Recognizing the analgesic and anti-inflammatory effects of cannabis sativa (marijuana), a number of possibilities are opened to treat various diseases. With some pharmaceutical establishments selling preparations with cannabidiol (CBD) and tetrahydrocannabinol (THC) , and with trained doctors, treating the sequelae of Covid-19 with this ancient medicinal plant is possible in Peru.
According to the Regulations of the Law that regulates Cannabis for Medicinal Use , it is up to the doctors and collegiate doctors to prescribe cannabis for the diseases they consider necessary according to the available evidence. This openness is explained by the fact that the number of scientific publications on cannabis has been increasing since 1964, when the Israeli chemist Raphael Mechoulam managed to isolate THC, the main active substance in the plant.
Taking into account the characteristics and needs of each patient, it is possible to treat the sequelae of covid, but always under the treatment of a health professional, stresses surgeon Cristina Leguía (UPCH), part of the Q2Clinic team , an international clinic specialized in cannabis that this February has begun to attend in the country through teleconsultations.
Leguía explains that sequelae are those effects of the disease that persist for more than three months. In the case of covid, the most frequent sequelae are chronic pain, sleep and mood disorders , as well as inflammation. Precisely these symptoms can be treated both with CBD, which has an anxiolytic and anti-inflammatory effect, and with THC, which works as an analgesic and muscle relaxant.
For example, in the case of an older adult who had a severe covid picture and came to be in the Intensive Care Unit (ICU) , Leguía has treated his joint pain and headaches with THC and CBD. As it should be in all cannabinoid treatments, the doctor started with an initial dose and then continued with a titration process by which cannabis concentrations are regulated until an effective dose is reached, which is different in each patient. .
“It was the first time that the patient was going to consume cannabis in his entire life, so he started with a conservative scheme with extracts high in CBD, titrating little by little and adding THC, which has seen greater benefit”, Leguía account.
“Each patient has a different risk / benefit profile and different needs,” highlights the doctor at the Q2Clinic clinic.
Currently, as the National Academies of Sciences, Engineering and Medicine of the USA (NASEM) have pointed out , there is conclusive evidence that products high in THC are effective in relieving chronic pain , reducing spasms in people with multiple sclerosis and reducing nausea and vomiting in cancer patients undergoing chemotherapy. In addition, the US Food and Drug Administration (FDA) has approved products with THC for increasing appetite and weight loss in patients with HIV / AIDS . He has also approved a high- CBD product as an anticonvulsant in severe cases of epilepsy .
However, this does not limit the use of cannabinoids considering their safety profile: there is no lethal dose with cannabis and the level of dependence it could generate is moderately low, similar to caffeine and much lower than alcohol, barbiturates and opioids. In December 2020, the United Nations (UN) removed cannabis from the list of dangerous substances by officially recognizing its medicinal effects based on a scientific report from the World Health Organization (WHO) .
Another factor to take into account is that cannabis is a plant that has more than 1,600 components, including 183 phytocannabinoids identified so far. This, explains the doctor Leguía, is a challenge for modern science that is used to working with isolated compounds.
“Some clinical trials, with the aim of doing a classical study, use isolates and what they conclude is not something that works in the real world, where we find natural whole plant extracts that have various compounds,” says Leguía.
Furthermore, due to the effects of cannabis, it is difficult for participants and monitors to remain blind in a clinical trial . Given this, Leguía points out that we must consider the evidence from the real world or from clinical practice, which is known in scientific research as Real World Evidence (RWE) .
“These are real-life observational studies, with which we observe what happens in practice, outside of a clinical trial context. Depending on the amount and volume of this evidence, one can do their own analysis, “he says.
In Peru, the legislation requires that medicinal cannabis users be registered on the Digemid website and undergo medical consultation. For products with CBD, the recipe is simple and for products containing THC it must be a special recipe for controlled substances.
“Patients should go to a doctor who knows how to safely prescribe cannabis. They should not self-medicate because it is necessary to evaluate the individual characteristics of each patient and the prescription will be made depending on that ”, highlights Leguía.
Currently, products are sold only for the sublingual / oral route with CBD and THC in some pharmaceutical establishments in Metropolitan Lima.
In 2017, Law No. 30681 was enacted, with which the therapeutic effects of cannabis were recognized. In February 2019, the regulation of this law was approved, which is still in the process of implementation: so far, the General Directorate of Medicines, Supplies and Drugs (DIGEMID) does not grant any license to grow and produce pharmaceutical cannabis in the country .
There is a lack of more variety of THC (only one company sells it) and that cannabis for medicinal use is no longer centralized in Lima, since there are more than 10,000 medicinal users and these are in all regions of Peru.
In addition, it is still pending that the Peruvian State respects the right of patients who use cannabis to cultivate their own medicine , since it was the cultivation associations that initiated the fight for Peru to recognize cannabis as a medicinal plant.