Getting High on Medical Treatment: Medical Use of Cannabis and Legal Approach - Healthcare Series 14

The use of medicinal cannabis dates to circa 2700 BC. It first appeared in traditional Chinese medicine and was used as a drug during surgery. However, the medical use of cannabis was mainly located in India. While medical cannabis was used in limited areas in other countries, in India, it was used as a treatment in many areas, such as anesthetics, antibiotics, tranquilizers, and as a painkiller.[1]

Although it became well-established over the centuries, by the beginning of the 20th century, it could be seen that the use of medicinal cannabis had decreased to a great extent. Due to the variability and instability of the plant, consistent results were difficult to achieve, which led to growing distrust and a decline in its use.[2] The emergence of medicinal drugs and the increase in legal restrictions are also major factors in the decrease in the demand for herbal methods. The production, sale, and use of cannabis are currently illegal and subject to certain sanctions in most places worldwide. There is, however, growing use of medicinal cannabis, especially in countries such as Belgium, Canada, Australia, the Netherlands, and some states within the United States.

The Medicinal Value of Cannabis

Medicinal cannabis refers to cannabis and its constituent cannabinoids used as a herbal remedy or therapy to treat diseases and/or their symptoms. While cannabis has a long history of medical use, at present, there is a lack of awareness among scientists, physicians, and patients about its medicinal value.

In 2017, a report from the National Academies of Sciences, Engineering, and Medicine assessed more than 10,000 scientific studies on the medical benefits and adverse effects of cannabis.[3] The report, “The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research”, found that cannabis or products containing cannabinoids are effective at treating some illnesses and symptoms such as the following:

• The cannabinoids in marijuana may reduce chronic pain in adults and may be helpful in treating conditions that cause chronic pain.
• There is moderate evidence that cannabis or cannabinoids are effective for improving short-term sleep outcomes in individuals with sleep disturbance.
• In addition, there is limited evidence that cannabis or cannabinoids are effective for increasing appetite and decreasing weight loss associated with HIV/AIDS and for improving symptoms of post-traumatic stress disorder (PTSD), Tourette syndrome, and anxiety.

In recent years, many countries have introduced specific laws and programs to allow patients to use cannabis in various forms to benefit in the treatment of diseases. Therefore, cannabis has been used to effectively relieve chronic pain, muscular cramps, and spasticity in patients, as well as for patients affected by neurogenic pain.

The Legal Background of Medical Cannabis in the USA and EU

In the United States, the use of cannabis for medical purposes — in many treatments, including pain, nausea, and any serious medical condition — is legal in 37 states and the District of Columbia; four out of five permanently inhabited US territories as of February 2022.[4] Although laws regarding medical marijuana in the states have created problems between the federation and the federal states, as the applicable law changes with each president, it is known that the use of medical cannabis is under the control of the state.

As for the United Nations' view on this issue, first, cannabis use is limited to scientific and medical purposes within the extent of international drug control agreements (UNODC, 2013)[5]. In the process of time, the perspective towards medical cannabis has changed, and some legalization studies have started. For instance, in 2018, the European Parliament adopted a draft resolution[6] tabled by the Committee on the Environment, Public Health, and Food Safety on the use of cannabis for medicinal purposes and encouraged the Member States to apply medical cannabis treatment to patients. In this treatment, medicinal use is supervised, and cannabis is prescribed by physicians.

Following the latest World Health Organisation statements against medical cannabis, the European Parliament voted on the amended Resolution[7] on the use of cannabis for medicinal purposes in February 2019. In this Resolution, the European Parliament “calls on the Member States to provide medical professionals with proper medical training and to encourage increased knowledge on medical cannabis based on independent and wide-ranging research.”

Looking back today, it is possible to see that some countries in the European Union standardly allow patients to access imported or domestically grown cannabis, while some countries only provide access to medical cannabis. A medicine based on cannabis extracts has been authorised in some European countries, and some European countries have specific legal processes governing the distribution and use of medical cannabis.

