Source: Bushka.cz

June14, 2012

During a moderated discussion with representatives of political parties of May 5 at the Million Marihuana March 2012 in Prague, I proposed a way to introduce in the Czech Republic cannabis self-medication as an additional alternative to the government proposal of pharmaceutization of cannabis. I consider the current situation, where sick people use cannabis for treatment of their diseases in fear of the police and courts, to be incompatible with the rule of law.

It would therefore seem that the current government bill to make cannabis available on prescription, meets the needs of society and improve the lives of citizens of the CR. Unfortunately, it seems that the opposite is true, and that this effort of our legislators instead of relief would bring only bitter fruits of disappointment. Promoters of the Bill falsely claim to the public that the monthly cost of treatment will be CZK 700-1500. In fact, such treatment will cost more than ten times as much, and it will not be covered by health insurance. The vast majority of those who would need it do not have the money to afford it. The government anti-drug coordinator through the media now threatens sick people, that when this law comes into force, all who will continue to grow cannabis for their own treatment will be considered as drug addicts by the police and courts. I propose to ease the situation of these sick people in such a way, that they would be allowed to grow a limited number of cannabis plants. Registration in a national registry would allow them impunity to grow cannabis for their own treatment in the range of existing decriminalization i.e. 5 female plants.

Tens of thousands of innocent criminals

Today it is clear that across the political spectrum has been obtained consent to use cannabis for medicinal purposes, so we need to find practical solutions to implement it. Currently in the CR there are tens of thousands of sick people treated successfully with cannabis, which they grow themselves. These citizens are not committing any crime because they do not abuse cannabis, but they rather use it in order to keep their health in the best condition. There are mostly elderly and chronically ill patients with autoimmune and neurodegenerative diseases, who are often among the poor, because their earning potential is limited by poor health. Their situation must be regularized because it is not possible that in a non-totalitarian democratic country lived in fear of the police tens of thousands of innocent people. While these people do not do anything wrong, but only care about their health, and yet they are criminalized for it. This situation is unique in the world, because nowhere in the world cannabis cultivation for the treatment of patients and indeed even for recreational purposes has been so common. Therefore it is necessary to take into account the situation and adjust appropriately the Czech legislation. The proposed program providing cannabis to patients via pharmacies should be approved in such a way that it would not have a monopoly, and especially would not be then exploited to even greater persecution of people who grow cannabis for their own treatment. In parallel, it is therefore necessary to depenalize (grant impunity) limited cultivation for self-medication, for example, following my proposal of registered self-medication.

No penalty for cultivation and possession of cannabis for self-medication

Due to the great shortage of doctors with knowledge of the treatment of cannabis it is suggested that cannabis self-medication would not be primarily subjected to medical opinions. Those interested in self-medication should be enrolled in the register kept by the Ministry of Health for example. Such registration would guarantee them that if someone denounces to the police their cannabis cultivation (as often happens), the police would not be obliged to confiscate cannabis, as it is today, but would wait for the outcome of medical examinations at any of the doctors accredited with the pharmaceutization program. This physician with knowledge of medicinal cannabis use would determine whether the self-medicated patient in question really suffers from an illness that cannabis helps. In the case of a positive statement the police would no more bother the patient. Sick people have no reason to hide, if they could be sure that the police does not cut and take away their medicine that can be grown in outdoor conditions only once a year. In order to facilitate the incorporation of my proposal to the current legislation it was proposed to reduce the number of plants to 5 (defined as 5 female flowering plants, excluding plants and immature males).

Registration of patients should be for a reasonable annual fee (i.e. 500-1000 CZK), which would cover the cost of keeping a register. If the fee were CZK 1000, it should provide once a year the self-medicated patients with a chemical analysis of active substances in their cannabis in order to know what material is used for their treatment. In the case of lower rates for registration, the patient should be entitled to a similar analysis at a reasonable price (up to 500 CZK), secured by the new state agency for cannabis. Registered patients will agree to provide the operator of the registry every 6 months with their data for an administration report about their health including the analysis of used cannabis. Registered patients should have the right to associate in cannabis clubs where they could together grow and process cannabis for their treatment. For patients with impaired motor skills and overall too physically weak and unable to grow their own cannabis, would grow and process cannabis other patients who are better off. Within such clubs would then be prepared ointments, oils, tinctures and extracts for their members, and would provide education on cannabis self-medication equally for them and a wider public. Through these clubs should be carried out regular collection of data on therapeutic effects of cannabis backed by analyses of used material that would certainly be very well useful to the state program of cannabis in pharmacies. The clubs of cannabis patients in addition to improving the quality of life of their own members would benefit as well as to general knowledge about the effects of cannabis treatment – their functions would be beneficial to society.

Price of the cannabis treatment

Promoters of the Bill, that would make legal cannabis on medical prescription and dispensed in pharmacies falsely claim in public that monthly treatment will cost CZK 700-1500. It is well known and generally accepted that the average dose in cannabis treatment is of 1-5 g / day, so the price of treatment as declared by the promoters would correspond to 20 CZK / gram. A document of the expert group that prepared the proposal, states directly: “For the Czech Republic, the price per gram of therapeutic cannabis would be higher than 80 to 130 CZK per gram and less than 200 CZK per gram.”

