An October 11 resolution by the Federal Council of Medicine (CFM), the agency with which Brazilian providers must remain in good standing or risk their license being revoked, limited CBD prescriptions to only a small handful of medical conditions and banned THC for all conditions—including cancer, Alzheimer’s, chronic pain or multiple sclerosis. Doctors were also banned from lecturing on the subject in academic settings.

“Patients who won the right to receive medication from the state, through the courts, [feared] having these legal decisions suspended,” Monique Prado, a parliamentary assistant in drug policy at the Legislative Assembly of Rio de Janeiro, told Filter. “And that their clinical situation would worsen.”

Harm reductionists, activists, legislators and providers had been bracing for such a development. The public backlash was immediate—and powerful. As a result, a second period of public comment (following an initial one in July) is now open, and will remain so through December 23.

“The [CFM resolution] was political,” Renato Filev, a neuroscientist and researcher at the Brazilian Centre for Information on Psychotropic Drugs of the Federal University of São Paulo, told Filter. “Civil society, the people who need cannabinoids for therapeutic purposes—and also the doctors who prescribe the cannabinoids—had to mobilize.”

CFM defended treating COVID with hydroxychloroquine, but was not so concerned with provider autonomy when it came to cannabis.

Medical cannabis access in Brazil has gained ground in recent years. In June 2021, cultivation and commerce were approved for licensed sellers. A patchwork of individual legal victories had allowed for some patients to receive prescriptions and begin using treatment. In June 2022, three patients won authorization to grow cannabis at home.

The resolution threw that legality into chaos.

Though CFM had allowed cannabis to be prescribed, ideologically it was known to be inclined toward prohibition. But the timing of this resolution was a surprise for many.

Alexandre Liblik, doctor and professor of medicine at Pontifical Catholic University of Paraná, told Filter that the current iteration of CFM comprises “acolytes subservient to far-right Jair Bolsonaro [who] seemed to choose precisely the pre-election period to publish this resolution.”

During the height of the pandemic, CFM had supported providers who pushed for treating COVID with the unproven hydroxychloroquine. Yet they weren’t similarly concerned with medical autonomy when it came to the prescription of cannabis, despite its myriad proven medical applications. No medical cannabis research more recent than 2015 was cited in CFM’s scientific review.

“People opposed to regulating the medicinal use of the plant [claim] it can boost illegal sales promoted by ‘drug trafficking,’ which is still very much associated with the Black population,” Prado said. “A prejudiced and racist view [supported by] prohibitionist ideology.”

Even under the current rules, medical cannabis is overwhelmingly inaccessible, in terms of cost as well as availability of supply. Many like Prado believe the way forward is to regulate domestic cultivation, and to cover cannabis treatments under Brazil’s universal public health care system (SUS).

With President Bolsonaro narrowly defeated by President-elect Luiz Inácio “Lula” da Silva of the left-wing Worker’s Party, CFM may not enjoy the same unreserved support as it did under the previous administration.

“A president who is less conservative, and more inclined to implement policies directed at the poorest population, will be fundamental to advancing full regulation and provision by the SUS,” Prado said.

Photograph via Wikimedia Commons/Creative Commons 3.0

Interviews have been translated from Portuguese

The post Public Outcry Forces Brazil to Pause Drastic Medical Cannabis Restrictions appeared first on Filter.

To give Brazilians a more complete, accurate picture of marijuana use, clinical therapists Maria de Lourdes Zemel and Luciana Saddi compiled the newly published anthology Maconha: Os Diversos Aspectos, da História ao Uso (Marijuana: The Diverse Aspects, From History to Use). The collection of articles spans topics including history, addiction, legalization battles and spiritual and ritualistic functions. It also debunks the false claim that marijuana is a gateway to other drugs.

“There is the idea that you can have a world without drugs, with everyone clean, pure. And this generates violence.” 

The writers aim to provide the public with a more accurate characterization of marijuana use than how it’s portrayed in the media. “Everything comes through the media,” Zemel said. “And [that’s always] fantasy, horror, promoting the War on Drugs.” 

I spoke with Zemel and Saddi about the injustices facing people who use marijuana in Brazil, including forced hospitalization, religious internment centers and indiscriminate criminal penalties. Our interview has been translated from Portuguese, and edited for length and clarity.

Raphael Tsavkko Garcia: How is marijuana decriminalization, legalization and medical use viewed in Brazil?

Maria de Lourdes Zemel: What is publicized here is that marijuana is the “gateway to all drugs.” This is of political interest, because there is a movement to hospitalize or arrest young marijuana users, to terrorize them by saying that they are small-time dealers and that they would lead other young people to use other “harder” drugs. So, this is something that we try to demystify—showing marijuana is a psychoactive drug, but it is not a gateway. 

There are many groups interested in keeping things as they are. It is difficult to discuss the liberation even of medical marijuana; there is considerable resistance. There are political movements of medical associations against the prescription of medical cannabis.

Luciana Saddi: Not only doctors, but also evangelical leaders. Conservatives in general.

