Raquel Peyraube, former adviser on the legalization of cannabis in Uruguay, talks about the therapeutic benefits of the plant, little known due to its prohibition. Read the original article in Spanish on Forbes Mexico.
DW.- The medical doctor with specialization in drug abuse and the endocannabinoidsystem, Raquel Peyraube, was an advisor to the team that prepared the legalization of cannabis for all its uses, medical, industrial and adult use, in 2013, during the government of José Mujica. Uruguay and the different regulations that already exist in 33 EEA states have created a domino effect throughout the world.
The expert, who has focused her work on the clinical application and legalization advice, says that although countless countries are regulating therapeutic use, there are still deficiencies in the different regulatory models. These deficiencies become more apparent in their implementation as there are not enough certified sources of supply causing many patients to resort to the black market.
Peyraube is the director of Public Policy and Health of Plena Global, a company founded in 2017 with the goal of improving the quality and supply of cannabinoids for medical use worldwide. She went to Germany to participate in the biannual conference of the International Association for Medical Cannabis (IACM), one of the two most important scientific organizations, where she is a member of the Executive Committee. During her stay in Berlin, the expert participated in activities organized by the Friedrich Ebert Foundation, close to the German Social Democratic Party.
What is the current regulatory landscape?
Raquel Peyraube:The world is moving towards the legal regulation of cannabis,but doctors have not had the opportunity to be trained due to the prohibition that weighs on the plant. A serious academic mistake has been made by not including what has been discovered about our own physiological system, the endocannabinoid system, in the university curriculums around the world.
The cannabinoid medicines work in the human body because we also produce cannabinoids.The endocannabinoid system, which has been discovered for 30 years, regulates the entire balance of the human body, in health and disease. Patients are requesting treatments that promise to bring relief and less adverse effects than conventional treatments, something doctors don’t know how to apply. But there is great greed right now. This has been the conference where I have seen the most doctors participating.
What have been the most serious consequences of cannabis’ prohibitionist policy?
There have been negative consequences in all areas. Its impact on crime was to favor and empower it. But the worst effect has been for people who have no relief for their diseases. There are at least 10 axes of human health and disease where cannabinoids can provide a benefit.Consequentially, public health costs remain very high. Not only do we have a low level of effectiveness against numerous diseases with conventional treatments, but their effects are infinitely more serious than those of cannabinoids.
How is it possible that this has lasted so long?
The ban has violated approximately 30 human rights and to do so, it had to violate the right to access information. There were lies, a catastrophic and pseudoscientific bias to the information was made, and the existence of a physiological system was denied.It is not included in the university curriculum. If we recognize the existence of the endocannabinoid system, and that some diseases, based on what science is demonstrating, have to do with an absolute or relative failure of the endocannabinoid system, cannabinoids should be prescribed, but it is not done because they are prohibited.
Is that why we have not known about its benefits until now?
They have not had the recognition of academies or governments but, in reality, cannabis-based treatments existed long before any drug treatment.They had been in the pharmacopoeia since an immemorial time but, with the ban, they were removed from drug stores and pharmacies.And now it turns out that it is something new, but they were always there, until the 1930s. The effect has potential, I don’t like to generate false expectations, but they have a potential effect in many clinical conditions.
What kind of diseases have been most affected by the ban?
In chronic adult paincases, in epilepsy. 33% of epilepsies are refractory to treatments, and cannabinoids manage to have an effect on up to 80%, reducing the amount of seizures, and, in 10%, leaving them free of seizures. If we talk about the digestive system and nutrition,they have a very important potential impact in metabolic disorders such as hypercholesterolemia (high cholesterol in the blood) and in inflammatory bowel disease and irritable bowel. If we talk about the skin, some dermatitis, acne, psoriasis.
Another important chapter is rheumatic diseases,not only because of pain. Some cannabinoids are immunomodulators, they modulate the activity of the immune system and cause the level of response against the body itself to be attenuated, as in rheumatoid arthritis, which younger people suffer from. It is not a disease that affects only the joints, there are ways where there is cardiac and renal involvement, the same in the case of lupus and autoimmune thyroiditis.
