Medicinal and recreational weed: are they all that different?

Once politicians have accepted that cannabis is useful for the treatment of some conditions, and that its benefit outweighs any potential dangers, is it not inevitable to ask: why are patients being forced to buy cannabis from a pharmacy, when they can grow or purchase what is essentially the very same substance off the black market, at a significantly cheaper price?

This week, a local pharmaceutical company announced it had started distributing a brand of medicinal cannabis in local pharmacies. The medication – Bedrocan flos – comes in the form of the dried female cannabis plant flower, commonly known as a bud, and not dissimilar to anything found in the market for illegal drugs.

Speaking in parliament earlier this year during a debate on relaxing legal restrictions to accessing medicinal cannabis, health minister Chris Fearne stressed that the law would not allow preparations “for smoking” to be sold, insisting that the government did not want to risk the medicine being used recreationally.

Even Prime Minister Joseph Muscat, in a separate debate on the manufacture of cannabis products in Malta, sought to allay concerns about medicinal cannabis being used recreationally, by claiming that the products developed in many cases would not contain the plant’s psychoactive ingredient – THC, the molecules in the plant that bring about its euphoric effect – and that the products generally came in the form of gums or oils.

In both debates, MPs from both sides of the House went out of their way to emphasise that while cannabis has several medicinal benefits, and while this medication should be made available to those in need of it, this could not be confused with “recreational cannabis”.

But like other products which recently hit the local market, Bedrocan flos has a THC content of 22% and a CBD content below 1%.

And by comparison, the type of cannabis smoked recreationally nowadays can have a THC content ranging from anything between 15% and 25%, significantly higher than it was just 20 years ago.

The fact that the plant is available in flower form means it is being sold in a form that can be smoked, and one which can be used recreationally, despite the impression given by both the Prime Minister and his deputy.

But Fearne insisted with MaltaToday that any cannabis products locally available in the form of a dried flower “are to be inhaled using a vaporizer. The product is produced under GMP (good manufacturing practice) licence and approved by the Maltese Medicines Authority and licensed by the Superintendent for Public Health. The pharmacies dispensing the product also have the vaporisers available. Patients are instructed on how to use the device. The prescribing doctors will be monitoring patients to evaluate their progress.”

This is not to say that the authorities were wrong to allow such products on the market. Smoking is one of a number of effective ways in which the plant’s medicinal benefits can be exploited and is also a route that allows users to control how much they are using and to get instant relief when it is needed by taking a few puffs of a joint.

As the government has itself pointed out, given that Malta has now accepted the plant’s medicinal benefits, the priority is allowing those who needed easy access to it.

For decades now, cannabis has been considered a harmful drug and a menace to society that leads those who use it into a downward spiral often ending in addiction to hard drugs. This has resulted in society having a deep-rooted stigma when it comes to the plant’s use.

But by emphasising a distinction between medicinal cannabis and recreational cannabis – as seen by Fearne’s invocation of the GMP mantra – local politicians as well as large pharmaceutical companies and industry players have sought to give the use of medicinal cannabis a clean slate by “decoupling” it from recreational use.

This was evidenced in the way Muscat stressed in a parliamentary speech that medicinal cannabis products were “different” because the companies that produced them could ensure traceability and accurate dosing.

That alone does not prevent medicinal cannabis from being procured legally, and then resold on the market… it is weed after all.

For what is exactly different from the weed available from a pharmacy and that from the streets?

Products produced under Good Manufacturing Practice (GMP) conditions can have individual ingredients traced back to when they were made and how they were formulated into the product.

GMP cannabis will also have a precisely known THC content allowing users to predict how a given amount of the drug will make them feel.

It could be said that a cook who regularly uses peppermint or any other herbal ingredient when cooking would benefit from a standardised product, one which always contains the same amount of its taste-producing ingredient.

This doesn’t, however, mean that leaves from a non-standardised plant grown at home are in some way different.

Traceability and accurate dosage don’t mean that there is anything different in the cannabis, or that its benefits, or indeed potential for harm, are altered: it just means you know exactly how much of each ingredient is in it.

In treating most ailments, the dose required for optimal effect can vary greatly from person to person and will require a certain amount of trial and error to determine whatever works best for that person.

The fact that it is impossible to overdose on cannabis means that ensuring an ‘accurate’ dose is relatively unimportant, as users can continue to consume it until they decide they are feeling better, while any adverse effects are relatively short-lived.