The Malta Independent 16 July 2020, Thursday

The highs and lows of chronic conditions – what they do not want you to know

Alice Taylor Sunday, 4 June 2017, 10:00 Last update: about 4 years ago

As of April 2015, medical cannabis has been legal in Malta if it is prescribed by a specialist such as an oncologist, anaesthetist, neurologist or psychiatrist. But if you go to almost any doctor in Malta and ask him to refer you to a specialist to prescribe this medication, you will be met with a blank expression. For some reason, and although it is legal under Maltese lawunder the right conditions, the Superintendent of Health and the Medicines Authority do not want you to have it.


To understand the benefits of medical cannabis and why its availability is so important, I spent a morning with Dr Andrew Agius, a family doctor with a special interest in pain management. Through his work specialising in treating patients with chronic pain, and other pain-related conditions he has become very aware of the therapeutic potential of medical cannabis. To appreciate its medicinal properties, you need to have an understanding of the endocannabinoid system. This system of receptors and neurotransmittersis present throughout most of our body and its role is to maintain a state of balance. In conditions such as anxiety, depression, pain and Parkinson’s, there are abnormal levels of neurotransmitters which can be regulated through the endocannabinoid system. This system is also responsible for correcting metabolic abnormalities such as in diabetes, and that is why medical cannabis can be used to treat so many different conditions.

Cannabis has been proven the safest and most effective treatment for chronic pain conditions such as fibromyalgia, IBS andmigraines – three conditions where there was previously no proper treatment available. This is because doctors found that these conditions are most likely caused by an abnormality in the endocannabinoid system and the introduction of cannabis helped to restore the balance. It can also be used to treat insomnia, period pains, diabetes and to stimulate hunger in patients with cancer or that are suffering the side effects of chemotherapy. Several clinical trials show its safety and therapeutic efficacy; the latest was by Professor Mark Ware who has been researching cannabis extensively for many years.

But when we think about all these conditions and think of the pharmaceuticals that are used to treat them such as painkillers, antidepressants, sleeping tablets, and sedatives, it is common knowledge that the side effects are less than pleasant. Nausea, addiction, and either accidental or deliberate overdose are extremely common, yet with medical cannabis,none of these risks is present.

But the most important fact of all is the proven benefits of using medicinal cannabis when treating cancer patients. Not only does it help with pain management and combatting the side effects of chemotherapy and other medicines, but there are studies (some of which have been suppressed) where it has been shown to attack and destroy cancer cells, while leaving the healthy cells intact. This is staggering information –- a safe, natural, cheap to produce, non-invasive treatment for cancers.Why is no one shouting it from the rooftops? Why are our governments not stepping in to provide a treatment for individuals whose families are being ripped apart by a supposedly “untreatable” disease? I wonder indeed.

When we speak of medical cannabis, it is important to make a distinction between what you buy on the streets, and what you can buy as a prescribed product.What you buy on the street can be of varying strengths, can contain other substances, or could even be synthetic. These are the things that lead to psychosis, fits, and in the case of synthetics, even death;medical cannabis is not the same.

The two mainactive ingredients derived from cannabis that can be used for medicinal purposes are THC and CBD. THC is psychoactive in nature but also has a range of therapeutic effects, whereas CBD has no psychoactive properties in any dose, and is suitable for a range of treatments such as treating anxiety, epilepsy, pain and others. The preparations work best when the two are combined; in fact, the CBD neutralises the psychoactive effect of the THC when it is present in a specific amount, therefore nullifying any of the “high” or euphoric side effects that are associated with THC on its own.

In Malta, the only one preparation you can be prescribed by law is a combination of THC and CBD known as Sativex. This retails at €500 per 10ml and some patients may need as much as 30ml each day. The Medicines Authority were considering making another preparation available, this time a synthetic mixture and a mere snip at €2300 per 20ml (when the same concentration of the natural product costs a maximum of €75). The problem is not only the exorbitant price for a preparation of something that really does not cost that much, it is that although Sativex can be prescribed, it is not being imported.

Once it was approved and licensed for use in Malta in November 2016, Dr Agius was hopeful that although it was expensive, it would be at least available. After months of urging patients to ask their local pharmacists to help, one pharmacist said that a supplier was identified and it would be available within a week or two. At this point, the Medicines Authority stopped the transaction and declared that importers need to have a special licence to import it and it can only be imported by one company. After a couple of weeks, there still hasn’t been much progress as it seems this importer “didn’t have time” to work on it. Why the sudden change of tune?