Zemel: It is difficult to think about the decriminalization of marijuana. First, we have to think about debating the legalization of medical cannabis—which we are achieving now—within the medical associations, to be able to discuss this with some freedom. Then we can discuss in the legal areas the question of recreational marijuana and the possibility of alternative sentences to not imprison so many young Black and Brown people for marijuana use.

Saddi: People don’t recognize that alcohol is also a drug. People don’t understand that [other] primates also use drugs. All higher primates look for drugs in the forest and get intoxicated. Also, there is no culture without drugs. All cultures have a use, ritualistic [or otherwise], for drugs.

There is [an abstinence-based] view about drugs, that if we take away drugs the world will be clean and perfect. There is the idea that you can have a world without alcohol, without marijuana, without drugs, with everyone clean, pure. And this generates violence. 

What have the consequences of the drug war been in Brazil?

Zemel: Our jails are full of young Black and Brown people caught with small amounts of marijuana. There are no light penalties for the use. Each and every person [charged with] possession of any amount can be accused of trafficking.

Saddi: The incarceration of this population doubled in the past few years; the largest incarcerated population in Brazil is of users and [lower-level sellers]. Sixty-two percent of the female prison population is involved with drug [charges], and youth are more than 50 percent of those incarcerated because of drugs. This policy of criminalization of drugs is also a policy of mass incarceration.

What has the current government done to decriminalize marijuana?

Zemel: Absolutely nothing. There were many difficulties in discussing marijuana in previous governments, but there used to be the National Secretariat for Drug Policy (SENAD) under the umbrella of the Ministry of Justice. Today it has been emptied. Everything was dismantled. 

The majority of the councilors, the people who make the municipal drug policy, are religious and know nothing about drugs. And there’s no possibility to work along with the federal government, in any sphere [to change current policies].

Saddi: We don’t see in the near future the decriminalization of marijuana [or] a serious debate about drugs. Brazil is not a country that does prevention on anything—eating disorders, drug use, etc. We don’t even have a prevention program for high blood pressure. The governor of Colorado was against legalizing marijuana in his state, but then he [realized] that crime in the state had gone down since legalization. And he was sorry that he didn’t do it sooner, that he was prejudiced, and he didn’t know that it would be so good for Colorado.

Zemel: The process in Brazil is long and complicated. It is a huge country and initiatives need to start locally. With the current government, it is impossible.

How does the current administration differ from previous ones?

Zemel: One of the things we know now that doesn’t work as the treatment is forced hospitalization. There [had been] a strengthening of Psychosocial Care Centers for Alcohol and Drugs (CAPS-AD). In these centers people get humane treatment for drug dependency. Now [with far-right president Jair Bolsonaro], all government money was taken from the CAPS and given to Therapeutic Communities—religious internment centers with a minimum internment of nine months, because apparently that’s how long it takes to be born.

Saddi: You will be reborn, be baptized and be born again for God. 

Zemel: It is brainwashing. All the money, and it’s a lot of money, put into these Therapeutic Communities, no matter how much we show that it doesn’t work. The SENAD, [which allocates] money confiscated from drug trafficking to fund harm reduction services and to finance the CAPS, all the movement that we made in taking money from drug trafficking to use in prevention and treatment, all this money went to the Therapeutic Communities.

Saddi: The problem is indiscriminate mass hospitalization. You don’t offer a treatment that one patient needs, but the same treatment for all people, even for those who are not sick and use recreationally.

Zemel: And families come to believe it. Any drug can be used in a recreational and [unproblematic] way. But the person will use it inappropriately according to the moment that he has an encounter with this drug, and it serves to fill an internal void. Our focus in the book is not on the drug, but that people are able to make the choice to put the drug in or take it out of their lives according to their wishes. It is not up to the therapist to define this.

Photograph via Flickr/Creative Commons 2.0

The post Marijuana Injustice and Forced Hospitalization in Bolsonaro’s Brazil appeared first on Filter.

It’s difficult to buy medical marijuana in Brazil, and difficult to maintain the course of treatment—the oil is very expensive. Carvana says she used to pay the equivalent of nearly $400 per month.

“The prejudice against THC is being fostered by the pharmaceutical industry … and this is for purely financial reasons.”

Carvana managed to pay for the treatment for almost a year, suffering from the devaluation of the Brazilian currency to import it. In March 2020 she went to court to force her health insurer to cover the cost. In May, she won. Today, her health care plan covers both types of extract that Theo uses: isolated cannabidiol and full-spectrum.

“In the middle of the pandemic, it was a great relief,” Carvana said. “I was able to pay all this time but it was very expensive … I work in the cultural sector and, in the last two years we have lost a lot of standard of living, economic crisis in Rio de Janeiro is very strong. If on the one hand I had this privilege of paying for my son’s medicine, it also cost me a lot in the sense that I have many debts.”

One of the biggest difficulties in the fight for the complete legalization of medicinal cannabis is the prejudice that exists against THC. “The industry, the market, gains much more from CBD oil than from full-spectrum cannabis oil, which can have high-, medium- or low-THC dosage,” Carvana said. “The full-spectrum oil will almost always act better because of the ‘entourage effect,’ and requires smaller doses. So, we see clearly that the prejudice against THC is being fostered by the pharmaceutical industry … and this is for purely financial reasons.”

