This European Country’s Government is Funding Cannabis Education for Doctors
While a growing number of countries are adopting medical cannabis laws, it is rare to see governmental officials encouraging healthcare professionals to become educated about this plant medicine. In mid-September of 2016, cannabis experts from various parts of the world were invited to Macedonia to instruct local healthcare providers on the use of cannabis in clinical practice. The program was held in Skopje and was supported and funded by the Macedonian Ministry of Health.
Cannabis provides a unique opportunity in Macedonia, a historically poor country whose medical system is in a stage of evolution and modernization. Local medical specialists are now able to prescribe cannabis, but many are not familiar with some of the basics about the herb. Considering this, Macedonian cannabis advocates worked with local governments and created the medical cannabis training program in an effort to support doctors and their patients.
The momentum of the Macedonian medical cannabis movement is moving quickly, and advocates report that public opinion on cannabis has changed dramatically. Davor Angelovski is a member of the local organization Green Alternative who uses cannabis for chronic neuropathy in his legs. He explained that in his country, “Word spreads quickly. Any news, good or bad. But cannabis is good news, so the word spread faster.” He reported that because of Macedonia’s small size and the close communal ties, it has made his efforts to educate people about the herb that much easier. “Everyone has at least someone, a cousin or a relative, who has been affected by cannabis medicine” he explained.
Some of what sets the Macedonia situation apart is that the law was largely formed by the opinion of the grassroots movement. According to Filip Dostovski, an organizer for the Macedonian educational symposium and founder of Green Alternative, cannabis advocates helped create the law with the Macedonian government. Once the law was passed in May of this year, cannabis advocates have been heavily involved in the emerging medical cannabis program. Green Alternative is a Skopje based educational non-profit who provides information on cannabis medicine and teaches people how to make their own herbal preparations.
Dostovski has guided many people on making their own cannabis oil. He also gives cannabis medications to patients for free. Dostovski has beat Hodgkin lymphoma twice. The first time was when he was 15 years old. He used chemotherapy with cannabis on the side to alleviate the symptoms from his traditional treatment. When the cancer came back a second time in his early 30’s, he treated it with cannabis oil only. He is currently cancer free.
Macedonia’s rich history with the cannabis plant could allow for further discovery of unique landrace strains. In the past, hemp was widely used for clothing and other textiles. As an example, Dostoveski came across a special landrace growing wild in the north of the country. He was very familiar with the cannabis plant, but this particular variety had a different appearance. The plant piqued his interested, but when he tried it, it didn’t get him high like he expected. His curiosity remained, so he sent a sample off to a lab in Israel to get tested. It came back at a 3.4% CBD, 0.02% THC. According to Dostovski, the plant is a Macedonian landrace that is “not hemp”. He didn’t keep his discovery a secret. He told people where the plant was growing so that they could harvest some of their own. There may very well be other local genetics in Macedonia worthy of further investigation.
The Symposium on the Legalization of Cannabis for Medical Purposes in Macedonia boasted some of the world’s leading cannabis researchers in the field. Invited experts gave an overall training to some 450 attendees on the basics of cannabis medicine in clinical practice. Željko Perdija, a Pulmonologist and Gastroenterologist from Slovenia, discussed dosing, the benefits of CBD, and the necessity to liberate cannabis from its stigma in the medical field. Dr. Perdija spoke to the audience about his initial reservations as a physician of using the plant, but how his apprehensions lifted through direct experience. Ethan Russo, MD, is the senior advisor at PHYTECS who discussed the endocannabinoid system, cannabis compounds, the history of the plant as medicine, as well as the importance of landrace genetics. Russo, whose grandparents were born in Macedonia, emphasized the correct applications for cannabis treatments as well as the possible adverse interactions with other medications.
