On January 31, São Paulo’s Republicanos party Governor Tarcisio de Freitas shocked Brazil by ratifying a law that will authorize medical CBD and low-THC products under the country’s universal health care system (SUS). As baffled conservatives looked on, Freitas spoke publicly about the therapeutic benefits cannabidiol-based medicines had provided for his nephew, who experiences seizures due to a genetic disorder.
The law was formally published on February 14, which means it will go into effect 30 days later on March 16. It will cover CBD products, including those containing THC up to the federal threshold of 0.4 percent. The United States federal threshold is 0.3 percent.
Medical cannabis access has meanwhile gained further ground in the neighboring state of Parana. Governor Ratinho Jr., who like Freitas has been an ally of former President Jair Bolsonaro, exempted himself from signing a law that would allow patients to access medical cannabis without having to request judicial authorization, instead leaving the responsibility in the hands of State Deputy Ademar Traiano. On February 13, Traiano signed the law: Beginning March 15, medical cannabis in Parana will be accessible through a comparatively straightforward prescription process.
At first glance, it might seem odd that two Bolsonaro allies are advancing medical cannabis access—one proactively, the other by washing his hands. Bolsonaro fiercely opposed cannabis regulation, including domestic cultivation—a stance that even the country’s rightwing media viewed critically.
The addition of even limited medical cannabinoid products to SUS will certainly benefit patients. It will also benefit pharmaceutical companies.
Upon closer inspection, however, the actions of Freitas and Ratinho Jr. make more sense. The addition of even limited medical cannabinoid products to SUS, along with the removal of some bureaucratic barriers, will certainly benefit patients. But it will also benefit pharmaceutical companies, which will see their profits rise even higher, and fit the larger agenda of creating processes that serve the wealthy few while leaving the public to foot the bill.
All authorized medical cannabis products in Brazil are produced with imported materials rather than cultivated domestically, somewhat like the process by which limited pharmaceutical heroin is made available in Canada. When importation was legalized in 2015, many expected it to open the door to the logical next step of legalizing domestic cultivation. But Bolsonaro and his allies claimed that this would facilitate “misuse,” and so for the better part of a decade all raw materials for medical cannabinoid products has been imported, as demand for those products has risen more than 9,000 percent.
Expensive product-sourcing begets expensive products, especially those needed for less common conditions. A 200mg/ml bottle of medication might cost nearly $500 US. Pharmaceutical CBD and low-THC medicines will be a strain on SUS, in addition to the patients who pay out of pocket.
Two months after Lula’s inauguration, Brazil’s battle for medical cannabis access at the federal level remains stalled.
Manufacturing the raw materials for these products domestically would reduce the increasingly unsustainable cost, which would in turn reduce the financial burden on SUS and thus on patients. This is especially true for those in southern and southeastern states where SUS is less robust. Allowing cultivation for personal use would reduce some of the bureaucratic burden for those patients and their families, too.
Though it may surprise those in the US who expect Medicaid to resist covering expensive treatments, the Brazil commission responsible for authorizing SUS coverage doesn’t necessarily refrain from doing so based on cost. The current debate is more about how much money to allocate to various levels of government, as the heaviest burden falls on municipalities and states.
Two months after President Lula’s inauguration, Brazil’s battle for medical cannabis access at the federal level remains stalled. A bill to authorize domestic cultivation is ready to advance to the Senate, yet President of the Chamber of Deputies Arthur Lira continues to keep it in a drawer rather than sending it on for final approval.
A close ally of Bolsonaro, Lira is now building a similar relationship with Lula, who supported his re-election as Chamber president. It would seem that the winds are favorable for passing such legislation. We await the political will to do so. It is beyond time.
Photograph via Centers for Disease Control and Prevention