Side Event: Global Access to Medicinal Cannabis: Programs, Challenges and Solutions

Global Access to Medicinal Cannabis: Programs, Challenges and Solutions 

Thursday, March 17th, 2020

Sponsored By:

Veterans Action Council

ENCOD.org

Moderator:

Etienne Fontanne, Veterans Action Council

Speakers:

Dr. Pavel Pachta, International Narcotics Control Board (INCB), former Deputy Secretary

Dr. Ethan Russo, CReDO Science, Founder and CEO

Michael Krawitz, Veterans for Medical Cannabis Access, Executive Director

Carola Perez, Dos Emociones Project & the Spanish Observatorio Español de Cannabis Medicinel (IECM), Founder

Bryan Buckley, Helmand Valley Growers Company, Battle Brothers Foundation, Owner, Founder

Etienne Fontanne, Veterans Action Council

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Etienne Fontanne, Veterans Action Council: Good morning from Berkeley, California in the United States of America. My name is Etienne Fontanne with the veterans Action Council, we welcome you to our site event Global Access to medicinal cannabis programmes, challenges and solutions. Thank you for joining our discussion today. We would like to acknowledge and thank the European coalition for just an effective drug policy, along with our group, the Veteran’s Action Council for hosting this side event. We would also like to thank the 65th CND for this honour to speak to you this morning. The Veterans Action Council is a group of venerated professionals in their respective fields, committed to setting higher standards of care for the veterans community. As equals each member brings a unique perspective and a wealth of lived experience both in and out of service. Our mission is to ensure safe and affordable access to natural medicines and alternative therapies for veterans. We are a United States based veterans organisation, and we consider ourselves in an international inclusive group, in that we represent veterans from every country around the globe. 

 

As we have devoted our lives to the service of our countries, we demand cannabis access for everyone. We are here to advocate for basic human rights, along with the access and accessibility to the therapeutical value of cannabis medicines. This would also include the nutritional value of their hemp seed as part of a sustainable agriculture for nutritional health and an easy way to get high protein foods to your people regionally, the fibre and herd can be used to create sustainable housing, as well as sustainable construction materials, among other outcomes. This is a complex, yet simple plant that is capable of cultivation on every continent. The first problem we must recognise is that this is a plant that must be utilised for all its available resources. With the increasing problem of climate change, this is a plant that could meet the need of future generations. Second, we have a suicide issue amongst our veterans that isn’t being properly addressed, except for pharmaceutical means, and  these medications also have suicidal ideation listed as side effects. We understand greatly the value of cannabis as medicine. I am one of those patients and I have used this as a medicine for 30 plus years. Third, due to the COVID reality we have existed under for the past two years, and citing the unprecedented stress caused by social isolation as a major explanation for the increase, the World Health Organisation said that loneliness, suffering and deaths in the family grief after bereavement, together with financial worries, were also major factors fueling anxiety and depression. Amongst among health workers exhaustion has been a major trigger, prompting suicidal thoughts. 

 

The stress and post traumatic stress associated with such compounded traumas has become a bridge that veterans along with health care workers and first responders must now cross together to find a beneficial solution for all. As veterans we have found one solution in cannabis medicines, and we want this knowledge to be widespread amongst frontline workers worldwide, and to have access to what we veterans have therapeutically utilised in cannabis. The veteran Action Council seeks to schedule cannabis internationally so that all countries can realise the benefits and have access to this most beneficial plant. Our first speaker this morning we are honoured to have Dr. Ethan Russo. Dr. Russo is a board certified neurologist, psychopharmacology researcher, and author. He is the founder and CEO of CReDO also credo-science.com. He has consulted or lectured on these topics in 39 US states and Canadian provinces and 39 countries. Good day.

 

Dr. Ethan Russo, CReDO Science, Founder and CEO: I’m Ethan Russo, a board certified child and adult neurologist. This is my contact information. Today I’d like to discuss the endocannabinoid system and cannabis therapeutics. It began with a plant called Cannabis. This makes glandular trichomes that produce substances called cannabinoids. These have led us to an understanding of an innate system in the body called the endocannabinoid system that works analogously in some respects to the cannabinoids from the cannabis plant. tetrahydrocannabinol is the main psychoactive component of cannabis. It lodges on the CB one receptor, as do in a chemicals called endocannabinoids: anandamide, and [missing] glycerol. The endocannabinoid system works among other places in the nervous system. What the endocannabinoid system is, is an internal homeostatic regulatory system that is in higher animals with three components. The endogenous cannabinoids themselves–anandamide, [missing] glycerol, the CB1, CB2, and TRPV1 receptors, and the regulatory enzymes. The endocannabinoids are produced on demand and go in a retro grade fashion to the presynaptic neurons where they decrease the elaboration of neurotransmitters. Additionally, they’re active and inactive components that work together on what’s called in entourage effect. CB one is highly expressed in the brain, and actually has more receptors than those for all the neurotransmitters combined. It’s particularly present in areas observing pain, balance, movement, and emotion. Whereas there are some CB1 receptors in the brainstem there none to speak of in the lower medullary centres that regulate breathing and heart rate. So it is not possible to produce a fatal overdose with THC or related cannabinoids, but the endocannabinoid system is seen throughout the body. Here we portray different aspects of the nervous system, the brain, spinal cord, peripheral nervous system and the enteric nervous system. The role of the endocannabinoid system has been characterised as relax, eat, sleep, forget and protect, but it affects every aspect of physiological function to keep it in balance. So this includes pain, memory, movement, emotion, appetite, ametic threshold, seizure threshold, and gastrointestinal function. CB2 is  a non psychoactive receptor that modulates immune function and pain. It also has a role in preventing fibrosis such as in cirrhosis of the liver. As mentioned, the endocannabinoid system is in every physiological system as we see here, also present in cardiac function, skin, and bone physiology. As an example cannabidiol a component of cannabis was recently demonstrated to stimulate bone fracture healing. Cannabis sativa is the plant that led us to knowledge of the endocannabinoid system. This is well known as a provider of food, fuel, fibre, and pharmacy, which comes primarily from the infertilised female flowering tops. Cannabis is also an ancient medicine, with written evidence going back at least 4000 years as depicted in these various languages. This is a schematic showing the different parts of the plants and the chemicals that produce them. And these are quite heterogeneous in the different parts. We’re usually most concerned with the unfertilized female flowers in the glandular trichomes. But the seeds also produced a very complete protein and fat with essential fatty acids. And there also are additional components from the roots and other parts. This is a biosynthetic schema of cannabinoids cannabinoid function in the plant.

