A view on medicinal cannabis

This column addresses several concerns I have over the publicized plans to legalize medical cannabis products in Barbados. I believe Barbados has the potential to make several mistakes that going forward maybe later considered as wasteful, impractical and possibly unethical.

I have no conflicts of interest in the matters discussed below. I am a medical doctor, a Senior Registrar in Anaesthesia, at the Queen Elizabeth Hospital. I am currently on leave from the Queen Elizabeth Hospital to further specialize in pain medicine at the University of Toronto. Some of the patients I treat use medicinal or recreational cannabis. I have been trained in prescribing cannabis and I am doing a research project involving cannabis using patients. I will prescribe cannabis when treating some patients (in Toronto). I have not been a part of the decisions made in Barbados regarding cannabis and I am not financially invested in cannabis.

I am concerned with the potential addition of selected imported cannabis drug products to the Barbados drug formulary (per the statement on the Barbados GIS Facebook page).

Cannabis medications, and cannabis itself, are currently a “third-line” treatment for pain conditions and chemotherapy associated nausea and vomiting. This means that cannabis should only be used when other therapeutic measures have been tried and failed. Furthermore, current evidence advises that for many patients, other medications do the same thing but better or with fewer side effects. Cannabis product prescribing is also relevant to only a few medical specialties – pain medicine, palliative care and oncology. There are a handful of these trained specialists practicing in Barbados.

Because of cannabis’s current limited role in medicine, I hope that the Government will not be spending foreign capital to import medical cannabis products or spending money to make these products available to the public at subsidized cost.

Legalizing cannabis drug products may make sense, but ultimately, the patient who is prescribed that product, or their insurance company, should bear that expense given the availability of other more robust therapies. This is especially true if you consider that resources that might be spent on importing cannabis drug products, and making imported cannabis products available to the public, might be better put towards preventing surgeries from being cancelled or to preventing less-than-optimal treatments being necessitated because of personnel, drug or other medical supply shortages within the Barbados public healthcare system.

If medical cannabis is grown in Barbados for exportation, I believe that it is this product that should be made available to the public at a partially or completely subsidized cost. If foreign capital is available for drug spending, it should go towards any of the medications on the WHO List of Essential Medications that Barbados is lacking or experiences frequent shortage of; that list is located online here – https://www.who.int/medicines/publications/essentialmedicines/en/ or https://en.wikipedia.org/wiki/WHO_Model_List_of_Essential_Medicines.

My second concern is that there still seems to have been no consideration or consultation with regard to cannabis and harm reduction. Harm reduction is when measures are taken to minimize harm to an at-risk group, as well as minimizing harm to the populations these at-risk groups are a part of. I do not endorse recreational cannabis use but it is already an established part of Barbadian life for many persons with many people currently, or previously, using it.

I do not believe recreational cannabis users should be prosecuted, extorted, denied employment or denied education opportunities because they have used, or are using, cannabis. Unfortunately, many young people in Barbados use cannabis, but I would argue that sending them to jail does them and the country no good.

I would not want my children using cannabis, but if they did, I think they would be better helped in the home rather than having their potential reduced even further by time in the judicial system. I also think the time and money spent on prosecuting cannabis users, as well as reviewing them at the Psychiatric Hospital and jailing them would be better spent on other public endeavours – like a better funded and staffed drug rehabilitation system for people who legitimately want to stop cannabis or other drug use – and not on those individuals who are sent for rehabilitation by the courts with a strong motivation of secondary gain (avoiding incarceration).

Decriminalizing or legalizing recreational cannabis would not absolve persons of crimes they commit while intoxicated (e.g. neglect, manslaughter) – much the same as it is with alcohol consumption. It also would not absolve persons from smuggling or illegally trading in cannabis. Finally, decriminalization or legalization of cannabis is not an endorsement of cannabis use; but it is an opportunity to better address an established societal practice in a way that may better benefit all Barbadians.

To summarize, I do not believe Barbados should spend resources importing cannabis given its limited and tertiary role in medicine. Public health resources should not be invested in foreign cannabis products but instead be focused on medical personnel, medicines and services that have a greater impact on national health but might be weak or lacking in the current public health care system. If public money is to be spent on cannabis, it should be spent on a Barbadian cannabis industry that could be used to derive financial benefit and also create medical products for Barbadians.

I also do not believe cannabis legislation is something Barbados can sensibly straddle the fence on. If medical cannabis is going to start being prescribed, an expert examination of the argument for harm reduction needs to be considered. Recreational cannabis decriminalization or legalization should be included as part of this consideration. I believe stronger thought should be given to the harm done to, and done by, cannabis users in Barbadian society (that can be directly attributed to cannabis use) as well as to the money and time already spent on them under current legislation. I acknowledge there are legitimate health concerns around cannabis, especially in young heavy users (e.g. permanent loss of IQ, cannabis use disorder, increased vulnerability to mental illness) but these problems have not, and will not be solved in our courts and in the prison.

Dr Alexander McLaren-Blades is an anesthesiologist and pain specialist from the Queen Elizabeth Hospital currently continuing training at the University of Toronto.