The much-desired “entourage effect”—whereby the many chemical components of a drug produce better results than any would alone—can only be obtained with full-spectrum cannabis, which is not yet found in pharmacies.

A Movement Toward Decriminalization

Brazil is moving toward the decriminalization of cannabis, but slowly and often against the efforts of authorities. President Jair Bolsonaro’s far-right, anti-science government and the strong presence of fundamentalist religions have made for a difficult path toward full legalization. “In the past, they said that there was no medicinal cannabis, that it had no effect. Now they say that indeed it has effect, but only the CBD isolate, which would be the substance of God while THC is the substance of the devil,” Carvana said.

And yet there have been some victories.

The fight for marijuana decriminalization in Brazil gained ground in 2011, the year the police violently repressed the annual Marijuana March in Rio de Janeiro. “[That] gave rise to a debate that reached the [Supreme Court], which then legalized the marches throughout the country that have been organized by the DAR collective [Desentorpendo a Razão, or Disentangling Reason],” Henrique Carneiro, professor of history at the University of São Paulo, told Filter. 

One year ago, the regulation of cannabis products in Brazil was approved by the ANVISA, the country’s health regulatory agency. Carneiro described the move as “a minimal concession”—a license to import a product that costs the equivalent of $375 per month.

The decision allowed companies like Prati-Nonaduzzi and Beaufor Ipsen to sell medicinal cannabis products in pharmacies to people with a prescription, subject to inspection by ANVISA. The cultivation of marijuana in Brazilian territory, however, was rejected—raising serious questions about production and import logistics. The first THC-containing medicine was released for sale in April 2020. 

“ANVISA’s decision makes it easier to access cannabis-based treatment for several conditions that can benefit from its use,” Dr. Pietro Vanni, psychiatrist at the Gravital Clinic in Rio de Janeiro, told Filter. “In the past, the patient had to import it asking for ANVISA’s authorization and he had to go to court. Only really very serious conditions could get access [to medical marijuana]. With the decision we can more easily treat a wide range of patients. This is reflected in a better treatment for the patient, a better quality of life. It is crucial that we have the medicinal cannabis legalized since it is something that has scientific proof of the benefits.”

According to Vanni, there are three ways to legally obtain medicinal cannabis in Brazil. The first is to buy from the pharmacy, where options are limited to two medications. One of them, Canabidiol Prati-Donaduzzi, is a very expensive cannabidiol/CBD isolate; the other, Mevatyl, has a 1:1 CBD to THC ratio.

The second way is to import the drugs—more affordable, but also more time-consuming because it involves securing ANVISA’s approval. Before ANVISA’s decision to regulate the import of cannabis, it took 90 days for the organization to decide on permissions on a case-by-case basis and at least one more month to import it. Today, authorization is much quicker—approximately two weeks.

The third way to access medical cannabis is through associations formed by users seeking to produce the medicine, which offer little in the way of variety. “It is not a question of lower quality, but it does not have all the certifications, analyses and there is a certain inconsistency in the doses,” Vanni said. There are only two legal associations in Brazil, and one of them, APEPI, had its court injunction revoked in November 2020. Today, only ABRACE can supply medical marijuana to its members. The only ways to access full-spectrum cannabis—the kind that produces the entourage effect—are importation or through associations.

The terribly high prices for the product in a country whose minimum wage is the equivalent of around $200 a month make it difficult for most to access to it, meaning that people have to still resort to illegal means—such as growing the plant themselves. In 2017, one in three Brazilians incarcerated had been charged with drug trafficking. In 2019, the number of Brazilians in jail on such charges totaled 163,000. And most of those incarcerated, whether for drug trafficking or other charges, are poor and Black.

The high prices for the product make it difficult for most to access to it, meaning that people have to still resort to illegal means

Access to medical cannabis in Brazil is therefore fraught. It’s out of reach for many who can’t afford it, or who don’t live near an association that produces it. One solution would seem to lie in individuals seeking court permission for planting and home production of their own medicine.

Barbara Gael is a translator based in São Paulo who researches medicinal cannabis and uses a cannabis oil-based treatment—high-CBD and low-THC—for her depression and anxiety. “The anxiety still exists but is much smoother,” Gael told Filter. “And the depression is gone, as are the suicidal ideas.”

Gael says it’s possible today for Brazilians to find physicians who specialize in medical marijuana, but that reliable information on treatment methods remains scarce. “People often think that CBD is good, but THC is evil,” Gael said. “The cost of treatment can be very high. Not everyone can pay for the consultation and for the oils. For those who need high doses the solution is to ask [for] habeas corpus to plant at home and make their own medicine. It is essential that cannabis treatment be quickly included in the SUS [Brazil’s public health system], so that low-income families can also benefit from it.”

Photograph by US Fish and Wildlife Service via Wikimedia Commons/Public Domain

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