And we see here some several cannabinoids but there have been upwards of 150 that have been produced in the plant. Each one of these depicted here has unique therapeutic properties. Additionally, the plant makes essential oils and terpenoids that contribute to therapeutic effects, as part of an entourage. Tetrahydrocannabinol is the most well known part of cannabis. It was first identified in 1964. It has what’s called a weak partial agonist at the CB one CB two receptor, well known for its pain reducing properties, also a Bronco dilator and it’s a neuro protective antioxidant that can reduce brain damage. It has very powerful anti-inflammatory effects. It’s a muscle relaxant and it’s an approved indication for Nabiximol, a cannabis based medicine in 30 countries well known as an antiemetic in cancer, and it is the primary sector psychoactive component with no Cox inhibition and produce associated side effects. It also may reduce beta amyloid in Alzheimer disease. Cannabidiol is a non intoxicating chemical in cannabis. First isolated 9040 But identified in 1963. It works in directly on the CB1 receptors. It is a neuro protective antioxidant stronger than vitamin C and vitamin E also works on TRPV1 receptors against pain, has multiple mechanisms mediated through the serotonergic system to reduce brain damage, to reduce nausea, and as an anxiolytic. It also increases the gain of the endocannabinoid system, and that was a Food and Drug approved anti convulsant in 2018. It’s also been effective in psychosis. This is a recent article that looked at considerations of cannabis administration and dosing and lists various levels of evidence. Again, it’s well established that cannabis based medicines are effective chronic pain treatment and adults, is an approved indication in Multiple Sclerosis spasticity, also in chemotherapy induced nausea and vomiting, and treatment of intractable seizures [missing] gastro syndromes, as well as in tuberous sclerosis. And then there are many other conditions where there’s been some evidence of benefit but this is all still being investigated. The adverse events associated with cannabis are mainly in the psychiatric realm and include anxiety and even hallucinations, if doses are excessive. However, this is easily avoided. Other associations are often respiratory that are only associated with smoking, which is not a recommended approach to cannabis therapeutics. In looking at different indications, it’s well established that tetrahydrocannabinol can be effective in seizures in animals at extreme doses that can produce seizures. cannabidiol seems to be anti convulsant at any dose on, is approved in various countries as nearly pure compound Epidiolex but in very high doses. Other cannabis based medicines with cannabidiol in them seem to work at lower doses and possibly as effectively. 

In the case of cancer. It’s clear that cannabinoids have benefits in treating nausea and vomiting associated with chemotherapy, and there have been two positive phase two randomised controlled trials on opioid resistant pain. Primary treatment of cancer cannabinoids are effective cytotoxics for cancer cells but are protective for normal cells. Generally high doses are required. But a recent trial showed benefit of big smalls in glioblastoma multiforme II and conventional doses. They’ve been many trials in pain. Cannabis is not helpful in acute pain except perhaps in conjunction with opioids but as a wide spectrum of activity and chronic pain, especially neuropathic pain. The best documentation has been for Nabiximol and Sativex, and this is a listing of various older clinical trials, many of which were quite effective. There are always concerns about using psychoactive drugs in elderly people but Nabiximol was used extensively in elderly populations with no indications of increased adverse events. Titration in all cases should be slow with attention to drug-drug interactions and possibility of falls. As previously mentioned, cannabis based medicines may have applications in Alzheimer disease, especially treating target symptoms with these various components, but there is also the possibility of neuro protection or even arrest of the pathologic process. There have been two phase two randomised controlled trials of cannabidiol. In schizophrenia, quite effective with even less side effects than were noted with conventional drugs. THC is recommended to be avoided by psychotic patients. But again, it’s possible to produce different components of cannabis and exclude THC. There are always concerns about using such drugs and children but historically usage in children was widespread. Children under 10 are quite resistant to psychoactive side effects of THC, on other components, cannabidiol tetrahydrocannabinolic acid seem to be useful, especially in common behavioural disorders and autism. Cannabis again historically has been extensively used in obstetrics and gynaecology for a list of different conditions here. The world is suffering the scourge of opioid addiction, particularly in the United States, where 100,000 people died from overdoses in 2021. But cannabis can be used concomitantly with opioids, even in those of medical dependency with close follow up. After a time in which pain reduction is achieved, dose reduction or tapering schedule from the opioids can be initiated, and various observational studies have been demonstrated opioid sparing with dose reduction or discontinuation with cannabis based medicines. Additional information can be found at these links which I will provide in an accompanying PDF. Thank you for your attention.

