Bermuda: Cannabis (Marijuana) Medicine Act approved by members of parliament
By Jonathan Bell and Rebecca Zuill
The Royal Gazette
Legislation allowing the use of cannabis-derived medicines won approval in yesterday’s House of Assembly.
However, the debate in the House of Assembly saw the Opposition criticising the new law as not going far enough, while Government members called it “a step in the right direction”.
The amendments will see Dronabinol, also known as Marinol; Nabilone, or Cesamet, and Nabiximols, also called Sativex, made legally available. In addition, the legislation allows for the addition of drugs to be provisionally listed or removed from the Act’s third of fourth schedule, on the recommendation of the Chief Medical Officer (CMO).
Introducing the Cannabinoid Pharmaceutical Products Act 2014 for its second reading, Premier and National Security Minister Michael Dunkley told MPs the debate should not focus on the pros and cons of cannabis itself.
“This bill introduces a new element to the medical assistance available to patients,” Mr Dunkley said, adding that it was also part of “a phased approach to cannabis reform”.
The Progressive Labour Party’s Walter Roban conceded that the Act might constitute “a good first step”.
However, he added: “I can’t say this piece of legislation goes far enough. In fact, it does not seem to have even approached the real issue.”
Rather than bringing flexibility to the medical use of cannabis, the Act permits the use of “synthetic, manufactured products” such as the anti-nausea drug Marinol, he said.
“Who is going to benefit from the Act?” Mr Roban asked MPs, saying that he had spoken with activists in the community and believed pharmaceutical companies stood to reap the most benefit.
Homeopathic practitioners did not support the Bill, and possible remedies such as cannabis oil were not addressed by it, he said.
“It limits access to what some would call medical marijuana,” Mr Roban said, restricting it to Marinol, Cesamet and Sativex. “This is not far enough.”
He branded it a travesty to many because the rewards would go to drug companies and those in Bermuda who control the distribution of these products.
Mr Roban asked: “Have the Cannabis Reform Committee endorsed this bill? It is my understanding that the CRC are not happy with this bill at all.”
He said medical practitioners had been disappointed by the “lack of voice on this issue”, and asked: “What is going to be the price point?” speculating that the process of producing synthetic derivatives would be more expensive than natural cannabis.
“We thought this might be an opportunity to go much farther — cannabis in an appropriate natural form can be a treatment for certain severe conditions.”
“This bill does not go far enough. I don’t say this because I think it is the intention of the OBA to reward large pharmaceutical companies, but we do have a situation where a certain few benefit from the distribution of medicine.”
The PLP’s Glenn Blakeney said the proposed legislation was a good start, adding: “It does not necessarily go far enough in the minds of some.”
He noted the latitude that the CMO was given by the legislation, and called it “living legislation” because of the ability of the Minister to amend it.
He noted that nations such as Israel have deeply researched cannabis and as a result “have had a long hard look” at policies regarding its medical and recreational use.
“I think this is a very good first start,” he said. “I think it can go a lot farther.”
He also noted the medical community had not weighed in on the subject, “so the public would hear from the lips not just of politicians but the lips of medical practitioners”.
Minister of Health Jeanne Atherden pointed to the flexibility the new legislation provided and said “If something new comes up, and we are satisfied it meets criteria we can add it, and remove it as well.”
She said the CMO had done her research and made sure the drugs have been through the appropriate trials.
“The drugs come with indications of the type of usage, the quantity you should use, counter indications. Natural products haven’t had the opportunity for the testing.”
OBA MP Craig Cannonier told the House that local patients were already able to bring in cannabis oil with the sanction of the CMO, and Suzann Roberts-Holshouser said that the drug Sativex was not a synthetic.
Minister of Finance and Economic Development Dr Grant Gibbons said he was an organic chemist who had worked extensively with natural products while obtaining his university degree.
He explained double blind testing methods are used to determine whether a drug is effective or not.
“The problem with teas, or oil, is that you don’t know what you’re giving the patient,” he said. Testing of drugs by pharmaceutical companies means “you have a much better idea of that.”
Dr Gibbons looked at the three drugs that are included in this legislation.
“Nabiximols has two ingredients which are both pure, both are extracted from the cannabis plant, so it is not synthetic. It is then purified so you know exactly what you are dealing with.” The active ingredients tetrahydrocannabinol (THC) and cannabidiol (CBD) are both main active ingredients in cannabis. “They are extracted and purified,” he said. “So there is nothing synthetic about them at all.”
He said they were tested for specific complaints, allowing doctors to prescribe with precision. Nabilone, explained Dr Gibbons “is truly a synthetic drug,” he said, used as an analgesic for neuropathic pain. It has benefits for which it has been tested and approved.”
The third drug, Dronabinol, is a single compound, synthetic THC, identical to the natural compound, and used to stimulate appetite in cancer patients.
“When you take a plant material like cannabis, nature is not always selective — you find a lot of different things in there. Some will have effect, some not,” he said.
Wrapping up the debate, Mr Dunkley said that pharmaceutical advances made it possible that other substances could be considered.
Discussions across the medical community had been “fairly wide”, he added.
As for prices to go on the new drugs, he said that once the legislation was passed, “the market will look at that”.