The Malta Independent 8 December 2022, Thursday
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Pain expert frustrated cannabis discussion ‘lumped’ together with recreation drug use talks

Helena Grech Sunday, 24 September 2017, 10:30 Last update: about 6 years ago

A doctor who is advocating the right to prescribe CBD oil, a component of the cannabis plant, as a way of helping certain patients manage their pain, cannot understand why the discussion on the subject is now being included in the talks regarding recreational drug use.

Dr Andrew Agius, who runs a private pain clinic in Malta, has seen the “miraculous” effect of CBD oil with his eyes when treating a patient who had been disabled for 10 years due to fibromyalgia.

Studying a patient for more than a decade, who had been completely unresponsive to medicine while suffering from the terrible disease, and seeing that same 34-year-old woman make such a drastic U-turn by using cannabinoids such as CBD oil was something that he just could not ignore.

The patient, who is also a mother of a nine-year-old, eventually stopped using medicine altogether, and remained using the CBD oil, and even applied to start her own business to sell the oil herself since her quality of life had improved so drastically. She was never allowed to do this however, since the authorities promptly informed her that the all-natural treatment that allowed her to get out of bed in the morning, care for her child and become an active member of society is illegal.

Speaking to The Malta Independent on Sunday, Agius explained that because the law passed in the early 20th century covered anything and everything coming from components of the cannabis or hemp plant, any products are illegal. This includes beauty products, clothes, literally anything that is derived from the plant itself.

Agius stressed that Malta is the only country in Europe where CBD oil is illegal. Depending on what country you reside in Europe, CBD oil with THC levels less than 0.3 or 0.2mg can be sold over the counter.


What is a cannabinoid, and how does CBD fit into it?

Agius explained that cannabinoids are components of the cannabis plant.

“The ones we know most about are CBD and THC, but those are just two therapeutic components that can help with various ailments and even treat various conditions. Besides those there are many others being researched and new things are being learnt every day.”

In the past, research in the plant was difficult due to the strict prohibition against it worldwide. Today, as more and more countries have relaxed their laws, from both a medicinal and a recreational perspective, far more research can be carried out than ever before.


Cannabinoids and pain

Agius was a GP for 15 years, and for the first 10 years focused on family medicine. From there, he went into stress-related illnesses and three years ago, he began specialising in physical pain.

“I saw the relationship between stress and pain, as chronic stress can very often lead to painful conditions.”

Two years ago, he started specializing in chronic pain doing an overseas course by correspondence, which led him to open the pain clinic.

“It is the only private pain clinic. The approach taken here is trying to find the root of the problem and trying to treat the patient in the most conservative way, using the most natural remedies possible such as exercise.

“I have managed quite a few patients by setting then up with the right exercise routine and diet, especially by making sure they take the right vitamins.”

He explained that stress usually manifests itself as headaches.

 “What can also happen is that if there is chronic stress or even very stressful events sometimes, this can lead to damage in the pain controlling area of the brain, which leads a person to being hypersensitive to pain and other things, such as food, light and noise. It even affects a person’s immune system which causes a person to become sick quite often.

“It is these people who can really benefit from cannabinoids.”


The fight to get CBD oil recognised

“Towards the beginning of last summer, this CBD story started when an English doctor approached me as he had heard of my pain clinic. He wanted to come to Malta to treat patients with CBD. He was doing some research in his clinic in the UK, and they were treating patients, together with a pharmacist, with synthetic CBD oil.

“I found this interesting and I started looking into it. I found the natural version in Malta either online or from health-shops. When I started looking into the legal side of it, some people from the Medicines Authority told me they were not involved because it is not a medicine. Other pharmacists and sources said it was legal.

“When we actually got lawyers to sit down and look into the legality of it, they informed me that it does not appear to be legal. At that point, around November 2016, I sent a letter to the Superintendent for Public Health, informing her that I was using this oil that was available in Malta. I said that whoever I bought it from said that it was legal, and that I was treating patients who were doing miraculously well.”

Here, Agius goes into the story of his 34-year-old fibromyalgia patient and her transformation from being fully disabled into a fully functioning person.

“With just two drops she immediately got out of bed, had energy, cooked, cleaned the house. Over the next few weeks, she stopped her medication, is now functioning normally and is opening a business after being disabled for 10 years.

“I told these stories to the Superintendent, to other doctors and authorities, but unfortunately they were ignored. Around February, I sent another reminder, urging them to consider the matter as this merited serious discussion because there are patients benefitting from it and it should be done the right way.

“Still, my e-mails were ignored. Towards May of that year, this patient is full of energy and wanted to open a business to sell this medication. She filed all the appropriate application forms but was refused a permit.

“In the meantime I managed to get the meeting for which I had been asking, for six months. The superintendent for public health said this product is illegal and to stop doing what I am doing. She also instructed me to stop telling patients to use it because it is illegal, and that I should be careful because I might get my warrant taken.

“I stopped, told my patients to stop, and told my patients that they would have to get it themselves. It is easily accessible online because this oil is legal in all Europe except in Malta.

“The law that was passed in the early 20th century put cannabis products and hemp products in one basket. This makes all products made from hemp, including beautiful products, illegal. If it is extracted from the hemp plant, it is illegal.


Why not use synthetic CBD oil, which is legal?

“This UK doctor was producing synthetic CBD oil together with a pharmacist and selling it to his patients for over €2,000 a bottle. My patients who I referred to him were also charged almost £400 for a consultation, because these people were terminal and would do anything to make their life more bearable. I did not agree with it, but at the time, there weren’t any options.

“He tried to convince me that because of the current laws in Malta, they could get this synthetic CBD oil approved as a medicine to sell here. After a year of fighting, he finally managed to get the Medicines Authority to approve it for the treatment of patients. Now, instead of selling it for €2,000, he is selling 20ml for €700. The other concentration costs €1,500.

The synthetic oil has no THC. There is what is known as the entourage effect. This is the synergistic effect of cannabinoids such as THC and CBD with each other, and with the other components that are present in cannabis or hemp. There are studies, and there is evidence, that natural CBD extracts that have a small level of THC work better than the synthetic, single module isolate.

This is because the little THC there is helps the CBD to work better, causing this synergistic effect.


Recent discussions on marijuana

“I think that when there was the proposal to discuss recreational marijuana, I thought that these patients who are suffering a lot should be given priority, they should be the first to get their medicine so that their suffering will stop and they can start living a normal life.

“Everybody is in favour of medicines that can cure pain; it is the recreational arguments that get much opposition. When it is all lumped together, people hear the bad things about using it for recreational purposes. People are misinformed, and this incorrect information has prolonged the discussion even more. Patients are suffering in the meantime.

“Sometimes the side-effects can be so bad for patients as in opioid-based pain killers that patients choose not to take them. Apart from not being effective for chronic pain, a patient can suffer from severe side-effects.”

Agius, who embarked on a weekly educational campaign called ‘Kannatalim’, discussing a different subject related to cannabis as a medicine, using studies, clinical trials and evidence that it can be used in many conditions, is trying to inform the public about the controversial issue.

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