 

Etienne Fontanne, Veterans Action Council: Thank you for that informative video Dr. Russo. Our next speaker will be Dr. Pavel Pachta, Dr. Pachta as a former Deputy Secretary of the Narcotics Control Board, the INCB. Dr. Pachta has numerous insights in the medical cannabis industry and approaches for regulations. He is former Chief of Narcotics Control and Estimate section at the Secretariat of the INCB at the United Nations Office of Drug and Crime, the UNODC. Dr. Pachta provides consultancy on international drug regulations to companies, governments and NGOs.

 

Dr. Pavel Pachta, International Narcotics Control Board (INCB), former Deputy Secretary: Yes, thank you. Thank you, dear colleagues, and it’s very nice to see some of you. I can see some, some faces and in such nice company. I was asked to say something about the regulations and about the global regulations of cannabis and cannabis products under the 1961 convention. You all know that cannabis from the beginning when the convention was drafted in the 1950s, when it was adopted in 1961, cannabis was included in the schedules of that convention–was included in the so called schedule one–with many other narcotic drugs. But, specific for cannabis, cannabis was included also in schedule four of the 1961 convention. And this is a very specific schedule, which contains substances that are considered to be very dangerous, and by the same time they do not have any significant medical usefulness. So that was the location under the 1961 convention of cannabis cannabis resin. It should be stated that for substances for drugs in schedule four, for the convention invites parties to consider the prohibition even for medical and scientific purposes, except for some very limited, limited uses. So that was the situation of cannabis. And the use of cannabis worldwide has really since 1961, decreased, you know that, and it was then only gradually starting with the pharmaceutical industry, which understood that some cannabinoids may have medical usefulness. And then of course, with the patients who basically knew that cannabis is helping them so the initiative came from the patient’s community, and gradually, they’re starting to process in the world of understanding what this cannabis, and that it is medically useful. I think most of you know about all these developments and what   had happened during the years. But we all know that, finally, in December 2020, the UN Commission on Narcotic Drugs, decided to delete cannabis and cannabis resin from schedule four of the 1961 convention, that was a very important event. That was very important because it freed cannabis from the stigma of very dangerous substance with no significant medical use. And, of course, it opens the way for an increase in this in its medical use worldwide. When this change had be done, so I have to again remind that cannabis continues to be in schedule one, and cannabis resin continues to be in schedule one of the 1961 convention, so cannabis is considered by the parties to this convention as a narcotic drug. However, I think that it would appear that in the near future, it will be very difficult to expect that the governments worldwide would agree under the 1961 convention to to delete cannabis at all from the international drug control and to delete it from schedule one of the 1961 convention.

That means that we are speaking of course about medical uses, and that means that recreational use of cannabis continues not to be in-line with the provisions of the 1961 convention. So what does it mean when in December 2020, the Commission on Narcotic Drugs decided that cannabis is decided that cannabis should be deleted from schedule four, what we can expect from that? Well we can expect that more countries will now allow the use of cannabis for medical purposes. Now, of course, we are only a few months from December 2020. We are in March 2022. Of course this is this period of pandemic. So this is not the best time for some big progress in this area. There are so many other priorities. And in fact, we have now again in Ukraine, such tragic, tragic developments which bring us in the world to other issues, and not only the subject of our discussion. Anyways, we can expect that there will be more countries using cannabis for medical purposes. Basically, when a scheduling decision is taken by the Commission on Narcotic Drugs, governments are informed by the Secretary General of the United Nations about this decision. And governments are required, more or less immediately that they receive this information, to start implementing this decision. And that means, if governments were prohibiting the use of cannabis for medical purposes, now the situation should change and they should delete it from those strictest controls, which might apply for heroin, which might apply for some fentanyl derivatives, but should not anymore apply for cannabis. Government’s have an obligation to report to the International Narcotics Control Board on the narcotic drugs from the production on the manufacturer on, onthe trade consumption. So you get some information and they also estimate the quantities which they need for legitimate purposes; they are submitting so-called estimates of legitimate requirements for cannabis. I must say that when I checked the information on the website of the International Narcotics Control Board, I could find that in 54 countries around the world, there is a requirement which is higher than one kilogramme. So I would, so the legitimate requirement for cannabis is considered in only 54 countries to be more than one kilogramme, I think this is still shows what still has to be done, because that means that the use of cannabis for medical purposes continues to be limited to maximum one quarter of the countries and territories around the world. We can see that there is the use of cannabis for medical purposes in North America, in some countries in Latin America, in the Caribbean, in Europe. However, the use of cannabis for medical purposes like in countries in Asia, except for Thailand, is in fact, extremely, extremely low. So similarly in Africa, except for, let’s say, the Republic of South Africa, there are no significant requirements for the consumption of medical cannabis in the African countries reported to the INCB. So I think this is something which the civil society may interest to look into because governments have the obligation to really look into the legislative and administrative systems for cannabis and cannabis resin, and to allow for the medical use. It would be good to check really around the word whether the situation is like that. And whether cannabis. How is this in the respective countries, I think this is very much for the civil society to talk to the authorities and to check on that. Among these 54 countries, which have a requirement for more than one kilogramme, there were of course, however, however, 22 countries which have a requirement for more than one kilogram, we know that countries like Canada, with very, very significant consumption of cannabis for medical purposes, the requirements reported can’t be 205 [?] tonnes. This year, we know about Israel which reported last year an increase in the consumption of cannabis to import this three tonnes and for this year, I think Israel has even predicted higher use of cannabis 49 tonnes. So, that’s really showing the situation around the world. It is interesting to note that what is increasing is also the number of countries which are interested in medical cannabis as producers, countries which would like to supply cannabis to the world markets. So people say that if you take into account the European markets for cannabis, in particular the German market, the traditional suppliers for the German market of medical cannabis in recent years were first of all Canada and the Netherlands. But now in just last year, and the year before additional countries are coming. So medical cannabis is coming to Europe from many many other countries and several countries are ready to to start this this production to supply a global market. 