To cut a long story short, anything made from Cannabis (including hemp products) in any amount is illegal in Malta unless it is prescribed by the aforementioned specialists. That goes for beauty products containing hemp, clothing items and oils that you can buy locally or online. The Superintendent and the Medicines Authority are refusing to approve any products with CBD in apart from the prohibitively expensive synthetic ones I have mentioned. Furthermore, they will only allow them to be prescribed by specialists who have no link or specialist knowledge in prescribing medicinal cannabis.To make matters even worse, when Dr Agius suggested that these specialists should be trained and educated properly about the endocannabinoid system and the therapeutic effects of cannabis (something that is not taught in medical school) so that they can prescribe responsibly, the response was that this is not the time for it and the last thing anyone wants is an expert in medical cannabis in Malta.

In other words, while it is legal on paper, it seems that not only has it been orchestrated in such a manner that it is completely inaccessible to anyone that needs it, but also that its import and any education or conversation on the matter has been inexplicably halted.

Where does this leave the people whose quality of life depends on this? Some are driven to the black market where they purchase products that are too strong, or the wrong balance of active ingredients that can cause unwanted side effects. Some inadvertently purchase synthetic products which can lead to fitting, mental issues, and even death. But most end up giving their money to drug dealers, drug traffickers, and individuals who use the profits to pump back into the dealing of harder drugs such as heroin and cocaine. Others who choose not to go down the illegal route, out of desperation, order online.They invariably end up with a product which, according to a study carried out by specialists at the Department of Food Analysis and Nutrition at the University of Chemistry and Technology in Pragueis 70 per cent likely to be not what they ordered and to be extremely unsafe. The remaining few are left to suffer in silence, spending their lives believing that they are stuck with their condition and that there is no cure for them.

What makes me even angrier is the fact that certain political parties have sought to buy the popular vote by talking of legalising cannabis for recreational use. So you make it legal for friends to share a spliff, but those who need it to help alleviate their suffering do not get a second thought? Or maybe the vote of a suffering minority is not as important as the vote of a few thousand who want to light up on a Friday night. What happened to putting the patient first and seeking to ease unnecessary pain, and even death? What is holding back the Superintendent, the Medicines Authority and licenced importers, and why are they not taking steps to allow a) the approval of perfectly safe and natural CBD and THC preparations for therapeutic uses and b) the importation of a product that is already approved?

In my mind, there are two issues present here. The first is that pharmaceutical companies do not want a low cost, natural alternative to around 60 per cent of their productsbeing made available on the open market.Secondly,the same companies do not want Sativex imported to Malta because if patients realise how powerful it is, they might seek something similar on the black market and reject traditional medicines. If someone has the choice between paying €1150 for 10mls, or €43 for 10mls, I know which one the majority would choose.The question is: how much influence do these pharmaceutical companies have over our supposedly impartial local medical authorities?

Asides from my time with Dr Agius, I have spoken to many local patients who suffer a range of conditions and all speak of the immediate and instant relief from their symptoms and through ongoing use, enjoy a happy and healthy life without needing pharmaceuticals. These people are normal individuals – parents, business owners, grandparents, and professionals – not drug addicts or new age hippies. These people have transformed their lives and made the switch from a toxic cocktail of prescription drugs, to a safe and natural alternative withoutside effects.

If you are an individual who suffers from depression, anxiety, IBS, insomnia, panic attacks, epilepsy, MS, CFS, fibromyalgia, chronic pain, or are undergoing cancer treatment, there is help out there for you. There is a product that will ease your pain and cut your medicine bills. There is a product that will help get you out of bed, reduce your symptoms, and give you back the normalcy that you crave without any adverse side effects – but there are individuals in this country who for some reason, do not want you to have it.

We need to push for our medical professionals to be educated in its uses, for Sativex to be made instantly available and put on the free medicines list, and for CBD oil to be made legal and available as a health supplement like it is throughout the rest of Europe. The health of the population should not depend on a profit margin, or the influence of a pharmaceutical company that is desperate to retain its billions. If you are someone that suffers from these conditions,I suggest that you contact Dr Agius in confidence who can point you in the direction of all the evidence and information that you need, and then I urge you to write to the Health Minister to demand that these changes are made – sooner rather than later.


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