Debate flares over smoking medicinal cannabis

The prohibition on smoking medicinal cannabis in Barbados is sparking mixed reactions among patients and doctors, according to Chief Executive Officer of the Barbados Medicinal Cannabis Licensing Authority (BMLA), Shanika Roberts-Odle. 

At present, medicinal cannabis is mostly administered topically through dermal sprays, gels and creams. 

Appearing on a recent radio programme, Roberts-Odle, highlighted the divergent opinions on this policy, its implications and alternatives.

Her comments come amid an ongoing national dialogue around appropriate medicinal cannabis policies. Since legalising medicinal cannabis in November 2019, authorities have taken a cautious approach, prohibiting smoking as a method of administration, while focusing on the growth of an export industry.

“There are significant amounts of persons who I have met who have indicated that for them, there’s a certain level of hypocrisy involved in that particular position,” Roberts-Odle told the programme.

“Doctors that I’ve spoken with have said smoking anything, in their position, is not recommended. Others have said if there is someone for whom that is their preferred method of use, then, as long as they know that their patient is getting what they need and the patient is aware of the risk that they’re taking, they are fine with that.”

This regulatory stance has drawn criticism from some patients who prefer the rapid onset provided by smoking over other delivery methods like topical applications or oral consumption. 

Some medical experts have voiced concerns about the potential health risks of inhaling cannabis smoke. Critics counter that smoking for palliative care provides relief that far exceeds risk to a terminally ill patient. They argue that a paternalistic approach undercuts patient autonomy and the medical benefits that smoking can provide for certain conditions.

Despite the current prohibition, Roberts-Odle noted that many patients, particularly those in palliative care, prefer smoking as a method of administration, sharing that they are “disappointed that they’re not allowed that avenue at this point in time”.

Anaesthesiologist Dr Adrian Waterman acknowledged the appeal of smoking cannabis due to its quick onset of action, crucial for those seeking immediate relief. But he raised concerns about potential lung damage from tar and other particulates in smoke.

“I can understand why some patients will like that route of administration because, especially in the past, it was a much easier route because the plant, basically the raw product, was [involved]…. People would say that it was a faster route of administration and they liked that,” he said.

“Today, with therapeutic development, they have found ways to administer the chemicals in cannabis, whereby we don’t have to use the inhalation route as much to get a faster onset of action.

“Doctors will tell you, especially in the pulmonary field, that they are very concerned when people smoke and that travels into the lungs.”

Roberts-Odle countered by distinguishing between recreational and medicinal cannabis usage, noting that medicinal cannabis typically does not contain additives like “fanta” used in recreational smoking.

“Generally, the tar comes from the additional things that you put in it,” she said. “For medicinal cannabis, what is actually being smoked is just the cannabis… you don’t add ‘fanta’ and those kinds of things.” 

She also addressed the risk of public smoking and secondhand exposure, stating that if legal, there would need to be restrictions on where medicinal cannabis could be smoked to prevent exposure to non-users.

Pharmacist David Workman, another guest, suggested an alternative rapid-relief method without smoking risks: “Drops or a spray under the tongue where there is a rich blood vessel supply and allows for rapid absorption. I can’t say it’s going to be as fast, but it’s going to be fairly quick.”

Roberts-Odle shed light on patient-specific treatment plans, noting that legislation does not restrict what doctors can prescribe medicinal cannabis for, as “its usage continues to grow and your doctor knows you.”

“They’re able to make an informed decision on whether this is good for you and so we have not restricted the kinds of things that they can prescribe you medicinal cannabis for,” she added.

So far, the BMCLA chief revealed, the drug has treated patients with epilepsy, pain, muscle spasms and anxiety. Underscoring responsible usage, she said: “The same way we have to be responsible with any kind of other medicine that we’re using, medicinal cannabis would have to be under those kinds of context as well… everything in moderation and in the correct usage patterns.” (SM)