City in the interior plans to supply cannabidiol in health centers

With about 36 thousand inhabitants, the city of Mandaguarilocated in the north of Paraná, should start supplying cannabidiol (CBD) and tetrahydrocannabidiol (THC)cannabis-based medicines, in health posts by the end of this year.

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According to the municipal law approved by the Legislature and sanctioned by Mayor Ivonéia Furtado (CDN), in mid-May, the care for patients with medical prescription will be provided by the municipal network of health, which has a period of 180 days for contracting suppliers and starting the distribution of medicines approved by the National Health Surveillance Agency (Anvisa) with derivatives of cannabis in the Basic Health Units (UBS).

According to the mayor, the forecast is that the medicines are available until November at health posts for the supply of cannabidiol after contracting associations that supply oils with CBD and THC, through bidding processes.

Target of lawsuits with decisions favorable to patients, the supply of medicines in the public network was also approved by the Legislative Assembly of Paraná, but the Secretary of State for Health (Sesa) responded to the People’s Gazette that “is carrying out studies for the technical feasibility of supply of products or medicines based on cannabidiol or tetrahydrocannabinol.”

Despite indications of the distribution of products in state or municipal pharmacies, funded with public money, scientific research does not show evidence of the effectiveness of cannabis derivatives in most treatments, including Autistic Spectrum Disorder (ASD).

On the other hand, the mayor of Mandaguari states that the reports from parents and relatives show the evolution of autistic children who are treated with the drug, which would have motivated the municipal law. “Autism has grown a lot, not only in our city, but in the whole country. Now, neurologists have a more humanitarian, more attentive view of autism. So, we believe that this cannabidiol, based on the reports of parents and families, has greatly improved the lives (of children)”, he opines.

She reported that more than 20 prescriptions for medicinal use were received by the city hall pharmacy, which also intends to provide medical care with a prescription for the supply of cannabidiol and tetrahydrocannabidiol by the municipal network or by the Intermunicipal Consortium of the Region of Maringá, through the Unified Health System (SUS).

According to Furtado, the initial quotations of the expense to the public coffers indicate that the 15 ml unit of the medicine will cost BRL 310.48 for the 20 mg/ml bottle up to BRL 2,772.22 for the 200 mg/ml bottle. Asked about the scientific evidence for the use of CBD and TCH, especially in cases of autism, she replied that caution is needed when purchasing to ensure “quality and safety” of the drugs, but reinforced the thesis of improving the condition of children within the spectrum .

“At Anvisa, it is authorized only for epilepsy, but the reports of parents (of autistic children) are something like that, evident. As a mother and grandmother, this moves us. A child does those repetitive movements, all day long, and with cannabidiol or tetrahydrocannabidiol, he has had a significant improvement, ”she replied.

Author of the project, councilor Sydney da Silva (PSD), better known as Chiquinho, argues that a public hearing was held in the presence of representatives of the Brazilian Association of Cannabis Industries (Abicann) and doctors, who defend the prescription for cases of fibromyalgia, Parkinson’s, anxiety and schizophrenia, in addition to ASD, according to the congressman, who named the project “Pedro Henrique Law”in honor of a 10-year-old autistic boy who died in a domestic accident in Mandaguari last year and was using cannabidiol.

“There is this issue of prejudice because it is extracted from the marijuana flower, but it is a pharmacy within a single medicine”, justifies the councilor. “The project is based on the Pétala Law, which was enacted by the Legislative Assembly. Now, we have the first city law from the state of Paraná and the south of Brazil”, he added.

He further argues that the patients are looking for the Public Ministry (MP) so that the supply of cannabidiol is funded by the public authorities, with payment via the municipal or state health network, through judicial decisions. “It is a citizen’s right to have access to health. The people who are entering, are winning the medicine in court.”

Public money can pay for treatment without proof

The coordinator of the Movement Disorders and Behavioral Neurology Sector of the Hospital das Clínicas of the Faculty of Medicine of the University of São Paulo (USP) in Ribeirão Preto, physician Vitor Tumas, classifies as “initial frisson” the use of substances derived from cannabis. With limited scientific evidence, the researcher’s follow-up shows that most patients abandon treatments. The main suspect is high cost of the drug with little result in the health framework.

“When people see cannabis, a prohibited drug, which the laboratories prohibit ‘because they don’t want to cure cancer and other diseases’, it seems that cannabis will cure everyone. So, there is an absurd expectation, but then (the patient) sees that the reality is different. In fact, it is not all of that”, commented Tumas, who was moderator of the round table “Medical cannabis: an international view on its role in the treatment of neurological and psychiatric disorders” during the Brazilian Congress “Brain, Behavior and Emotions”held in Florianópolis (SC) in June.

He remembers that the formal position of medical and scientific entities is that there is no evidence for most indications, but in practice people look for the medical prescription because of “promising news”and the treatment is done in the “trial and error” model.

“I’m not radical to the point of saying that ‘if there’s no evidence, then let’s not try it’, but the problem is the government paying for this treatment. It is an issue that needs to be discussed, as products, which are reasonably reliable, are not cheap and the government will foot the bill. The patient will go to court to pay for the expensive treatment, which eventually another cheaper drug would solve”, he evaluates. “Also, if you release any medication based on what the patient has said, it can get messy,” he added.

Tumas points out that scientific evidence points to the effectiveness of cannabidiol in the treatment of epilepsythe use of cannabis extracts for pain and nausea, especially in patients with terminal cancerin addition to a small improvement in cases of stiffness and pain due to multiple sclerosis with spasticity in the combination of THC and CBD. “In the case of epilepsy, only for some very specific infantile forms. It is not for any type of epilepsy. Even so, it is introduced as an additional drug, and not exclusively, ”he added.

Asked about the studies that support other treatments with cannabis derivatives, the doctor replied that the laboratories promote surveys based on personal and subjective responses of patients using the drug. “That is, it is the opinion of the person. But this is a momentary thing, nobody looks at whether there is a placebo effect, nobody looks at whether there is any interest in using cannabis, nobody looks at whether it persists in the long term”, he criticizes.