So that means that there is an increasing number of countries which are producing cannabis for the world market. And it’s sometimes I would say sad that these countries are producing and ready to allow supply to certain markets, but in their respective countries there is none or very limited consumption of medical cannabis. So, this is something which I think has to be taken into account. The world (should) open the way, the Commission on Narcotic Drugs (should) open the way for the medical use of cannabis worldwide. But for the time being, it is shown that the number of countries really using it is not so high. And we can hope for improvement in the future. What can you hope else in addition to these changes with the Commission on Narcotic Drugs? This was a great change also from the point of view, that we can expect that there will be much more research with medical cannabis and we can hope that medical cannabis products will come to the market and this will help the research overcome the problems which exist in some countries. And this is reported also for example, from Germany, a big medical cannabis market, where the use is somewhat limited. And this is really limited to use cannabis only in cases where it is proved that cannabis may help. And this is of course, this research must help a lot in that and this can improve the situation. So to develop the medical cannabis market, you need patients getting interested in cannabis, and you need suppliers getting interested in cannabis. But we also need medical doctors prescribing and in many countries, you know, that is considered to be a somewhat weak point. So still this use of medical cannabis by doctors is not at the level we would like or you would like to see. So that’s something which is, I think, also an area where through training, an improvement may be achieved. If you look at manufacturers, if you look at consumers, the control mechanisms around the world are different from country to country. I would say that the 1961 convention provides for a lot of flexibility on how to organise the cannabis market or the production of cannabis. We should understand that we are producing medical cannabis, medical cannabis, it is not cannabis like it used to be produced somewhere around the world in the 1950s in large quantities. This is specific medical cannabis of high quality. So, so the control requirements can be flexible. And I personally, for example, think that this is really not necessary to establish the mechanism of government monopoly for medical cannabis in the countries, like some countries have it, for example, the Netherlands has or Germany has. So this is in my opinion, really not necessary to achieve the objective of the convention. And in particular, if we look at the convention from the point of view that we speak about medical cannabis, we do not speak about some uncontrolled production of cannabis worldwide. 

So, this again is an area where a lot can be done. I hope that also the pharmaceutical industry and the medical cannabis industry will help. For the patients I think it is very important to get this involvement of doctors and this involvement of the medical cannabis industry and pharmaceutical industry because you would like to get products which are safe, which are effective and which have the appropriate quality. So these are the basic requirements for medical products: safety, efficacy and quality. And this is then the best also for the patients. And this is of course, very important also to achieve support from insurance for the patients. It is very important that the insurance companies, the insurance schemes in various countries around the world include cannabis. Please, if we follow this commission the session of Commission on Narcotic Drugs and if you see the statements made, for example, during the first day, you can hear that such international control bodies like the INCB, the compare the UNODC and others, WHO, are very much supporting the availability on control substances for medical and scientific purposes. So, let’s take advantage of this approach of international control bodies and let’s push on the government’s to facilitate this use. Thank you very much.

 

Etienne Fontanne, Veterans Action Council: Thank you very much, Dr. Pachta for your time today. Next up is speaker Michael Krawitz. Michael Krawitz is the executive director of Veterans for Medical Cannabis Access, a member of Virginia’s cannabis control authority cannabis, Public Health Advisory Council, and the Veterans Action Council. Michael is a disabled United States Air Force veteran and has worked on cannabis policy within the United Nations system since 1997. Mr. Krawitz:

 

Michael Krawitz, Veterans for Medical Cannabis Access, Executive Director: Thank you, Jim. It’s great to virtually see everyone this morning. Good morning, everyone. I guess you could call this a report from the field. I want to try to make sure we give time to our last couple of speakers. We have Brian Buckley and also Carola Perez speaking after me, all three of us speaking from the patient perspective, I guess you could say, I’m the activist patient, I guess, speaking for the perspective of the inside view of cannabis activism at the United Nations and around the world. And especially, of course, in the United States, where I where I hail in the mountains of southwest Virginia. First thing I want to point to and quote attention to [missing names], and myself are very proud to have our first journal article of the series that sums up the last couple years of our work published in the Drugs Habits and Social Policy journal. And it’s the WHO’S first scientific review of medicinal cannabis from global struggle to patient implications. And it’s an amazing story. I’ll tell you a little backstory, just to give you a taste. It’s a fantastic adventure through the last five years of our lives, working through Geneva, where the World Health Organisation and Vienna with the Commission Narcotic Drugs, and this outstanding change in the treaty that Dr. Pachta described. But the story is this, they being the World Health Organisation, they began this process saying that there was a review of cannabis back in 1935. And our team went to the library of the World Health Organisation in Geneva and had to dig back in the books of the League of Nations, because this was 1935 before the United Nations was actually  the League of Nations medical committee. So it was before what we call the World Health Organisation as well. And they cracked open these books because a lot if not most, all this stuff was in French. So I really couldn’t help much in reading this stuff. But an amazing story of how cannabis was entered into control. And that story, the bigger story is on the web, we’ve got the 75 page document that this journal article is called from on the web, please do check it out. Just look up our names and you can find that under ResearchGate. But we actually found and proved to the World Health Organisation that in fact, there wasn’t a review in 1935. That was a misnomer. And in fact, cannabis was never reviewed. What that means is that it was entered into control in the treaty without ever having conducted any scientific evaluation at all. And just a quick walk through my last couple things. I want to talk about a short history of medical marijuana and medical cannabis in the United States, and how Appellations of Origin fit into this stuff.

