doi: https://doi.org/10.1080/15360280902727973
Maa E, Figi P. The case for medical marijuana in epilepsy. Epilepsia. 2014;55(6):783-6. doi: https://doi.org/10.1111/epi.12610
Testimonios. Fundación Cultivando Esperanza [Internet]. [citado: 2018 jul 11]. Disponible en: http://www.fundacioncultivandoesperanza.org/testimonios/
Cubillos P. Comunicación teléfonica. Juan Manuel Galán, Senador. Julio 10, 2018.
Santacruz CV. Legalización medicinal de la marihuana en Colombia, con el liderazgo del Senado [Internet]. [citado: 2018 Jul 24]. Disponible en: http://www.senado.gov.co/historia/item/23351-legalizacion-medicinal-de-la-marihuana-en-colombia-con-el-liderazgo-del-senado
Democrático PC. “Legalizar uso Terapéutico de la Marihuana es abrir el camino para otros fines”: senador Castañeda [Internet]. [citado: 2018 jul 24]. Disponible en: http://www.senado.gov.co/el-senado/mesa-directiva/presidencia/oficina-de-informacion-y-prensa/item/23228-legalizar-el-uso-terapeutico-de-la-marihuana-es-abrir-el-camino-de-su-consumo-para-otros-fines-senador-castaneda
Ministerio de Justicia. Tipos de licencias y modalidades [Internet]. [citado: 2018 Jul 6]. Disponible en: http://www.minjusticia.gov.co/CannabisConFinesMedicinalesyCientificos/Tiposdelicenciasymodalidades.aspx
Subdirección de Control y Fiscalización de Sustancias Químicas y Estupefacientes. Licencia de uso de semillas para siembra. Licencia de cultivo de plantas de cannabis psicoactivo. Licencia de cultivo de plantas de cannabis no psicoactivo [Internet]. [citado: 2020 ago 26]. Disponible en: https://asocolcanna.org/wp-content/uploads/2020/09/Licencias-de-Cannabis-Otorgadas-MJD-30-04-2020.pdf
Listado de inscripción de pequeños y medianos cultivadores, productores y comercializadores nacionales de cannabis medicinal [Internet]. [citado: 2020 ago 26]. Disponible en: https://www.minjusticia.gov.co/Portals/0/Cannabis/Documentos/LISTADO%20DE%20PEQUENO%20Y%20MEDIANOS%20CULTIVADORES%20DE%20CANNABIS%20MEDICINAL%20DICIEMBRE%202020.pdf?ver=2020-12-30-084556-06
MinSalud. Licencias de fabricación de derivados de cannabis. [Internet]. [citado: 2020 ago 26]. Disponible en: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/VS/MET/licencia-fabricacion-cannabis-uso-medicinal.pdf
Zochodne G. Canopy Growth unveils new Latin America plan, buys Colombian medical marijuana company [Internet]. Financial Post. 2018 [citado: 2018 Jul 6]. Disponible en: https://business.financialpost.com/cannabis/canopy-growth-unveils-new-latin-america-plan-buys-colombian-medical-marijuana-company
Pot producer Aphria raising $225 million for expansions, facilities, possible acquisitions [Internet]. Financial Post. 2018 [citado: 2018 Jul 6]. Disponible en: https://business.financialpost.com/cannabis/aphria-raising-225-million-for-expansions-facilities-possible-acquisitions
Casa Editorial El Tiempo. Más capital canadiense para cannabis medicinal [Internet]. Portafolio.co. [citado: 2018 Jul 6]. Disponible en: http://www.portafolio.co/economia/mas-capital-canadiense-para-cannabis-medicinal-516988
Beleave Expands its Global Footprint into Colombia [Internet]. [citado: 2018 Jul 6]. Disponible en: https://www.prnewswire.com/news-releases/beleave-expands-its-global-footprint-into-colombia-300670135.html
Ministerio de Salud y Protección Social. Decreto 613 de 2017. Disponible en: https://www.minsalud.gov.co/Normatividad_Nuevo/Decreto%20613%20de%202017.pdf
Presidencia de la República. Decreto 1156 del 06 de julio de 2018. Disponible en: http://es.presidencia.gov.co/normativa/normativa/DECRETO%201156%20DEL%2006%20DE%20JULIO%20DE%202018.pdf
Allsop D. Unravelling the evidence for prescribing medicinal cannabis. Med J Aust. 2017;207(7):285. doi: https://doi.org/10.5694/mja17.00063
