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Drug war rages on

A jar of medical cannabis. Many doctors in Cyprus still refuse to prescribe it.
A law ostensibly to ease access to medical cannabis has faltered over interpretation and suspicion

By Evie Andreou

Expectations raised that medical cannabis might be more readily available after the law on drugs was amended a year ago have faded rapidly because little has changed, patients and activists say.

The new regulations passed last year covered the import of cannabis seeds and plants, the cultivation, production, import, export and use of medical cannabis.

But activists say the health ministry has proved reluctant to change its practices. They say the amendments widened the right to access to medical cannabis and provided for a committee to assess the patients’ applications, not the minister.

Before the law was amended last year only cancer patients could apply directly to the health minister for access.

Even though these restrictions were loosened, activists say the minister has kept the sole say over whether medical cannabis can be prescribed and has kept the conditions exactly as stringent as they were previously.

The health ministry concedes that the new regulations “do not specify the patient groups or medical conditions eligible for receiving pharmaceutical cannabis”.

But it also concedes it does not like easing access and is trying reinstate tough restrictions.

“The ministry is currently in the process of proposing an amendment … [to] … impose further restrictions on the use of cannabis that includes prescribing, handling and disposal, having taken into consideration the social conditions and in order to adjust to scientific progress,” the ministry said in a statement to the Sunday Mail.

And while it rushes to make those changes, the old rules apply, activists complain.

Prior to the amendment, patients had to seek permission from the health minister to use medicinal cannabis with a THC component, the primary agent responsible for creating the high associated with recreational cannabis use and widely accepted abroad as useful pain relief.

“The so-far practices and procedures continue to apply,” the health ministry told the Sunday Mail.

According to the ministry, it is mostly cancer patients who apply and those with autism or resistant epilepsy.

For patients to receive medical cannabis, an application must be submitted by their treating physician to the health minister with information on their medical condition and justification on the requirement for treatment with medical cannabis. This procedure concerns the procurement of cannabis oil formulations. The required Tetrahydrocannabinol (THC)/Cannabidiol (CBD) content should also be submitted.

But supporters of medical cannabis say it’s not just the ministry’s reluctance to abide by the new regulations at issue. Another persistent obstacle is the lack of doctors convinced of the benefits.

Αccording to Kyriakos Stylianides, a palliative care doctor, who is among the few to prescribe medical cannabis, not many of his colleagues are convinced.

He has prescribed medical cannabis to more than 200 of his patients.

He said that according to regulations, cancer and HIV patients and those suffering from neurological conditions are eligible to receive the drug.

“Doctors don’t believe it will help their patients,” he said.

But for cancer patients, for example, it helps control some of the symptoms. Medical cannabis causes euphoria, he said, so patients feel better, it improves appetite and helps relieve nausea.

He stressed however that the THC can cause addiction and so it is necessary for the patient to be observed.

“Not all patients need it, only some groups of patients do, therefore, caution is needed to avoid creating an uncontrolled situation,” he said.

More awareness among his colleagues would allow more patients to benefit he said.

Patients suffering from other conditions, also go to him seeking to take the drug.

“Based on the regulations I cannot prescribe it to anyone outside these three groups of patients,” he said.

Solon Antartis, ‘the law is a sham’

But for Solon Antartis, co-founder of Friends of Cannabis group, who has been fighting for patients to have legal, easy and safe access to medical cannabis, the whole issue is “a scam”.

“The law is not applied,” he told the Sunday Mail.

He argued the law stipulates that all doctors can prescribe medicinal cannabis and there was no restriction as to who can benefit. He said the minister refused to give permission to other patients with chronic illnesses such as multiple sclerosis or Crohn’s disease.

Antartis said that the amended law last year does not restrict the right to access to cannabis to certain patient groups while other stipulations have not been applied.

“The law provides for setting up a committee to assess the patients’ applications which has not been done. Instead, the health minister still is the authority to approve these applications.”

Some patients have yet to receive a response to their request, a year after they submitted one, forcing some to illegally procure medicinal cannabis, he said.

“The state violates patients’ rights.”

According to the EU Charter of Patients’ Rights, which Cyprus adopted, patients are entitled to choose their medication and treatment.

He said that some patients have gone to court, but most cannot afford the legal expenses.

Antartis also referred to the importance of convincing doctors of the medical cannabis’ benefits.

“Most doctors are ignorant and cowards. The law gives them the right but their cowardness does not allow them to prescribe medical cannabis,” he said.

The excuse by doctors refusing to prescribe cannabis because there is no research on its benefits, is baseless, he said.

“But of course, there is, a simple online search reveals how much research there is. In the case of absence, they could just start their own research, be pioneers,” Antartis said.

George Papageorgiou, 50, who suffers from chronic pancreatitis, fatty liver disease, chronic arthritis and a number of other medical conditions, says that being allowed to take medical cannabis would be ideal since the prescribed pills for chronic patients are based on opiates.

“Basically, people suffering from chronic illness are prescribed these tablets that are addictive,” he said.

He said his numerous attempts to get permission to use medicinal cannabis had been ignored.

“The ministry of health is violating my rights to pain management,” he told the Sunday Mail. “They choose to give tablets that can lead to addiction and eventually death. I would love to ask the minister and the cabinet, when did nature become illegal?”

George Papageorgiou in hospital for pain relief

He added that synthetic drugs like opioids, and most pharmaceutical medication are making people worse.

“Prohibition on cannabis is coming to an end on the USA. Cyprus can’t even give it to sick people,” he said.

But while Stylianides is in favour of medical cannabis, he warned that it cannot replace the opioid drugs used for pain.

“Cannabis alone is not enough to help with the pain. It more helps with psychological pain than the physical one,” he said. He added that his patients do not stop using opioid drugs, but they use fewer of them.

Even so, in terms of side effects cannabis is much safer than the opioid-based ones he said.

The absence from the local market of CBD is “another sad story” according to Antartis.

Unlike other cannabinoids — such as THC — CBD does not produce a euphoric ‘high’ or psychoactive effect. It is believed to help ease symptoms from various health conditions and relieve pain.

In Cyprus CBD is not on the list of forbidden drugs, and Cypriot authorities have registered it as an over-the-counter drug but no company imports CBD products because of the red tape involved.

Antartis said, any company interested in importing CBD products is forced through a very time-consuming procedure.

“The state loses taxes and patients are forced to order online,” he said.

But even if they order CBD from abroad, some find themselves scrutinised by authorities once their orders arrive.

He said people have been taken in for interrogation while authorities take the CBD products for lab tests.

He puts this down to lack of knowledge by most of customs officials, the health ministry and police.

Paul, who did not want to give his last name, admitted to procuring CBD oil for his sick girlfriend who has many health issues and is in constant pain from the “black market”.

“I would watch in amazement as the CBD would give her immediate pain relief,” he said, adding he didn’t see any negative side-effects.

“Cyprus classifies itself as an EU country, yet its laws on cannabis are outdated,” he said.

Most advanced western democracies have educated themselves and relaxed their cannabis laws, he said.

Antartis said that concerns that legalisation of medical cannabis would lead to the creation of a grey economy is baseless.

Where cannabis has been legalised the use of opioids was reduced as well as of hard drugs, he said.

For Antartis authorities and decision makers in Cyprus are “still in the dark ages; everyone is allowed to take legal drugs which are lethal such as the opioid based, but cannabis is forbidden.

“They’d rather see people suffer from pain. This is a crime in my book,” he said.

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