So very briefly, a short history of medical cannabis in United States: Doctor Shaughnessy, was published in the journals in the 1850s in the United States. That started the cannabis experiment, which I think hit its peak around 1900, where the journal articles read something like this? Can there ever be a cannabis Americana product that’s worth using? But in fact, they answered that and they did come up with a cannabis product that was worth using. And the way I usually describe this is the veterans came back from World War One and they found pharmacy shelves filled with cannabis products. Our veterans came back from World War Two and those products were literally stripped from the shelves. Cannabis was removed from the formulary and removed from the Pharmacopoeia. And then the veterans came back from Vietnam with and I guess Korea as well with duffel bags full of cannabis, which started the new cannabis experiment and doctors like Dr. Weil and Dr. Andrew Weil and Dr. Todd McKorea and Dr. Lester Grinspoon and others respond to the imagination of the medical community had to go back 100 years to bring in the the medical texts, and here we are today. And the last thing I’ll just say Appellations of Origin, speak to the geographically spit specific cannabis varieties that are very special. And I just want to say a couple quick things about that. One is patients need a variety of patient plant materials to get their best outcome. This is something that we’ve had a great deal of difficulty putting into a bottle putting into a capsule putting into a formula, the United States federal government likes to put everything in a, you know, just a molecule. Well, we haven’t been able to do that with a single molecule or group of molecules that elegantly comes up with that entourage effect, or as he likes to call it the Ensembl effect. So Appellations of Origin can help patients get connected with this plant material that gives them very special outcomes. And think about this, if a patient is using very high dose cannabis extracts, like, let’s say, for treatment of symptoms of side effects of cancer, and using very small, very large actually, doses of these strong extracts, wouldn’t it be nice if they were sourced from places geographically known places to have low heavy metal concentrations, low dangerous things in the soil, that you don’t even have to worry so much about the individual farm because the whole region is safer geographically, and I think that helps the consumer be safer and pick a better product. And it also helps to spread this out where you have small farmers around the world that can benefit from cannabis and cannabis cultivation for therapeutic purposes under an indigenous and traditional medicinal use model that goes back eons , and we need to benefit from that experience and give back to those communities. Thank you so much.

 

Etienne Fontanne, Veterans Action Council: Thank you, Michael Krawitz, for your decades of dedication to this subject. Our next speaker will be Bryan Buckley.

 

Bryan Buckley, owner of Helmand Valley Growers Company, founder of Battle Brothers Foundation: Thank you, good morning, esteemed colleagues, and greetings from San Diego, California. My name is Brian Buckley. I served the United States military and in United States Special Operations. I am the owner of Helmand Valley Growers Company, a cannabis organization that dedicates 100% of its profits to veteran medical cannabis research. I’m also the founder of Battle Brothers Foundation, a nonprofit that empowers us veterans through personal medical and economic pillars, and a proud member of the Veterans Action Council. During my military career, I served in Iraq, Africa, Southeast Asia, and Afghanistan. I’m a recipient of our nation’s Purple Heart Medal for wounds received during combat operations, and had been diagnosed as a 100% Disabled Veteran by the Veteran Health Administration. After my transition from the military, my mind and my body began to feel the full impacts of combat. My soul was enveloped by war. From the moment I would wake, I thought of combat. Throughout the day, hyper vigilance would devour my thoughts, who were my threats and who was in danger. At night, the shrapnel in my body would cause my joints to swell and memories of the battlefield would consume my emotions. Sleep was no longer a luxury I had. I was in my own personal war, a war with my body. Veteran Health Administration was providing me pills with the hopes that would combat my pain, ease my emotions during the day and provide much needed sleep at night. They were doing the best they could with the tools that they had. Sadly, this was only exasperating my ailments. In 2016, I was introduced to cannabis. I had my reluctance, but I was desperate. Once I consumed the medicine, my life instantly changed. No longer was I feeling swollen joints. No longer was my mind racing to identify potential threats. No longer did I lay in my bed and stare into the night. I was no longer at war, my soul returned to my body. I was at peace. After the attacks on America on September 11 2001, through current day, America has been engaged in the global war on terrorism. During this time, we have had 7070 service members killed on the battlefield. During that same time period, nearly 31,000 veterans and active duty members have committed suicide. In essence, it is more dangerous for our service members to be home in America than it is to be in combat operations. The pills that we were being prescribed are not working. Our brave men and women are physically returning from combat, but their souls remain at war. That war is taking their lives daily. America lists cannabis as a schedule one drug meeting under the Controlled Substances Act, cannabis has a high potential for abuse, no currently accepted medical use and treatment and a lack of accepted safety for the use under medical supervision. Not only can the Veterans Health Administration not prescribe cannabis to those needs, they have conducted very limited research. For veterans to obtain life saving treatment, they must spend their own money, and many are forced to purchase cannabis in the illicit market with no idea of what they’re putting into their body. After the life changing results that I’ve personally experienced from cannabis, I knew I had to help our veterans, not just on the advocation front, but how can I win the hearts and minds of our elected officials in the United States Congress. I had an opportunity to meet with members of US Congress and I asked them what is needed in order to make medical cannabis federally legally United States, and had the ability for the Veterans Health Administration to prescribe and provide medical cannabis to veterans. I was told if I could get data and have it backed by United States doctors, I would have a case. Being the marine that I am, I told them no problem. But as soon as I walked out the door I thought how the heck am I going to do this? Through my nonprofit Battle Brothers Foundation, I formed a partnership with nine medic healthcare research services out of Israel, and the University of California at Irvine.

