Tittle: Doctor’s orders
An interview with: Paola Cubillos, M.D., N.D.
Paola Cubillos is an experienced physician and medicinal cannabis advocate. Colombian by birth, she studied and worked in Toronto for several years before she returned to Medellín to further medical cannabis research at the Clinica Las Américas Hospital
CCI: Have you seen a change in the attitude of the country’s health authorities towards cannabis under the new government?
PC: The previous Minister of Health, Alejandro Gaviria, began the Colombian discussion about medicinal cannabis that went beyond the usual focus on numbers and the sustainability of the system. He is a strong advocate for decriminalization. The new minister has been less vocal about cannabis but I don’t think there will be any slowing of the medicinal cannabis industry in Colombia. However, there is clearly a cognitive dissonance between the government’s move to prosecute people carrying pot in their pockets while at the same time allowing corporations to benefit. The commercial push is taking priority at the moment.
CCI: How have medical professionals reacted to the growth of the industry?
PC: I think doctors are curious. Some of them have had experience using cannabis on their patients and are recommending it, without knowing exactly how it works and why. Its difficult to say what triggers a cannabis recommendation at the moment. Colombian pharmacies are interested in providing magistral formulas to begin with.
CCI: What progress has been made regarding the approval process for cannabis treatments in Colombia?
PC: I think both the government and the industry are learning from one another. The first point of entry in this market would be the magistral formulas, whereby pharmacies prepare a certain ratio of CBD vs. THC oil for each individual patient. That’s not an option for mass production and it has limited profitability. Asocolcanna successfully petitioned for cannabis to be included as a phytotherapeutic plant, which happened in December last year. This is a big change.
CCI: Does that mean that cannabis medicines must pass through the same stringent and lengthy approval systems that INVIMA applies to other medical drugs?
PC: The original intent of the legislation was for R&D to happen in Colombia. However, the fastest and easiest route to market is to use evidence from other approved medicinal cannabis products available internationally. We’ll see a lot of companies trying to replicate GW Pharmaceutical products in the form of sprays and sublingual oils and if they can prove the product is bioequivalent to GW’s medicines, in order to apply for a registration number from INVIMA and be able to sell. The other path is creating pharmaceutical compounds at different concentrations, but this will require going through phases 1, 2 and 3 of clinical trials, which is a very long pipeline.
CCI: Is the complexity of the healthcare system in Colombia an obstacle for medicinal cannabis?
PC: I think there is going to be a niche market for those who can afford cannabinoid-based medicines, I don’t think it’s going to be included in the basic benefits plan available in the public health system. This is going to work for people who have a higher purchasing power than the rest.
CCI: What should the government and private sector do to educate patients about cannabis?
PC: We need demand-driven legislation. The National Academy of Scientists report outlined a few cases in which evidence was strong: in chronic pain cases, pain and spasticity related to MSE, fibromyalgia, and nausea related to chemotherapy. So, there’s a lot of noise creating acceptance and enthusiasm for cannabis as medicine but the scientific rationale is not necessarily there. Because we are more relaxed with ethical rules, we may be willing to push boundaries that are usually kept between traditional pharma and physicians. So nothing to try to separate the real benefits from what’s not in commercial interest. You’re going to find a lot of doctors interested in the industry just to benefit from the financial boom, it should not be difficult for companies to attract medical knowledge and talent.