Canadian researcher Dr. Paul Hornby specializes in human pathology and gave extensive overview on pharmacology and case reports from his work in Vancouver, BC. He explained that high quality and affordable cannabis products should be available to all those in need. Other researchers included Jack McCue, MD, a family practitioner who shared his clinical experience with a special emphasis on cancer. Dr. McCue divulged that patients can use cannabis as a complementary treatment to chemotherapy, and it may be utilized on its own with sometimes promising results. Currently in Macedonia, cannabis patients cannot choose to forgo the use of chemotherapy for cancer. They can only use cannabis in conjunction with traditional therapies.
Spanish researcher José Carlos Buoso, Clinical Psychologist and Pharmacologist, educated the Macedonians on the complexities of the endocannabinoid system and the use cannabis for mental health issues. He explained that cannabis therapeutics can directly affect many situations for which modern medicine has no adequate solution. Dr. Javier Pedraza (a Spanish family practice physician living in Portugal) provided dosing information and guidelines on the various forms of cannabinoid preparations. The invited presenters at the medical cannabis symposium challenged the ideas of current Macedonian law about dosing and the the indications that cannabis therapeutics can be used for.
Local advocates hope that in the future there will be a broadening of indications for which cannabis can be used, as well as creating access points to enable patients to obtain their medicine. There are only four accepted medical conditions in Macedonian law: HIV, childhood epilepsy, cancer, and MS. Only public doctors are able to prescribe cannabis to patients with these specific conditions. Davor Angelovski shared that “patients will have to continue to treat themselves illegally. They would like to be part of the system, but they can’t because their indication is not one of the four listed. We hear from doctors and researchers about a lot of good results with other conditions, but this is something that we have to work on in the future to make it more accessible.” Presently, there aren’t dispensaries or social clubs for cannabis patients. The only way to obtain their medicine is in the pharmacy, where current product options are limited.
Macedonian doctors are allowed to give patients dosing guidelines, but local advocates claim that the dosage recommendations are relatively low. Invited experts to the medical cannabis symposium gave first-hand experience of using higher doses of cannabinoid therapies in their clinical practice. Expert presenters also demonstrated that a wider variety of conditions could benefit from using cannabis than the four legally allowed illnesses in Macedonian law. Some that were discussed were PTSD, autism, and chronic pain. Macedonian advocates remain hopeful that the law will adapt and improve to better accommodate patient’s needs. According to Angelovski, “It will be very obvious very soon that some things have to be changed. We will see what develops.”
The mix of strong community support as well as the backing of educational training programs by governmental entities gives Macedonia advantages that many other countries do not have. Macedonian law allows for human clinical trials to be conducted within the country. There is no limit on THC content for cannabis products, which is different from other Slavic countries who have a medical law on the books. Macedonian law allows for the importation of dry material, extracts, and other products. Despite this, the law prohibits patient-to-patient transfer of cannabis, as well as self-cultivation. Patients must get a prescription from their doctor to obtain cannabis through a pharmacy. Current legislation recognizes indoor and greenhouse cultivation, but outdoor growing is not considered suitable for medical use.
There are two types of cannabis extracts allowed by Macedonian law. People can visit a pharmacy to get CBD dominant products. There is no limit to the CBD content of these preparations, but the product must stay below 0.02% THC. These items are considered a food supplement. Cannabis products containing above 0.02% THC content are available only by prescription to those who have received permission from their doctor. Cannabis product makers must register with the Macedonian Ministry of Health as private companies. At the time of this writing, there is one cannabis company manufacturing products and one registered producer creating cannabis medicine in Macedonia. Companies must be affiliated and test with a cannabis testing lab. This currently provides a challenge as there are no operating public laboratories that provide cannabinoid content analysis.
While there are some constraints on the current Macedonian cannabis law, the government’s desire to educate their medical professionals to better service patient’s needs is exceptional. The Macedonian example is further proof that once cannabis laws are passed, constant changes must be made to support the evolving needs and interest of the community. As more countries prosper from the use of cannabis medicine, we may unlock more investigation on unique cannabis strains and a deeper understanding on the clinical applications of this plant.
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