Albert Francis E. Domingo, MD

my flight of ideas

From Guilty Pleasure to Medicinal Measure: Evolving Cannabis Policy in the Philippines

Posted on | October 23, 2014 | No Comments

When is a drug “therapeutic” as opposed to “recreational”? The first term connotes an established usage in clinical medicine, while the second implies use for leisure with attendant state intervention in varying degrees across multiple jurisdictions.

Cannabis, which is more commonly known as marijuana, has the primary psychoactive ingredient Δ9-tetrahydrocannabinol (THC); other molecules found in its leafy plant include dronabinol and nabilone, both indicated as anti-emetics in cancer treatment and as anti-anorexics for patients with AIDS (Borgelt L.M. et al. 2013).  However, caution has been aired as regards risks versus benefits of medical cannabis use, most significantly with its primary psychotic action (Pierre J.M. 2010).

Following the framework of Calman K. (2009, p.e8)’s intervention ladder, the Philippine state can be said to have eliminated choice when it comes to cannabis, which is a heavily regulated (in fact, prohibited) substance by law (Anon 2002). That may change to something weaker (such as guide choices through disincentives, or even as weak as enabled choice) depending on how a proposed legislative bill will sail through Congress (Geronimo J.Y. 2014a). It would be worth mentioning in relation to the de jure prohibition of particular drugs in the Philippines as elsewhere that some attempts to rationally assess the harm of drugs of potential misuse have shown that such regulatory systems may have a different ranking, and one that may be based on an unspecified or obscured methodology or process (Nutt D. et al. 2007).

The international debate on risks versus benefits of medical use of the traditionally regulated substance is as complicated in the Philippines as it is elsewhere, with healthcare provider groups such as the Philippine Medical Association (PMA) and its affiliate specialty organisations opposing the legislative measure by saying that it is “contrary to the policy of the state to safeguard the well-being of its citizenry particularly the youth from the harmful effects of dangerous drugs” (Geronimo J.Y. 2014b). It would be interesting to find out how much of this zeal to protect the public against the “ill effects” of illicit drugs is founded on what Parker R.N. and K. Auerhahn (1998, p.293) point out to be an ideological tendency “to lump all illicit drugs together, as if all drugs might be expected to have the same relationship to violent behavior.”

While it is becoming a battle of evidence-based policy making versus eminence-based policy advocacy, at this point it might help advocates both for and against the shift in Philippine policy on medical cannabis to appreciate that state protections to safeguard health are not completely black-or-white prescriptions – with frameworks like Calman’s allowing for gradients.

[Note: This is provided purely as an example of one of the academic requirements (specifically, the online seminar) of the course “Population Health and Health Policy” offered by the Global Public Health Unit, School of Social and Political Science, University of Edinburgh. The views expressed are entirely my own, and are not necessarily offered as expert advice in this forum of the internet.]  

 

Work(s) Cited:

  • Philippines. An Act Instituting the Comprehensive Dangerous Drugs Act of 2002, repealing Republic Act No. 6425, otherwise known as The Dangerous Drugs Act of 1972, as amended, Providing Funds Therefor, and for Other Purposes. Congress.
  • Borgelt, L.M. et al. (2013) The Pharmacologic and Clinical Effects of Medical Cannabis. Pharmacotherapy, 33(2), pp.195-209.
  • Calman, K. (2009) Beyond the ‘nanny state’: Stewardship and public health. Public Health, 123, pp.e6-e10.
  • Geronimo, J.Y. (2014a) Bill on medical use of marijuana filed in Congress. Journal, [Online]. Available at: http://www.rappler.com/nation/59118-compassionate-use-medical-cannabis-bill [Accessed: 23 October 2014].
  • Geronimo, J.Y. (2014b) PH doctors say no to medical marijuana bill. Journal, [Online]. Available at: http://www.rappler.com/nation/72172-ph-doctors-medical-marijuana-bill[Accessed: 23 October 2014].
  • Nutt, D. et al. (2007) Development of a rational scale to assess the harm of drugs of potential misuse. The Lancet, 369, pp.1047-1053.
  • Parker, R.N. and K. Auerhahn. (1998) Alcohol, Drugs, and Violence. Annual Review of Sociology, 24, pp.291-311.
  • Pierre, J.M. (2010) Psychosis Associated With Medical Marijuana: Risk vs. Benefits of Medicinal Cannabis Use. American Journal of Psychiatry, 167, pp.598-599.
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