And in cancer?
That is another important chapter. Cannabinoids can have three uses. One is used along with the chemotherapy to reduce nausea and vomiting, and has been recognized by the FDA (responsible for regulating medications in the United States).
The other is used for terminal stages, that is, palliative care, making the patient feel less discomfort and detachment from pain and distress. It is not different from what doctors do by administering morphine to the patient in terminal stages, so that he does not agonize in suffering. Cannabinoids promise this too.
The third effect, the most promising and interesting, is that, while cannabinoids are not as effective as chemotherapy,they have antitumor effects. They kill cancer cells and preserve healthy ones, unlike chemotherapy. It also reduces the nutrition of the tumor by decreasing the generation of vessels and, therefore, blood flow, and also the risk of metastasis because it does not allow cells to detach so easily.
Another anti-tumor mechanism is to make cells commit suicide. Because tumor cells do not have a life limit,they accumulate. Cannabinoids get into your metabolic system and inhibit the AKT enzyme,which causes cells to die. However, so far, we cannot say that these treatments are more effective than conventional chemotherapies, but they are adjuvant.
Can they be combined with conventional treatments?
Leading researchers have shown that, if cannabinoids are added from the onset of chemo and radiotherapy, the efficacy of conventional treatment is increased, which is big. But, in addition, there are many treatments, especially chemotherapy,that cause nerve damage. The peripheral neuropathy caused by chemotherapy,for example. We see it very often in women with breast cancer, in addition, if it is a product of proven quality, which is not adulterated or contaminated, they are potent analgesics and anti-inflammatories, and they can be used in the treatment of chronic diseases. They work, we often have very rewarding results.
In Germany, as in many countries, its legalization is discussed, what is the progress?
Germany has a severe problem with drug abuse, and it is important to separate the markets to prevent young people from going to the black market, because there is an overlapping of markets. You are going to buy marijuana and are offered other things. Germany legalized the medicinal use, but there are difficulties for accessibility, as in most countries. It is the only country in the world that has forced the subsidy of cannabis and cannabinoid-based medication to be covered by the public and private health system.
From the example of Uruguay and the United States there is a very important domino effect. There are already 33 states in the EU that have regulated medicinal use. In Latin America, they have done so, in addition to Uruguay, Chile, Peru, Colombia, and now theMexican Congressdiscusses a model with similarities to that of Uruguay, of complete regulation. Canada has also made full regulation. The Netherlands changed the law for medicinal use. Its Coffee Shops system is a counter that separates the user from the black market, but who provides the Coffee-Shop is an illegal producer. Italy is moving markedly towards legalization.
Will cannabis regulation become similar to that of alcohol and tobacco?
There is a gradient of nuances, of cannabis regulation possibilities ranging from models based on safety, public health and human rights,such as the one in Uruguay, to those based more on business, as in the United States. In this case, it is dominated by the industry.
What the tobacco and alcohol industryhas done has been of enormous responsibility for the development of these additions. Alcoholism and smoking are the two most important addictions. And it is because they have been licit drugs not regulated by public health. Experts warn against doing the same with cannabis.
There is research from the United Kingdom University by David Nutt and other academics that compared regulatory models based on 27 indicators. The best regulatory model according to that study is that of Uruguay, and the worst is that of Colorado,in the United States. Each regulatory model has its pros and cons. The Colombian model tries to include the peasantry in licit production, to get it out of the black market. But there are others that are at risk.
In the United States the industry does what it wants, there are promotions and happy hours of cannabis, there is no limit to the concentrations of the most toxic and addictive components. It is possible to do all the advertising, there is no regulation.
We are limiting the advertising of alcohol and tobacco and we are allowing cannabis to be an apology. That’s not good. Do not encourage consumption indiscriminately, because adolescents are being invited. We are telling you that your consumption is fun and festive. In Uruguay, it is not called recreational use, we talk about adult use,and there is a message, it is a substance for adults.