ENCOD BULLETIN ON DRUG POLICIES IN EUROPE
MEDICAL CANNABIS IN ITALY
The European Union claims among its highest goals the preservation of health for its citizens. After years of activism by groups of patients and professionals, some European states have approved partial legal access to medical cannabis and cannabinoids. This is the case for Germany, Finland, Austria, Switzerland, Netherlands, Spain and Italy. However, the legal way to obtain medical cannabis, although theoretically possible, is often difficult if not impossible for most people.
Access to medical cannabis in Italy is not easy, not only because of restrictive laws but also due to cultural and political obstacles, not to mention the costs. Italian doctors suggest that the patient should try out all possible medicines before being recommended for cannabis treatment. Some institutions or professionals help only patients whose situation is terminal. That is a cynical and in some cases inhuman attitude which is paramount to torture for many patients.
The medical staff in many places avoids working in what they believe are controversial areas. A good example of this attitude is the procedure for abortion in Italy’s public hospitals. Althought entirely legal, it has become quite difficult if not impossible in some regions.
In Italy we are supposed to have the best rules for medical cannabis that nevertheless are in accord with one of the worst drug laws in Europe. Posession of 0,5 gramme of THC or cultivation of a few cannabis plants can be punished with 6 to 20 years imprisonment. Two consecutive right wing governments declared a war on cannabis consumers that now produces 75% of the criminal cases prosecuted. This in turn has produced the deplorable situation where fully 40% of the prison population has resulted from the infamous Fini-Giovanardi law on drugs.
The right to health is anchored in the article 32 of the Constitution and this principle has been confirmed for cannabis by the Decree of Ms. Livia Turco issued on April 18, 2007. This decree considers THC among the substances of therapeutic importance and suitable for medical prescription, allowing pharmacies to distribute galenic preparations as well as importing cannabis preparations produced outside Italy.
But the guidelines have generally not been adhered to and there are many problems to obtain prescriptions. In fact, most politicians, the general public and even the large majority of cannabis users still think medical cannabis is illegal. Even doctors tend to ignore that the favorite imported medical cannabinoids are just cannabis flowers.
Health minister Andrea Riccardi wants a discussion on drug policies to take place in a regularly elected government but the staff of his Antidrug Department continues on the same outdated pathway, recently publishing an ideological antidrug manifesto signed by many medical directors and warning about the dangers of illegal cannabis. This sounds like a warning to the professionals who may not be aware of the present legal status of medical cannabis.
On the Italian legal market it is theoretically possible for patients to obtain most cannabinoids legally produced on the planet. Even though not produced in Italy, synthetic and natural products as well the dried female blossoms with a well defined content of active components should be available.
The costs of cannabis products can be reimbursed by the Health National Service if they have been prescribed by a hospital surgeon, when the budget of the institution allows and when used at the hospital level. It is completely at the discretion of the surgeon which pathologies and symptoms qualify the patient for cannabis.
Medication begins within 3-4 days after the request in the case of galenic preparations and only after 2-3 months for cannabis products imported from another country. At this point the pharmacist delivers the prescription directly to the surgeon or even to the patient, after the payment of the wholesale price requested by the producer. The patient will pay much less than the pharmacy price in the producing country: the italian health service does not apply any surcharge. In Germany, for example, herbal cannabis flowers can cost much more than in the producing country, but that is not the case for Italy.
Unfortunately for most qualifying patients, it is quite difficult to find out how to obtain medical cannabis products. There are some organisations like the PIC, Impatient Patients using Cannabis, but they have a very basic structure and cannot reach most people that need help for coping with a quite complicated bureaucratic procedure.
Lacking a more efficient importation procedure or the Italian production of medical cannabis products, at least it is possible to import medical cannabis that costs less than that payed in the production country. So would it not be better to continue importing relatively cheap medical cannabis? Leave everything like it is now and work to make the medical staff more sensitive to the issue in view of its present reluctance?
On this point a member of the Impatient Patients using Cannabis answered that “yes, theoretically from the viewpoint of the freedom of access, it would be better that everything would stay as it is, with all therapeutic potentials already feasible on the national level, but only in the case that the surgeons would really prescribe those drugs and their preparations, and the hospitals would not hinder the application of the actual norms. Unfortunately this is not the case, and it is necessary to unambiguously legislate a law that would be not necessary if everything would already function as it should. It is necessary to compensate for decades of political anti-cannabis campaigns that have had subconscious influence on medical staff and citizens, and attempt to “normalize” at cultural level the medical use of cannabis derivates.”
It is difficult to influence the doctors, however. Nobody can tell them, not even with a law, what is to be prescribed if they do not want to do it. Many seem to be in fear of the clinical evidence and of their patients’ therapeutic preferences. The surgeons’ normal sources of drug information are the salesmen for the pharmaceutical companies who push them to prescribe one drug or the other, and cannabis is not among them. One might suspect that cannabis prescription would be much easier if there were a pharmaceutical salesperson who would propose the product to the surgeons.
What are the perspectives of the right to use cannabis for Italian patients?
If the politicians and the surgeons will not allow the access to treatment with medical cannabis derivates for the sick persons that have or could have some therapeutical benefit, without prejudice nor a priori exclusion of whole categories of patients, then the problem will remain. One cannot ask a patient, who perhaps has verified personally the efficacity of this substance for his/ her symptoms, general health state and life quality, to give up or to await the time required for research or politics. He/she will only succeed by organizing oneself or in a group, as it is his/her right.
by Enrico Fletzer
Report from the Encod Secretariat
On the occasion of the Conference on the use of cannabis in medicine in the European Parliament on 19 October we issued a press release.
We also sent a letter requiring urgent support to Harm Reduction measures in next EU drug strategy to European authorities. This letter can be copied and pasted by any member to contact authorities in his/her country.
The Steering Committee met three times via Skype. Among others it adopted a code of conduct for Encod representatives in the Civil Society Forum meetings. With these guidelines in mind, Fredrick Polak attended the core group meeting of the CSF that took place on 22 october. he will publish a full report on this meeting in the coming days.
In the coming month, Encod will participate in the conference on Cannabis Social Clubs in Slovenia at the University of Ljubljana on November 8, and at the Cannafest in Prague from 9 – 11 November.
No Encod member has yet applied to the Encod Action Fund for small projects, Seeds for Drug Peace