BAGUIO CITY – Whether state-level marijuana liberalization policy becomes a reality is an open debate given how a number of national legislators are wary of scientific evidence on use of marijuana. To them, evidence is “inconclusive.”
Crux of the matter facing these legislators, as gleaned from their sentiments publicly revealed, is, they need time to study the matter deeply.
Understandably, the Philippines needs to come out with research of its own on medical marijuana use. Pragmatically, it cannot just depend on studies conducted by other countries. If research on the Philippine side correlates with studies conducted abroad, policy-makers are armed with what weighs best when it boils down to correlation between legalization of medical marijuana, crimes and crime rates associated with it.
In short, legalization of marijuana impacts law, politics and decision-making since the challenge to face legislators when approving the proposal of Padilla is: will legalizing marijuana for medical purposes achieve the goal or, will it increase more risk to its illegal use, aside from other illicit drugs?
Will it aggravate further the illegal drug problem?
In determining these, legislators will, at the back of their minds, contend whether the Philippines as a state will later be embroiled in a situation of triumph on compassionateness for those in need of marijuana medication, or, failure.
Advocates of marijuana as medication for certain diseases lament that current rules in acquiring Compassionate Special Permits required by the Department of Health (DOH) and the Dangerous Drugs Board (DDB) for patients suffering from extreme pain from debilitating diseases are “too stringent.”
During a Senate hearing, senators were informed that acquiring a Compassionate Permit for marijuana medication as required is “stringent” and “not compassionate,” by advocates of the Padilla proposal.
Dr. Donnabel Trias Cunanan, spokesperson of Cannahopefuls, a pro-medical marijuana organization, told senators that applying for a Compassionate Permit is “too tedious and not compassionate at all.” She has a child suffering from epilepsy and cerebral palsy that needs pain medication.
“I want to inform everyone here that the process of getting a Compassionate Special Permit is not compassionate at all. It’s such a difficult process. I went through the eye of a needle. I begged our doctors to prescribe cannabis to us,” she informed the panel of senators.
Benjamin Reyes, undersecretary of DDB, admits the compassionate use scheme presently in place is complicated but steps are being remedied to simplify it. “We are in the process of reviewing the guidelines for compassionate use, as they are way back in 1992, so they are obsolete,” he explained, referring to the DOH Administrative Order.
Senators also found out to their dismay that the cost of acquiring marijuana medication – after fulfilling DOH and DDB requirements – is prohibitively expensive and well beyond the capacity of mainstream Filipinos to afford.
Hence, a patient in possession of a Compassionate Permit will have to import a drug with cannabis as the main ingredient in it, at a very expensive price. Or, illegally secure it. In short, break the law.
Take the drug Epidiolex (Cannabidiol), for example. It is a drug for epileptics, the first marijuana-based drug developed in the United States and approved for use by the US Food and Drug Administration. An epileptic patient using this for one year has to shell out 32,000 or more US dollars, depending on fluctuation of the Philippine peso.
An anti-epilepsy drug that costs 55,000 Philippine pesos per 60 ml. bottle will, at the end of the day, boil down to cost of medicine totally out of reach by the majority of Filipinos, the senators observed.
Given its exorbitant price and the average Filipino income reaching only an average 5,77 US dollars per year, Cunanan asked, “How can the compassionate scheme to be followed as indicated in the DOH Administrative order be compassionate?”
The epilepsy drug is also approved for Filipino use by the Philippine FDA. But the process of securing a Compassionate Permit for it under present set-up is extremely complicated.
Only physicians with S2 license issued by the PDEA and further issued special prescription pads by DOH can prescribe the medicine under FDA review, studying the qualification of the physician and legitimacy of the prescription. Once reviewed, a permit is issued.
However, importing marijuana-based medicines entail additional cost, like shipping. Getting it inside the country is easily said than done. Once inside the country, the medicine must be inspected and registered with the Philippine FDA before release.
“No Filipino has accessed medical cannabinoids legally, except for those who flew abroad to acquire it,” according to Gem Mutia, founder of Philippine Doctors for Medical Cannabis.
Padilla’s proposal strives to lessen requirements on medicines containing tetrahydrocannabinol (THC) and make it available to every Filipino under extreme pain due to certain diseases.
In January 2019, the World Health Organization (WHO) struck world news headlines when it recommended to the United Nations (UN) the reclassification of cannabis and cannabis-related substances.
In a letter addressed to UN Secretary-General Antonio Guterres, WHO Director-General Tedros Adhanom Ghebreyesus recommended that cannabis and cannabis resin should be stricken out from Schedule IV, considered the most restrictive on the Single Convention on Narcotics Drugs.