Ziemianski D, Capler R, Tekanoff R, Lacasse A, Luconi F, Ware MA. Cannabis in medici- ne: a national educational needs assess- ment among Canadian physicians. BMC Med Educ. 2015;15:52. doi: https://doi.org/10.1186/s12909-015-0335-0
Rubin R. Medical marijuana is legal in most states, but physicians have little evidence to guide them. JAMA. 2017;317(16):1611-3. doi: https://doi.org/10.1001/jama.2017.0813
Fitzcharles M-A, SteMarie PA, Clauw DJ, Jamal S, Karsh J, LeClercq S, et al. Rheuma- tologists lack confidence in their knowledge of cannabinoids pertaining to the manage- ment of rheumatic complaints. BMC Muscu- loskelet Disord. 2014;15:258. doi: https://doi.org/10.1186/1471-2474-15-258
Karanges EA, Suraev A, Elias N, Manocha R, McGregor IS. Knowledge and attitudes of Australian general practitioners towards medicinal cannabis: a cross-sectional survey. BMJ Open. 2018;8(7):e022101. doi: https://doi.org/10.1136/bmjopen-2018-022101
Invima. Guía para las visitas de buenas prácticas de elaboración de preparaciones magistrales a base de cannabis [Internet]. [citado: 2020 ago 26]. Disponible en: https://www.invima.gov.co/documents/20143/908412/guia-para-las-visitas-de-buenas-practicas-de-elaboracion-de-preparaciones-magistrales-a-base-de-cannabis_ASS-AYC-GU017.pdf/8021bdd8-13f1-4cf6-fe69-39163ee09ee-f?t=1572042596864
Pellechia T. Legal cannabis industry poi- sed for big growth, in North America and around the world. Forbes Magazine [Internet]. 2018 Mar 1 [citado: 2018 jul 6]; Disponible en: https://www.forbes.com/sites/thomaspellechia/2018/03/01/double-digit-billions-puts-north-america-in-the-worldwide-cannabis-market-lead/
Canada H. Understanding the new access to cannabis for medical purposes regulations Canada.ca [Internet]. 2016 [citado: 2018 jul 10]. Disponible en: https://www.canada.ca/en/health-canada/services/publications/drugs-health-products/understanding-new-access-to-cannabis-for-medical-purposes-regulations.html
Canada. Regulations to support coming into force of the Cannabis Act - Canada.ca [Internet]. 2018 [citado: 2018 Jul 10]. Disponible en: https://www.canada.ca/en/health-canada/services/drugs-medication/cannabis/laws-regulations/regulations-support-cannabis-act.html
A Public Health Approach to the Legalization, Regulation and Restriction of Access to Cannabis. Canadian Public Health As-sociation [Internet]. [citado: 2018 Jul 10]. Disponible en: https://www.cpha.ca/public-health-approach-legalization-regulation-and-restriction-access-cannabis
Comunicado IRCCA Cannabis Farmacias [Inter- net]. Scribd. [citado: 2018 Jul 10]. Disponible en: https://www.scribd.com/document/353779148/Comunicado-IRCCA-Cannabis-Farmacias
Reuters. Uruguay reglamenta uso de marihuana con fines medicinales y de investiga- ción. Scientific American [Internet]. [citado: 2018 Jul 10]. Disponible en: https://www.scientificamerican.com/espanol/noticias/reuters/uruguay-reglamenta-uso-de-marihuana-con-fines-medicinales-y-de-investigacion/
Abuhasira R, Shbiro L, Landschaft Y. Medical use of cannabis and cannabinoids containing products - Regulations in Europe and North America. Eur J Intern Med. 2018;49:2-6. doi: https://doi.org/10.1016/j.ejim.2018.01.001
Hasin DS. US Epidemiology of Cannabis Use and associated problems. Neuropsychopharmacology. 2018;43(1):195-212. doi: https://doi.org/10.1038/npp.2017.198
Klieger SB, Gutman A, Allen L, Pacula RL, Ibrahim JK, Burris S. Mapping medical marijuana: state laws regulating patients, product safety, supply chains and dispensaries, 2017. Addiction. 2017;112(12):2206-16. doi: https://doi.org/10.1111/add.13910
Robinson M, Berke J, Gould S. This map shows every state that has legalized marijua- na. Business Insider [Internet]. 2018 Jun 28 [citado: 2018 Jul 24]; Disponible en: https://www.businessinsider.com/legal-marijuana-states-2018-1