We submitted a study design to an Institutional Review Board, which is a group of doctors that has been formally designated to review and monitor biomedical research involving human beings. This falls under the Food and Drug Administration Regulations. Our study is to examine if medical cannabis can reduce the symptoms of post traumatic stress within veterans. Our steering committee is led by Dr. Victor Novak from Nyan medic and our principal investigator is Dr. Marcella Dominguez from the University of California Irvine. The goal of this study is not only to prove that medical cannabis can reduce the symptoms of post traumatic stress, but to also create a formulation and a treatment protocol. And it is with great honor to say that our study design was approved by the IRB, and we are finalizing funding to begin our research. I often think our government sent us to war, but they are not doing everything possible to help us recover from combat, both physically and mentally. That is why we are no longer waiting for our government to conduct the much needed research. We will do it ourselves and prove to our elected officials that cannabis is medicine that can save the lives of our nation’s heroes. After all, post traumatic stress is not a veteran issue. It is a human condition. And in this Veterans opinion, cannabis is the medicine that can help reduce this tragic disorder that has taken so many lives. I want to thank you all for your time and your consideration.

 

Etienne Fontanne, Veterans Action Council: Thank you for your important work Mr. Buckley and we wish you success on your mission. Our final speaker this morning is Carola Perez. Carola Perez is a director of Dosemociones project and the Spanish Observatorio Español de cannabis Medicinel the IECM, two distinct organizations working in the field of dissemination of public scientific knowledge about cannabis. Corolla is a team leader of the International Association for cannabis as medicine patient coalition, and has a valuable perspective both as a patient and as an advocate of medical cannabis access. Miss Perez:

 

Carola Perez, Dos Emociones Project & the Spanish Observatorio Español de Cannabis Medicinel (IECM): Thank you so much for this amazing opportunity to be here with you today. Thank you so much for listening to us. I would like to thank all my colleagues, all the patients associations around the world that we are working in silence day by day, year by year to take them out to make the world a better place after suffering from severe illnesses and conditions. Thank you, Michael, for giving us this opportunity for the IECM here. Well, my name is Carla Paris, I come from Spain. I’m a patient myself too. I suffer from very severe chronic neuropathic pain after 13 surgeries on my back. After they removed my coccyx bone when I was 18 years old, I could spend my whole time explaining shout my pain, but it’s about all our pains and suffering. Well, we all agree that we patients deserve quality of life. This is a human rights issue. All our colleagues have insisted and you will have heard all our stories. And you will realize  that we all have common messages. If cannabis works for you, it really changes your lives. We are patients, we didn’t choose to suffer. And we need help. We need empathy. We need science. And we need you by our sides. We offer you or all our experience or our knowledge in these difficult times of humanity. And in 2022 We all deserve to be treated with all the tools possible. We reserve the right to choose the best treatment for us. And our doctors need to have the right to treat us with all the tools they can. And cannabis is one of these tools. I want to make a special mention to [missing name], the executive director of IECM because he has been working with us for 20 years. And he is one of these researchers that always says patients first. This is maybe the first time in medicine as some colleagues have already said, that patience more quickly than science because our pain cannot wait. And if governments don’t put some effort into research, we will and maybe we can go to jail. Maybe we are prosecuted, but if something changes your life and the decisions are so very unfair. Please realize that if you were asked you will do the same for helping people who are in pain. As we all know, for example, we patients don’t have the same drive to have the same treatment all around Europe, all around the world. Why is the German patient having some medicine that I, a Spanish patient cannot have? Why in this AI times and big data times we need these clinical trials placebo, double blind etc. They are needed, of course but we don’t have time. For them to come. One right we need is to have the right to have access for standardized products. Our right to have our medicine accessible to anyone with no relationship with religion, race or economical issues. As was said before, the use is limited in Canada right now and we have so many opportunities to deliver in these cannabis markets and patients suppliers and the doctors prescribing have to be in the middle of all of this. I also would like to thank all the growers, breeders, seed banks and all the people who have been taking so much risk in order to give us free info and help us patients to do what we’re doing right now, to find some quality of life. Of course, a lot can be done, a lot has to be done. The ACM patient Council is an international coalition of patients’ organizations all around the world, that we are here to help and give a voice to patients of this world over and over together in order to protect our rights and interests.

