The Struggle for Medical Marijuana Access in Brazil

    Theo, a 14-year-old living in Rio de Janeiro, suffers from a type of epilepsy that causes absence seizures—brief lapses in awareness. “It’s not exactly those seizures that we know where the person falls to the ground, but they are challenging and difficult to control and have an impact on his quality of life,” Theo’s mother, Rita Carvana, told Filter. Theo was diagnosed when he was 12. The first drug prescribed by his neurologist had little effect. Neither did the second. Carvana decided to try medical cannabis. There were many difficulties in obtaining it; “few neurologists in Brazil prescribe,” she said.

    It’s difficult to buy medical marijuana in Brazil, and difficult to maintain the course of treatment—the oil is very expensive. Carvana says she used to pay the equivalent of nearly $400 per month.

    “The prejudice against THC is being fostered by the pharmaceutical industry … and this is for purely financial reasons.”

    Carvana managed to pay for the treatment for almost a year, suffering from the devaluation of the Brazilian currency to import it. In March 2020 she went to court to force her health insurer to cover the cost. In May, she won. Today, her health care plan covers both types of extract that Theo uses: isolated cannabidiol and full-spectrum.

    “In the middle of the pandemic, it was a great relief,” Carvana said. “I was able to pay all this time but it was very expensive … I work in the cultural sector and, in the last two years we have lost a lot of standard of living, economic crisis in Rio de Janeiro is very strong. If on the one hand I had this privilege of paying for my son’s medicine, it also cost me a lot in the sense that I have many debts.”

    One of the biggest difficulties in the fight for the complete legalization of medicinal cannabis is the prejudice that exists against THC. “The industry, the market, gains much more from CBD oil than from full-spectrum cannabis oil, which can have high-, medium- or low-THC dosage,” Carvana said. “The full-spectrum oil will almost always act better because of the ‘entourage effect,’ and requires smaller doses. So, we see clearly that the prejudice against THC is being fostered by the pharmaceutical industry … and this is for purely financial reasons.”

    The much-desired “entourage effect”—whereby the many chemical components of a drug produce better results than any would alone—can only be obtained with full-spectrum cannabis, which is not yet found in pharmacies.

     

    A Movement Toward Decriminalization

    Brazil is moving toward the decriminalization of cannabis, but slowly and often against the efforts of authorities. President Jair Bolsonaro’s far-right, anti-science government and the strong presence of fundamentalist religions have made for a difficult path toward full legalization. “In the past, they said that there was no medicinal cannabis, that it had no effect. Now they say that indeed it has effect, but only the CBD isolate, which would be the substance of God while THC is the substance of the devil,” Carvana said.

    And yet there have been some victories.

    The fight for marijuana decriminalization in Brazil gained ground in 2011, the year the police violently repressed the annual Marijuana March in Rio de Janeiro. “[That] gave rise to a debate that reached the [Supreme Court], which then legalized the marches throughout the country that have been organized by the DAR collective [Desentorpendo a Razão, or Disentangling Reason],” Henrique Carneiro, professor of history at the University of São Paulo, told Filter

    One year ago, the regulation of cannabis products in Brazil was approved by the ANVISA, the country’s health regulatory agency. Carneiro described the move as “a minimal concession”—a license to import a product that costs the equivalent of $375 per month.

    The decision allowed companies like Prati-Nonaduzzi and Beaufor Ipsen to sell medicinal cannabis products in pharmacies to people with a prescription, subject to inspection by ANVISA. The cultivation of marijuana in Brazilian territory, however, was rejected—raising serious questions about production and import logistics. The first THC-containing medicine was released for sale in April 2020. 

    “ANVISA’s decision makes it easier to access cannabis-based treatment for several conditions that can benefit from its use,” Dr. Pietro Vanni, psychiatrist at the Gravital Clinic in Rio de Janeiro, told Filter. “In the past, the patient had to import it asking for ANVISA’s authorization and he had to go to court. Only really very serious conditions could get access [to medical marijuana]. With the decision we can more easily treat a wide range of patients. This is reflected in a better treatment for the patient, a better quality of life. It is crucial that we have the medicinal cannabis legalized since it is something that has scientific proof of the benefits.”

    According to Vanni, there are three ways to legally obtain medicinal cannabis in Brazil. The first is to buy from the pharmacy, where options are limited to two medications. One of them, Canabidiol Prati-Donaduzzi, is a very expensive cannabidiol/CBD isolate; the other, Mevatyl, has a 1:1 CBD to THC ratio.

    The second way is to import the drugs—more affordable, but also more time-consuming because it involves securing ANVISA’s approval. Before ANVISA’s decision to regulate the import of cannabis, it took 90 days for the organization to decide on permissions on a case-by-case basis and at least one more month to import it. Today, authorization is much quicker—approximately two weeks.

    The third way to access medical cannabis is through associations formed by users seeking to produce the medicine, which offer little in the way of variety. “It is not a question of lower quality, but it does not have all the certifications, analyses and there is a certain inconsistency in the doses,” Vanni said. There are only two legal associations in Brazil, and one of them, APEPI, had its court injunction revoked in November 2020. Today, only ABRACE can supply medical marijuana to its members. The only ways to access full-spectrum cannabis—the kind that produces the entourage effect—are importation or through associations.

    The terribly high prices for the product in a country whose minimum wage is the equivalent of around $200 a month make it difficult for most to access to it, meaning that people have to still resort to illegal means—such as growing the plant themselves. In 2017, one in three Brazilians incarcerated had been charged with drug trafficking. In 2019, the number of Brazilians in jail on such charges totaled 163,000. And most of those incarcerated, whether for drug trafficking or other charges, are poor and Black.

    The high prices for the product make it difficult for most to access to it, meaning that people have to still resort to illegal means

    Access to medical cannabis in Brazil is therefore fraught. It’s out of reach for many who can’t afford it, or who don’t live near an association that produces it. One solution would seem to lie in individuals seeking court permission for planting and home production of their own medicine.

    Barbara Gael is a translator based in São Paulo who researches medicinal cannabis and uses a cannabis oil-based treatment—high-CBD and low-THC—for her depression and anxiety. “The anxiety still exists but is much smoother,” Gael told Filter. “And the depression is gone, as are the suicidal ideas.”

    Gael says it’s possible today for Brazilians to find physicians who specialize in medical marijuana, but that reliable information on treatment methods remains scarce. “People often think that CBD is good, but THC is evil,” Gael said. “The cost of treatment can be very high. Not everyone can pay for the consultation and for the oils. For those who need high doses the solution is to ask [for] habeas corpus to plant at home and make their own medicine. It is essential that cannabis treatment be quickly included in the SUS [Brazil’s public health system], so that low-income families can also benefit from it.”

     


     

    Photograph by US Fish and Wildlife Service via Wikimedia Commons/Public Domain

    • Raphael Tsavkko Garcia

      Raphael is a Brazilian journalist currently based in Belgium. He’s been published by Al Jazeera, MIT Technology Review, DW and the Washington Post, among other outlets. He holds PhD in Human Rights from the University of Deusto.

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