Drugs@FDA: FDA Approved Drug Products. [citado: 2018 Jun 28]. Disponible en: https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&ApplNo=018651
Drugs@FDA: FDA Approved Drug Products. [citado: 2018 Jun 28]. Disponible en: https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm?event=overview.process&Appl-No=018677
Krcevski-Skvarc N, Wells C, Häuser W. Availability and approval of cannabis-based medicines for chronic pain management and palliative/supportive care in Europe: A survey of the status in the chapters of the European Pain Federation. Eur J Pain. 2018;22(3):440-54. doi: https://doi.org/10.1002/ejp.1147
Canada G of, Canada H, Products H, Branch F, Directorate TP. Notice of Compliance (NOC) online query. 2010 ago 25 [citado: 2018 jun 28]. Disponible en: https://health-products.canada.ca/noc-ac/search-recherche.do?lang=en
Smith LA, Azariah F, Lavender VTC, Stoner NS, Bettiol S. Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy. Cochrane Database Syst Rev. 2015;(11):CD009464. doi: https://doi.org/10.1002/14651858.CD009464.pub2
Tramèr MR, Carroll D, Campbell FA, Reynolds DJ, Moore RA, McQuay HJ. Cannabinoids for control of chemotherapy induced nausea and vomiting: quantitative systematic review. BMJ. 2001;323(7303):16-21. doi: https://doi.org/10.1136/bmj.323.7303.16
Whiting PF, Wolff RF, Deshpande S, Di Nisio M, Duffy S, Hernández AV, et al. Cannabinoids for medical use: A systematic review and meta-analysis. JAMA. 2015;313(24):2456-73. doi: https://doi.org/10.1001/jama.2015.6358
Van den Elsen GAH, Ahmed AIA, Lammers M, Kramers C, Verkes RJ, van der Marck MA, et al. Efficacy and safety of medical cannabinoids in older subjects: a systematic review. Ageing Res Rev. 2014;14:56-64. doi: https://doi.org/10.1016/j.arr.2014.01.007
Tafelski S, Häuser W, Schäfer M. Efficacy, to- lerability, and safety of cannabinoids for chemotherapy induced nausea and vomiting-a systematic review of systematic reviews. Schmerz. 2016;30(1):14-24. doi: https://doi.org/10.1007/s00482-015-0092-3
Elsohly MA, Slade D. Chemical constituents of marijuana: the complex mixture of natural cannabinoids. Life Sci. 2005;78(5):539-48.
Ware MA, Adams H, Guy GW. The medicinal use of cannabis in the UK: results of a nationwide survey. Int J Clin Pract. 2005;59(3):291-5.
Ogborne AC, Smart RG, Weber T, Birchmore Timney C. Who is using cannabis as a medicine and why: an exploratory study. J Psychoactive Drugs. 2000;32(4):435-43.
Babson KA, Sottile J, Morabito D. Cannabis, Cannabinoids, and Sleep: a review of the literature. Curr Psychiatry Rep. 2017;19(4):23.
Madras BK. Update of cannabis and its medical use. Report to the WHO Expert Committee on Drug Dependence (http://www who int/medicines/access/controlled-substances/6_2_cannabis_update pdf [Internet]. 2015. Disponible en: http://www.who.int/medicines/access/controlled-substances/6_2_cannabis_update.pdf
The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research: Health and Medicine Division [Internet]. [citado: 2018 jul 5]. Disponible en: http://nationalacademies.org/hmd/reports/2017/health-effects-of-cannabis-and-cannabinoids.aspx
Bellnier T, Brown GW, Ortega TR. Preliminary evaluation of the efficacy, safety, and costs associated with the treatment of chronic pain with medical cannabis. Ment Health Clin. 2018;8(3):110-5. doi: https://doi.org/10.9740/mhc.2018.05.110
Bradford AC, Bradford WD, Abraham A, Bagwell Adams G. Association between US State medical cannabis laws and opioid prescribing in the medicare Part D Population. JAMA Intern Med. 2018;178(5):667-72. doi: https://doi.org/10.1001/jamainternmed.2018.0266
Bachhuber MA, Saloner B, Cunningham CO, Barry CL. Medical cannabis laws and opioid analgesic overdose mortality in the United States, 1999-2010. JAMA Intern Med. 2014;174(10):1668-73. doi: https://doi.org/10.1001/jamainternmed.2014.4005
