Spanish health authorities already allow medical use of cannabis extract Sativex, and recently released the good clinical results obtained with it so far. Consider the impact it can have regarding the therapeutic use of cannabis itself.

Health authorities have not authorized the medical use of joint by bronchial irritation produced by the smoke of her burning, not for lack of medical benefits such

I recently attended as a guest to a conference organized by the University of Cadiz in Algeciras on cannabinoids as new therapeutic tools. Orgado Dr. Antonio Martinez, who works at the Hospital of Alcorcón in its neuroprotective effects in cases of neonatal ischemic encephalopathy, I made the following comment: Now that studies are demonstrating the effectiveness of cannabis extract, not the one their isolated agonists, are out all the arguments against therapeutic joint and open the door to its legalization, is not it?. With positive results in clinical trials in chronic pain 65% of patients and considering that, in effect, Sativex is not nothing but "pure cannabis" might be questioned:

Sativex will facilitate the path to medical cannabis ...

There is reason to think, actually. Since long been known that consumption of this plant has, in certain circumstances, therapeutic efficacy. Health authorities have not authorized the medical use of joint by bronchial irritation produced by the smoke of her burning, not for lack of such medical benefits. We also know that is not a good route of administration the digestive effects being erratic and irregular because the active ingredients must pass through the liver, where they undergo metabolism determined, before reaching its site of action. Investigations since then have been directed towards the development of a cannabis extract that does not need nor the digestive tract or inhaled, and containing a certain amount of tetrahydrocannabinol (THC) and cannabidiol (CBD), the main cannabinoid responsible for therapeutic effects, the general consensus among scientists

Extract or tincture is any formulation type to facilitate the administration of a drug, usually plants. Do not think that the use of herbal extract is rare in Spain. Although there are neighboring countries with long experience in its use, such as Germany, the Spanish pharmaceutical legislation contemplates and here long, have been prescribing more. As an example we recall the famous plant extract capsules Pygeum africanum marketed by a laboratory known for the treatment of prostate hypertrophy (Pronitol ®), or even extracts intended for inhaled administration in colds, eucalyptus and mint (Sinus ®) .

With the cannabinoids are being tested multiple routes of administration alternatives to inhalation and digestive: suppositories, transdermal patches, injections, eye drops ... So far that has achieved higher levels of popularity has been a nebulizer absorption through the buccal mucosa, Sativex, developed by GW Pharmaceuticals. From a legal cultivation of cannabis produced a solution introduced into a spray to spray the inside of the mouth, similarly to those designed for bad breath. Health authorities, to support the extract as a drug, they have only demanded that its composition is constant and that the amount of THC and CBD are quantified, considering the other components of the herbal extract as excipients without effects on the body.

Authorize the use of Sativex is on the one hand, support the effectiveness of the plant as such and, second, to normalize from a pharmacological point of view the use of administrative and extract. One could similarly consider any kind of dye. There would be no grounds to deny a patient with the same clinical profile than those authorized to use the statement said, using the plant itself in any form, any extract manufactured by himself too.

... Or, conversely, kill him?

There are reasons for that may occur. For some time, as you reminded us Gaspar Fraga in a recent editorial Hemp, the path of the demand for recreational-leisure use of cannabis has kept pace with its use as medicine. The reasons are complex and, as our director felt, sometimes not at all beneficial. Among other things has made certain sector of the public and health professional could think that such a therapeutic claim was nothing more than an excuse for self-authorization of cannabis. While the fight for medical use has been sued by those who did it for recreational use, health authorities have given no answer.

It was not until recently that our politicians had no choice but to respond to such information: Agate Group of patients with breast cancer in Catalonia, knowledgeable about the medical benefits of consumption of the plant, filed a formal request for legal access . The response was the provision of these patients Cesamet tablets. Is a drug composed exclusively of nabilone, a cannabinoid agonist and, therefore, of assumptions same effects as THC. The Cesamet was not in our pharmacies, but could save the problem by using the rules on foreign drugs: if a drug does not have the backing of some powerful laboratory that can circulate in our country and a doctor deems it appropriate to use, health authorities should handle your overseas purchase and distribution to the patient. The response of patients, and scientific knowledge supports them, preferring the joint was therapeutic: it is better for its composition and its route of absorption. The demand continued.

With the apparition of Sativex, therapeutic joint demand could suffer another serious, perhaps fatal, setback. The advantages are obvious from the first point of view of accessibility: the patient wants to get rid of the symptoms (vomiting, pain) as soon as possible, wants to cross the street and buy the medicine at the corner drugstore. As with the joint, avoiding the dreaded first pass metabolism but also prevents bronchial irritation, maintaining the same therapeutic effect to contain the entire plant. Furthermore, any of the offers available now seem to me more complex, from the self-cultivation of the plant until its acquisition in the black market.

Clearly, the answer to a new therapeutic claim to the joint may be the facilitation of access to Sativex patients. In order to quell the demand for raw plant, as once did with nabilone, health authorities can now turn to two ways: in addition to that described in the Foreign medication from Canada, where it is marketed for multiple sclerosis and soon also for cancer pain, known as the Compassionate Use. Spain is one of the countries participating in clinical trials that are currently performed with Sativex for other indications (neurological pain, nausea and vomiting from chemotherapy, stimulating appetite) and the Clinical Trials Act provides that any doctor can prescribe a drug listed at the time still under study, before they end and outside thereof, acting under the Compassionate Use, as is being done in Catalonia. In addition, the powerful laboratory has bought the rights for distribution in Europe is precisely Spanish.

Epilogue

Once approved Sativex do you tip the scales only to him or also to other types of cannabis extract, manufactured by the same patient, too? If a physician requests access to the nebulizer to a patient and not get hit, what if it turns to self-cultivation and preparation of your own statement? And scientific arguments are not legal to prevent that. The future looks interesting, no doubt.

Dr. Ricardo Navarrete
Member of the IACM