We are under the auspice of the International Association of cannabinoid medicines and work includes alliances with the IECM to uphold the level of professionalism that has been associated with IECM since we are the patients, we are the family of the patients, we are the caterer, the caretakers, and we have joined together to improve our upon the rules of access for those who require cannabis. We believe that the world patient belongs at the centre of this community and that the needs of the patient must be the focus for all scientific communities, for our health care providers, and for members of the cannabis industry as a whole. That all patients are equal and must have equal access to cannabis and cannabinoids for medical treatments, no matter where they live, and regardless, or financing status. As I have said before, that all patients have the right to seek guidance and assistance from appropriately trained medical medical personnel. The right to grow our medicines in these conditions we are right now here in our countries where we don’t have access to proper products, at least, that cannabis products when used as medicine must be included in national health programmes and covered by both public and private insurance programmes. And that the medical profession must open their eyes up to the possibility of cannabis being a viable option to the patients to inform and educate patients, caretakers, and health care professionals as well as the media and the public at large while supporting and encouraging members of the scientific community and improving cooperation with industry. We are here at your disposal. If you need anything from us, please ask us. And please don’t forget that patients need to be in the center of this discussion. Thank you so much for the opportunity again. And it was my pleasure to be here for the first time. Thank you. Thank you.

 

Etienne Fontanne, Veterans Action Council: Thank you for your important work and we wish you success as well Carola Perez. This will wrap up our speaker portion of our site event the Global Access to Medicinal Cannabis Programmes: challenges and solution. We have run over time slightly and for those that may need to leave as you have another meeting at nine. This would be your opportunity at this time. We are here to see if there are any follow up questions at this time, especially from those of national delegations. Any questions at this time? Please raise your hand.

 

Thank you. Mr. Kenzi Rabelais Zimmerli, you’re recognised.

 

Guest: Yes, thank you. Hello, everybody. I hope you can hear me. Thank you, everybody for the great presentation. Just I had a quick question. Maybe a quick follow up, but there is always some programmatic issue of home cultivation for patients. And I will just like to have a quick reaction from the speakers. 

 

Bryan Buckley, owner of Helmand Valley Growers Company, founder of Battle Brothers Foundation: Hi, Etn. Kanzi, just so unclear, did you say how do we feel about patients conducting homegrown operations?

 

Guest: Yes, it’s a debate. So and in particular, in the context of the convention, we always says access is provided for candidates in medicine but when it comes to, you know, that access an the possibility to grow at home with the possibility which exists for other medicinal plants by the way, it’s not often that evident for cannabis. So maybe patients have something to say about that.

 

Bryan Buckley, owner of Helmand Valley Growers Company, founder of Battle Brothers Foundation: Yeah, I’m, I’m on the cannabis brand owner and you know people buy our cannabis from stores and but I’m 100% for veterans are not veterans, any patient growing their own medicine, I think there is a great thing with agro therapy, I just think it’s a kind of the hidden medicine people don’t think about where you sit there and take care of your plant. And, you know, I’ve just heard a lot of great feedback, I’d say speak from a veterans angle. But we know just a lot of vets love to go and grow and cultivate. And that’s kind of part of the reason how we got into this is, you know, one of our one of my friends, he wants to set up a security plan for a cultivation site, and they said, how much do we owe you and he’s like, just teach me what you do. And he said, it helped me transition from a warrior to a gardener. So I just thought it was an incredibly impactful thing to do.

 

Etienne Fontanne, Veterans Action Council: Thank you, Councilmember Buckley. Michael Krawitz, you’re recognised.

 

Michael Krawitz, Veterans for Medical Cannabis Access, Executive Director: Thank you, Jen. I, I think the thing that comes to mind to talk about with home cultivation is an experience that I had, I was going with Kenzi to a investors meeting is this international meeting that was being held in Barcelona, have a big investment group working on cannabis, I can’t remember the name, which I guess is convenient. So I don’t give him a plug by accident. But, uh, anyway, I would if I can remember the name. But anyway, I was on the stage talking about home cultivation. And I, I thought it was an interesting comparison to talk about downloading music. And the thing I was talking against really, was this notion that seems very pervasive and even shows up sometimes in law in the United States, where it seems that the home cultivator is at odds with the industry that produces cannabis and sells cannabis. But that isn’t the case. And it shouldn’t be the case. And I thought talking about downloading music was a good example, because that was the theory. But it didn’t work out that way. Downloading music did not destroy the music industry, it created a new type of industry. So anyway, to my surprise, this is a part of the story that I thought was interesting. The next speaker who’s this really great investment, high ranking investment banker, agreed with me and took it one step further and and really carried the ball on that on that discussion; it’s absolutely important for people to be able to grow their own, you get a therapeutic benefit from cultivating cannabis you get from just the interaction with the plant, you get this therapeutic benefit. And maybe even more than that, it’s like having, you know, a puppy or something. I mean, it’s something that depends on you, that requires you to survive, and that you develop a relationship with this actually can help people, you know, survive in the situations that Brian was talking about. So I think it’s really incredibly important. 

 

Dr. Pavel Pachta, International Narcotics Control Board (INCB), former Deputy Secretary: Thank you. I only would like to comment very briefly, from my opinion on the conventions in this regard. As Kanzi knows very well, there might be very different interpretations of the conventions and various provisions of the conventions. I personally think that this is possible under the 1961 conversion for governments to authorize the domestic cultivation of the cannabis plant. So this, this could be this could be possible. Of course, the question is, as I recall, the international equities control board was always referring to was the issue of the quality safety and efficacy of the of the product people are getting, so are the caregivers or other patients really, in a position to produce the best, best kind of from my point of view?

 

Etienne Fontanne, Veterans Action Council: Thank you and Miss Perez.