Medicinal Cannabis Use and Legal Limitations in Türkiye

Türkiye has a long history of growing industrial cannabis or hemp. Archaeological evidence shows that people living in Anatolia, have been growing cannabis at least since 700-800 B.C. and some believe that hemp may have been cultivated as far back as 1,500 B.C.[8]

Although cannabis had been produced intensively during the 1960s, following pressure from the U.S., Türkiye began strictly controlling the use and production of cannabis by imposing heavy penalties on those who grow, sell, and own the plant, which can lead to prison sentences of up to five years. At present, cannabis is highly illegal for recreational use but allowed for limited medical and scientific purposes in Türkiye.

In 2016, with the Ministry of Health's (“MoH”) approval of the sale of the drug, the use of limited medicinal cannabis — only in sublingual sprays such as Sativex — with a physician’s prescription has been allowed in Türkiye, while all other forms of cannabis and use of whole-plant cannabis remain prohibited.

As previously mentioned, the MoH has added Sativex, which can be obtained with a red prescription, to the list of importable drugs. Although it is not named directly, it can be understood that the ATC name “cannabinoids”, which was added to the list on 25 January 2016 in the list of drugs that can be brought from abroad dated 12 February 2016 on the Turkish Medicines and Medical Devices Agency (TITCK) website, refers to Sativex[9]; and even as of 8 July 2022, “cannabinoids” still remains in that list[10]. In order to obtain these drugs, patients must visit a physician who is authorized to issue red prescriptions. Physicians must evaluate the condition of a patient and decide whether medical cannabis is the best or only treatment.

The Turkish Government announced it had legalized controlled cannabis production in 19 provinces of Türkiye with the publication of the regulation on the cultivation and control of hemp in 2016.[11] In accordance with the new regulation, farmers are allowed to grow and produce hemp after obtaining a license, which will last for three years. Production is controlled by the Ministry of Food, Agriculture, and Livestock and is only used for medical and scientific purposes. Those wishing to grow these plants must prove they have never been involved in illegal drug production.

Conclusion

Cannabis has been used in various medical fields, such as painkillers and antibiotics, as well as in psychotherapy since ancient times. Although the use of cannabis has grown over the centuries, its risks and harmful effects have led governments to develop regulations to restrict its usage. As the knowledge of cannabis’s medical value is becoming increasingly common, lawmakers have taken action to regulate the medical use of cannabis in the treatment of illnesses and symptoms. Along with countries including Canada and the Netherlands, some US states have legalized cannabis for medical use. In 2016, Türkiye took a big step in the cultivation of cannabis, and the use of medicinal cannabis was approved. It should be borne in mind that cannabis is not completely bad, dangerous, and illegal, nor the cure or solution for all diseases. Therefore, a balance should be observed when regulating the medicinal or recreational use and restriction of cannabis.

With thanks to Ece Mert and Öykü Emecan for their assistance on this article.

The article has been updated on 21.07.2022.

[1] Before the Christian era https://www.scielo.br/j/rbp/a/ZcwCkpVxkDVRdybmBGGd5NN/?lang=en

[2] Decline and rediscovery https://www.scielo.br/j/rbp/a/ZcwCkpVxkDVRdybmBGGd5NN/?lang=en

[3] https://www.ncbi.nlm.nih.gov/books/NBK423845/

[4] https://www.ncsl.org/research/health/state-medical-marijuana-laws.aspx

[5] https://www.emcdda.europa.eu/system/files/publications/10171/20185584_TD0618186ENN_PDF.pdf

[6] https://www.europarl.europa.eu/meetdocs/2014_2019/plmrep/COMMITTEES/ENVI/RE/2018/06-28/1155079EN.pdf

[7] https://www.europarl.europa.eu/doceo/document/B-8-2019-0071_EN.html?redirect

[8] https://www.researchgate.net/publication/330118009_Suclu_Olarak_Bilinen_Bitki_Kenevir

[9]https://www.titck.gov.tr/storage/Archive/2019/dynamicModulesAttachment/Yurtdışı%20İlaç%20Listesi%20(11.11.2019%20Tarihinden%20İtibaren%20Geçerli%20Olan%20Liste).xls_a44166f1-1ca3-4c5f-8409-757572132db9.xls

[10]https://titck.gov.tr/storage/Archive/2022/dynamicModulesAttachment/YurtDlaListesi08.07.2022TarihindentibarenGeerliOlanListe_54e95ee9-1dc3-4ab0-bf8c-7c70446ec72a.xlsx

[11] https://www.resmigazete.gov.tr/eskiler/2016/09/20160929-3.htm