Instead, these should be categorized exclusively under Schedule 1, which recognizes that cannabis and cannabis resin, while having known negative properties, can also be used for medicinal purposes.
At present, opium, morphine and cocaine are all classified under WHO Category of Schedule 1. Heroin is both categorized under Schedules 1 & IV – similar to the current classification of cannabis and cannabis resin.
Ghebreyesus recommendation was based only after the culmination of conventions of medical experts of WHO 41st Expert Committee on Drug Dependence in June 2018 that tackled “Recommendations on Cannabis and Cannabis-related Substances.”
Gilles Forte, coordinator at the Office of the Assistant-Director of Access to Medicines, Vaccines and Pharmaceuticals of WHO, explained that “the recommendation is meant to allow better access to cannabis-related pharmaceutical preparations and to encourage that more scientific research is carried out on these substances and more countries use evidence-based approaches in using them for medical purposes.”
At the time of the establishment of the UN Single Convention of Narcotics Drugs in 1961, cannabis was not recognized as possessing therapeutic use, said Jason White, emeritus professor of the School of Pharmacy and Medical Sciences, University of Australia and presently chair of WHO Expert Committee on Drug Dependence.
“We, (the WHO) now recognize therapeutic uses for cannabis, understood in the conventions to include medicines prepared with cannabis – based on extensive research,” White emphasized.
Such a move by WHO reflects the changing poise of the international community towards marijuana as a medicine. In Southeast Asia, Thailand rewrote history in the region by being first to allow marijuana medicine in 2018. Thailand law covers not only use of marijuana for medicine but in-country cultivation and production of pharmaceutical marijuana medicine.
Earlier, South Korea became the first Asian country to legalize medicinal cannabis on a “case-by-case” basis.
Singapore, which has a law prescribing death for possession of drugs, already began exploring use of cannabinoids produced pharmaceutically.
Whether the bill filed by Padilla will pass muster in the 19th Congress – a subject of conjecture between the aisle of the august body dividing those in favor and those against it – therefore, remains to be seen.
Or, will it meet the same fate as that of a similar bill filed by Isabela representative Rodolfo Albano III on May 26, 2014, but slumbered in the Senate’s dustbin of history.
In Southeast Asia, the Philippines, like Indonesia and China, counts among countries that enforce strict policies on medical marijuana. Indonesia and China impose the death penalty for drug possession.
Closer to home in CAR, it can be remembered that way back in December, 2018, the Regional Development Council (RDC), CAR’s top governing body approved a resolution supporting the proposed legalization of marijuana for medical purposes.
Former city mayor Mauricio Domogan, then the RDC chair, stated: “Personally, in the medical aspect, we can use marijuana extract to address terminal cases like cancer.”
Domogan further clarified that, “The main problem here (referring to CAR and the possible use of marijuana medically), is the plantation. It should be strictly government-controlled. Otherwise, it will be subject to abuse.”
“If we allow private individuals to cultivate marijuana, then that will be a big problem, “Domogan explained.
Dr. Amelita Pangilinan, then Officer-in-Charge of the Department of Health (DOH-CAR), explained during that December 2018 RDC Forum that the Philippine Institute of Traditional and Alternative Health Care (PITAHC) had performed numerous studies on benefits of alternative medicine, like marijuana.
Pangilinan however cautioned that if approved, it must go with its policies based on operational research, meaning, evidence-based. Pangilinan is now presently director of DOH-R02.
Dr. Julie Cabato, member of the RDC-CAR during that time, narrated that she once had a cancer patient suffering from intense pain and could not be relieved by the drug, morphine. Someone gave her patient marijuana and Cabato said it helped in easing her patient’s painful condition.
Many questions crop up if and when Padilla’s proposed law will be approved. For one, if it will be approved for legal cultivation in CAR, where does the Department of Agriculture- Cordillera Administrative region (DA-CAR) fit into the picture, given it holds the region’s agriculture portfolio.
Will Congress pound a law that will enable DA to legally cultivate or grow hemp? Or, what agency will be tasked to do such an effort.
On another front, will Congress enact a law for DOH to conduct “clinical studies” after the hemp is considered a “registrable product?” Remember, there is no existing law listing marijuana as a registrable product in the Philippines.
And in such cases, DOH hands are tied. It cannot conduct clinical trials for the hemp legally produced under Padilla’s proposal unless a bill is worked out allowing government agencies to do clinical trials and for marijuana as a registered commodity.