 

Carola Perez, Dos Emociones Project & the Spanish Observatorio Español de Cannabis Medicinel (IECM), Founder: Thank you. About self growing, I talked a little bit before about the situation here. For example, I grow here in my play 16 different strains, because my quality of life depends on this because in Spain, we don’t have access, just to Sativex and Epidiolex, so yes, I have to make my own my own oils, my own topicals, my own vaporizing tools and everything. Also I have a question for all of you: what kind of products are we going to get to be given in this industry where, for example, when we talk to other Patients Association around Europe, they don’t have a standardized like terpene profile, for example, the flowers they have been given. So you need to realize that we patients will have to be under THC effect all day. So we really have to find the proper dose for us. So we need to know each moment of the day with what we are taking. For example, you can make responsible home growers like we do in Spain, by teaching patients how to grow properly, by giving them free analysis by Fundacion [Canna?] or whatever, and a laboratory can help us to know what are the cannabinoid and terpene profiles in our extracts. So yeah, I also think that when I go on surgery, I have to be three, three months laying face down. And it’s really difficult for me to do my plants because I need the help of some friends or my parents. So I think there is a place for everyone. Of course, I agree with self growing if the patient has the proper knowledge and tools to make analysis of the products. But also we need to take care of these people who cannot grow at home because they don’t have the access or maybe the knowledge. So there is a place for everyone. And I think it’s our right as we have been abandoned for so many years to let us continue with our work and research. But at the same time, we need to provide people with some quality products. 

 

Bryan Buckley, owner of Helmand Valley Growers Company, founder of Battle Brothers Foundation: As a patient myself of 30 plus years I have become dependent on the availability to home grow and we encourage veterans to home grow if possible. There is a thing called Grow Therapy by just growing a plant and working alongside something that’s living while you’re going through and struggling can be very uplifting if you again, have the availability to grow so we want to see that continue and that opportunity be available for everyone as Miss Perez, eloquently spoke toward, but we also need access to quality medication. As I have stated growing cannabis is easy. Growing medical grade cannabis is hard. Growing medical grade cannabis consistently is an art form and it is not easy to do and requires a lot of expertise and understanding of plants and genetics. I now recognise [missing].

 

Guest: Hello, everybody. Thank you for opening the floor. Just one quick question and little remarks. From your testimonies. There is a kind of empiric experience that shows that cannabis works as a medicine and the full plant works as a medicine. Actually we know that there are some kinds of drugs made from cannabis like Sativex, which is a compound compounded with 50% of THC and 50% of CBD which is not possible to find in nature. But from my view, and from the testimonies I received, people, patients are more willing to take the natural plants because of its entourage effects, than to choose the medicines that come after years and years of research. So would you mind telling us and especially the patient, but maybe also Carola about this entourage effect about the fact that there is not only cannabis but also other compounds that are interesting, in this view of trying to heal the people, thank you.

 

Carola Perez, Dos Emociones Project & the Spanish Observatorio Español de Cannabis Medicinel (IECM): Thank you. I use Sativex myself I have a prescription of Sativex and I have to say that Sativex is a product that makes it’s work it’s as you said rate you want to one it’s a secure, you know with its path, you get 2.5 2.7 Our CBD THC product, but the thing is that Sativex, I always say an in comparison like having Sativex or using whole the whole possibilities that the plant gives you, it’s like using one drop of one ocean. You know, Sativex is alright. It’s an extract from the plant and is made with ethanol so it burns your throat a little bit but you can use it with milk. [missing] in 2014, but well Sativex is okay but we have so many other opportunities of using other products with different rates of cannabinoids perfume profiles, ways of administration, because Sativex also has its advantages and disadvantages, such as vaporizing does or transdermal patches or whatever, as other products cannabis products you want to use. So I have to thank Sativex for having compassionate medicine here in Spain. But if I have to be honest, I don’t use it that much because I prefer, as you said the whole plant. All the things that I made I prefer to choose sometimes so they’re perfect, perfect terpene profiles or cannabinoid profiles. Also Sativex makes me cry a lot because it’s like really sativa and well, it has sometimes it gives you this psycho activity that is difficult to to deal with all the time and night and for example my radio is not one to one, but three two one, four to one, because I need high doses of THC. So yeah, I think Sativex is alright, I think [missing] is alright, but we have so many things to discover and to try with patients of course.

 

Etienne Fontanne, Veterans Action Council: This kind of follows up, Liam asked a question to the panel: is splitting the subunit cannabinoids as unique drugs the way forward for reclassifying cannabinoids in a UN convention and in domestic regulation? I think as [missing] and Carola spoke eloquently, many of us are fans of whole plant medicine. This isolation of single compounds has been challenging. There needs to be a recognition of the whole plant medicine but at the same time, we do know that your conventional medicines are usually single cell compounds. So we are aware that there is as stated a need for both. Does anybody or another member wish to speak toward Liam’s question regarding that?

Okay, if there are no other questions, I would like to once again thank the European Coalition for Just and Effective Drug Policy, known as ENCOD or encod.org, and also the Veterans Action Council at Veterans Action Council.com for hosting this side event. I would also like to thank our panelists, Dr. Pachta, Ethan Russo, Michael Krawitz, Bryan Buckley, Carola Perez, and myself Etienne Fontanne. We would like to thank you for joining us this morning. And if there’s anything else at this time, I think we will wrap it up. So my name is Etienne Fontanne with the Veterans Action Council and Berkeley Patients Group, the United States’ oldest operating cannabis dispensary in the United States. Good day and thank you all!

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