In recent years, a growing interest in CBD-rich Cannabisstrains has emerged in several countries to treat a wide range of human ailments. Lawmakers are beginning to loosen regulations on medicinal Cannabisand health professionals are beginning to take an interest in this promising therapy based on the secondary metabolites of the Cannabisplant.
The latest government regulations and laws on Medicinal cannabisin Colombia were promoted by local researchers, along with patients, caregivers and mothers of epileptic patients, who in many cases had exhausted the use of traditional anti-epileptic drugs without finding an effect and were desperately seeking relief for this difficult-to-treat disease.
However, the former Law 30 of 1986 of the Republic of Colombia already allowed health professionals in the country to prescribe Cannabisfor therapeutic use and also in some indigenous communities in Colombia, marijuana was included in their healing practices, as were coca leaves and poppies. The eighties in Colombia was marked by a bloody and prolonged war between drug cartels that came to control the great demand for coca, poppy and marijuana abroad and made huge fortunes at the cost of thousands of deaths, all the fault of the prohibition; Marginal substance use became a public health problem and was commonly associated with crime. In the midst of this panorama, it was unthinkable for the medical community or for patients to use Cannabisas a medicinal alternative. Recently, at the end of 2015, the Ministry of Health of the Republic of Colombia issued a regulatory decree of Law 30 of 1986 for the medicinal use of plant derivatives and in August of 2016 the Colombian Congress approved a new law that regulates the medicinal use of marijuana and allows the commercial cultivation, processing and export of products derived from it. According to the government, this is a step forward to change the country’s repressive drug laws and guide them to public health for the benefit of many patients, and it also calls for attention to doctors and researchers to work on the issue.
Paola Pineda Villegas is a Colombian doctor born in Medellín who has been prescribing Cannabisfor medical purposes for a long time, under the old regulation of 1986. Dr. Pineda began to prescribe Medicinal cannabis for the treatment of pain associated with HIV, a field in which he specializes, and with the passage of time his practice extended to the treatment of arthritis, anxiety, fibromyalgia, epilepsy, migraine, the syndrome of irritable colon.
Pineda’s first case of epilepsy was Valeria Rincón, a small girl who had her first seizure at three months of age with a crisis that lasted 17 minutes and ended up in hospitalization for status epilepticus. “He did not respond well to traditional treatment with valproic acid, keppra, clonazepam, and clobazam. All of these drugs kept the baby in a constant state of dizziness and caused severe side effects and abundant salivation or salivation. He became withdrawn and this made it difficult for him to interact with people “says Paola Zuluaga, Valeria’s mother.
When the multi-drug medication was used up, the girl’s doctor and mother decided to supply her with oral doses of Cannabis oil that had been extracted from a local Sativavariety. After a few months, Valeria’s seizures stopped being daily and occurred every three or four days. As the girl responded well to the treatment and lasted for several days without crisis, Pineda continued to adjust the dose of the oil and the seizures decreased to one every three months, one every five and more and more, her recovery was remarkable, her mood changed and even conventional medication was reduced. Until now little Valeria has been free of attacks and getting better. She goes to the school garden, laughs, sings, she is a beauty.
The database of Dra. Pineda has more than a thousand patients across the country, where 30% are children with neurological disorders such as Dravet syndrome, Lennox-Gastaut syndrome, West syndrome, tuberous sclerosis, Ohtahara syndrome and idiopathic epilepsies and a large part of this population is currently controlled with THC and low CBD while others respond to a combination of different THC / CBD ratios. Even some children treated with THC seem to get worse by giving them more CBD. “All my epilepsy patients have THC in the formula, to a greater or lesser extent,” reports Dr. Pineda.
Dr. Pineda, together with her collaborators, has developed several formulas for oral use with different ratios of cannabinoids THC / CBD measured on HPLC to determine the milligrams of the doses and following a dosing protocol that they designed based on experience and follow-up work. to patients in treatment. “It is the first clinical research with cannabinoids in the country and has been driven by study, education, patient cooperation, and above all by responsibility and commitment to help improve people’s health,” says Paola Pineda.
At the beginning there was no possibility of precise measurement of cannabinoids in oral formulas and interestingly, the extraction of Cannabisadministered to Valeria and other children with epilepsy, came from a sativa plant “Landrace”1 Colombian who showed a rich THC content and very low CBD after finally being quantified by HPLC. It is known, based mainly on current experience in the US, that medications with a high proportion of CBD can help reduce seizures, and that high proportions of THC may even be pro-seizure for certain patients. However, preliminary data in Colombia indicates that many children like Valeria respond well to low-CBD-rich THC strains.
Dr. Paola and her group of collaborators had the opportunity to chat with Professor Raphael Mechoulam from the Hebrew University of Jerusalem in September 2016 and tell him that there were infantile epilepsy patients in Colombia with more THC than CBD in the formula. Mechoulamstated that so far everything that is known for sure about epilepsy and Cannabis has to do with high-dose, concentrated CBD. También afirmó que él es un científico y que estaba dispuesto a recibir evidencia nueva, porque se sorprendió al contarle que algunos pacientes de epilepsia empeoraban con CBD.
There is, of course, a fear of THC and the long-term effects it may have, especially when the treated population is children, “but when you see the evidence of the therapeutic benefits in these children, you realize that there is nothing to fear , fear of THC is based on myths and misinformation, all medications must be supplied with care and with great responsibility, but the possible unwanted side effects of THC in children are outweighed by the visible positive effects of the decrease in crisis ” , affirms the Dra. Pineda.
In addition, it must be remembered that many of these children suffer very serious neurological disorders whose consequences in the future result in irreparable damage; all pharmacological drugs to treat epilepsy have negative short and long-term side effects. With pharmacological medicine it is always a matter of balancing the positive effects of crisis reduction against the negative effects.
Local CannabisSativa strains like “Mango Biche” and “Punto Rojo” are biologically adapted to the climate and environmental conditions of Colombia. In the fertile volcanic areas with their varied thermal floors, varieties of Wild cannabisfor many decades and although most of the original genetics have been disappearing due to cultivation practices with the objective of drug trafficking, there are still remote places where they can be found intact.
Professor Raphael Mechoulam states that the natural distribution of endocannabinoids in the body could shape the phenotypic expression of personality traits in humans; in the same way, it can be hypothesized that indigenous varieties could be better for promoting the balance of local endocannabinoid systems, which in evolutionary terms are well adapted to the local ecosystem, local diet, local solar radiation, etc. ., which would favor a more consistent interaction of the molecules of the Cannabiswith the particular organism.
THC, like CBD, could prove to be an important ally for the treatment of childhood neurological syndromes. The “Entourage Effect” 2 is a concept introduced into cannabinoid science by Professors Raphael Mechoulam, Shimon Ben-Shabat and collaborators in 1998; It consists of the combined effect of cannabinoids as a better therapy versus the therapeutic effect of isolated cannabinoids. However, it could be that the particular distribution trend of THC vs. CBD (Cannabinoid Ratio) of Cannabis strains local sativa from a certain region, has a better medicinal performance in the endocannabinoid systems of humans from the same region, and while collecting data from clinical experience across the country, more research will be needed to minimize unwanted side effects – if any some – and overcome the moral implications of THC use in epileptic children.
It is increasingly clear that Cannabisis personalized medicine.
By: Julián Caicedo and Alexander Gómez.
1. A local variety.
- BEN-SHABAT, Shimon, et al. An entourage effect: inactive endogenous fatty acid glycerol esters enhance 2-arachidonoyl-glycerol cannabinoid activity. European journal of pharmacology, 1998, vol. 353, no 1, p. 23-31.