And what to say on the availability of imported medicinal cannabis products as the oral spray Sativex, for which the purchase price at the manufacturer is 8000-16000 CZK for one month of treatment (250 pounds per 20 ml – recommended price of manufacturer) – how many patients with multiple sclerosis will be able to pay such amount for the treatment without reimbursement by insurance company? (Average old age pension in the CR is 10000 CZK / month and less than 6000 CZK for invalids.)

The actual price of the cannabis available for treatment in the Czech Republic would therefore be of the order of ten times higher. Given that the Deputy Minister of Health Martin Plisek said that the cannabis in pharmacies will NOT be reimbursed by health insurance, it is apparent that such treatment will not reach the vast majority of the population, especially the elderly, who are now using cannabis for self-medication practically for free.

If cannabis is grown outdoors or in greenhouses, costs are negligible, all you need is just a sunny place, good soil and as fertilizers you can use chicken crap or horse manure that are for free in the country. For many diseases help weaker strains, originally selected from hemp birdseed, which seeds are also given for free. How does the state justify to the sick people who are successfully treating themselves with self-grown cannabis, that they must stop growing it and instead buy their medicine for the price of black market? After all, even the meanest drug dealer would not proceed like that!

The government’s proposal Cannabis to pharmacies

Parliamentary document No. 590/0 with the proposal of cannabis pharmaceutization, which will be presented at the beginning of June in the 1st reading in the Parliament, lists options 1 and 2 and in both variants the medicinal cannabis will be imported at least during the first two years, so that patients will pay world market prices. On the Lower House website is a PDF document to download of the Working Group: “Cultivation of medicinal cannabis – an analysis of international experience in regulatory and economic terms.” The document states directly the planned price of domestic production of cannabis, which would be slightly below world prices. The House will vote on two versions of the proposal, the first counted with the importation of cannabis for treatment, while under the second proposal, the first two years of imported and then grown in the country. World prices of cannabis (200-250 CZK / gram) are listed in a table in the document and they are even higher than those proposed by the working group for the domestic production (80-130 CZK to 200 CZK per gram). Directly it is stated that the price of foreign models of indoor medicinal cannabis ranged between retail and wholesale price of cannabis on the black market.

It is therefore evident that the promoters of cannabis pharmaceutization Bill were either grossly mistaken or simply lying in their estimate of the montly price for cannabis treatment because in the world markets you can’t buy a gram of medicinal cannabis for twenty Czech crowns (the value of 20 CZK is approx. 1 US dollar or 0,8 euro), but you will more probably purchase it for the price of marihuana black market.

Promoters of the Bill brandish the Israeli model, but there is cannabis grown by voluntary organizations, non profit companies. The cannabis treatment there was until recently for free and now with the large number of patients (over 7500) it is paid for, but costs less than a tenth of subsistence minimum. In addition, the Bill allows the government to limit the prescription of cannabis for a few thousand patients, while at present in the CR have been tens of thousands of sick people, who are successfully using cannabis for self-medication.

This whole project on cannabis in pharmacies seems to me to be just another private “tunnel”, it will bring nothing good to the sick people, but the change of legislation will allow for opening of private cannabis clinics for VIP patients by certain politicians. There is only one way to add credibility to the project – allow parallel system of registered self-medication with depenalized limited cultivation. My proposal also complies with international agreements, the signatory states are requested to modify their legislation so that cannabis would not be freely available, but with some restrictions. In my proposal this condition has been met by the requirement to register for self-medication.

Cannabis treatment without a prescription

Doctors who have knowledge and experience in the treatment of cannabis in this country is less than the fingers on one hand. How will the district or even specialized doctors want to prescribe cannabis? Based on what? For the treatment of cannabis people react very individually and there are different strains of cannabis, you have to be aware of their specific medicinal effects. Many patients treat themselves with cannabis for many years and they know about the treatment by cannabis more than all Czech physicians altogether. Some of them have been for many years cultivating the varieties of cannabis that help them, and if they would buy cannabis at the pharmacy, it would not necessarily help them, because it might have a different composition than their own plants. Under these circumstances, cannabis by prescription only is an absurd and harmful concept for patients. The blind leading the one-eyed!

A large proportion of patients who are currently treated with cannabis, inform their doctors. And the rest would also do it if they would not need to be afraid that the doctor denounces them to the police or considers them as addicts. If such self-medication becomes legal, the vast majority of patients will be under medical supervision and our doctors will get a unique opportunity to draw on the knowledge and experience of patients and broaden their horizons.

Registration would give patients the opportunity to have their cannabis annually analyzed at a reasonable price, so they would know exactly what heals them. The register could be used to collect data on the medicinal cannabis used by patients and on its effects in the treatment of large number of patients, which would be a gift from heaven for the official research on therapeutic effects of cannabis.
The risk of abuse of self-medication

Recreational cannabis users today may grow up to 5 plants with little risk, and when the police harvest their plants, they can get it from friends or on the black market. Therefore, why should they register themselves, as my proposal assumes, and unnecessarily attract attention of the police? And if it is established that a registered patients sell their cannabis, they would lose the right to register and renew the registration annually.

This system of self-medication has got one big advantage – there is no big money in it, which would be worth of stealing!

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