Boehnke KF, Litinas E, Clauw DJ. Medical cannabis use is associated with decreased opiate medication use in a retrospective cross-sectional survey of patients with chronic pain. J Pain. 2016;17(6):739-44. doi: https://doi.org/10.1016/j.jpain.2016.03.002
Serrano A. As vets demand cannabis for PTSD, science races to unlock its secrets. Scientific American [Internet]. 2018 ene 4 [citado: 2018 Jun 21]. Disponible en: https://www.scientificamerican.com/article/as-vets-demand-cannabis-for-ptsd-science-races-to-unlock-its-secrets/
Devinsky O, Cross JH, Wright S. Trial of canna- bidiol for drug-resistant seizures in the dravet syndrome. N Engl J Med. 2017;377(7):699-700. doi: https://doi.org/10.1056/NEJMc1708349
Devinsky O, Marsh E, Friedman D, Thiele E, Laux L, Sullivan J, et al. Cannabidiol in patients with treatment-resistant epilepsy: an open-label interventional trial. Lancet Neurol. 2016;15(3):270-8. doi: https://doi.org/10.1016/S14744422(15)00379-8
Office of the Commissioner. Press Announcements - FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. [citado: 2018 jul 5]. Disponible en: https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm611046.htm
Häuser W, Finn DP, Kalso E, Krcevski-Skvarc N, Kress H-G, Morlion B, et al. European Pain Federation (EFIC) position paper on appro- priate use of cannabis-based medicines and medical cannabis for chronic pain management. Eur J Pain. 2018;22(9):1547-64. doi: https://doi.org/10.1002/ejp.1297
Australian Government Department of Health. Therapeutic Goods Administration. Guidance for the use of medicinal cannabis in the treat- ment of chronic non-cancer pain in Australia [Internet]. [citado: 2020 ago 26]. Disponible en: https://www.tga.gov.au/publication/guidance-use-medicinal-cannabis-treatment-chronic-non-cancer-pain-australia
Allan GM, Ramji J, Perry D, Ton J, Beahm NP, Crisp N, et al. Simplified guideline for prescribing medical cannabinoids in primary care. Can Fam Physician. 2018;64(2):111-20.
Mu A, Weinberg E, Moulin DE, Clarke H. Pharmacologic management of chronic neuropathic pain: Review of the Canadian Pain Society consensus statement. Can Fam Physician. 2017;63(11):844-52.
Young-Wolff KC, Tucker L-Y, Alexeeff S, Armstrong MA, Conway A, Weisner C, et al. Trends in self-reported and biochemically tested marijuana use among pregnant females in California from 2009-2016. JAMA. 2017;318(24):2490-1. doi: https://doi.org/10.1001/jama.2017.17225
Wang GS. Pediatric concerns due to expanded cannabis use: Unintended consequences of legalization. J Med Toxicol. 2017;13(1):99-105. doi: https://doi.org/10.1007/s13181-016-0552-x
Arseneault L, Cannon M, Poulton R, Murray R, Caspi A, Moffitt TE. Cannabis use in adolescence and risk for adult psychosis: longitudinal pros-pective study. BMJ. 2002;325(7374):1212-3. doi: https://doi.org/10.1136/bmj.325.7374.1212
Bernardini F, Gobbicchi C, Attademo L, Pucha- lski S, Trezzi R, Moretti P, et al. Cannabis use, psychotic like experiences and aberrant salience in a sample of Belgian students. J Nerv Ment Dis. 2018;206(7):493-500. doi: https://doi.org/10.1097/NMD.0000000000000849
Bourque J, Afzali MH, Conrod PJ. Association of cannabis use with adolescent psychotic symptoms. JAMA Psychiatry [Internet]. 2018 jun 6. doi: http://dx.doi.org/10.1001/jamapsychiatry.2018.1330
Piomelli D, Cooper Z, Abrams D, Grant I, Patel S. A Guide to the National Academy of Science Report on Cannabis: An exclusive discussion with panel members. Cannabis Cannabinoid Res. 2017;2(1):155-9. doi: https://doi.org/10.1089/can.2017.29009.dpi
Search of: medical cannabis - List Results - ClinicalTrials.gov [Internet]. [citado: 2020 ago 26]. Disponible en: https://clinicaltrials.gov/ct2/results?cond=&term=medical+canna-bis&cntry=&state=&city=&dist=