Kanapių naudojimas medicininiais tikslais: Lietuvos ir užsienio valstybių teisinio reguliavimo ypatumai, iššūkiai ir perspektyvos ; Cannabis use for medicinal purposes: peculiarities, challenges and perspectives on legal regulation in Lithuania and other countries

Abstract

The subject matter of the monograph is the medicinal use of cannabis, the most consumed illicit drug worldwide. Although the therapeutic use of cannabis has been forgotten for a long time, recently a Renaissance of medicinal cannabis may be observed, especially in North America. Many clinical trials are being conducted on the use of cannabis and cannabinoids to treat various medical conditions. There is still a lack of extensive clinical research of medicinal use of cannabis, but according to existing scientific knowledge, cannabis, and natural or synthetic cannabinoids may be useful for treating certain medical conditions, e.g., cancer chemotherapy-induced nausea and vomiting, multiple sclerosis pain, loss of appetite due to various diseases and others. The monograph discusses scientific research on the history and newest developments in medical cannabis use, the international regulatory frameworks concerning such use, and relevant legal experience in countries both within and outside the European Union. Comprehensive legal regulation of medicinal cannabis is important to ensure patients' right to health, for example, providing access to appropriate medicines or maintaining high quality and control of the medicines. The use of cannabis and its products for medical and scientific purposes, as opposed to recreational use, is not contrary to international law. It should be noted that the United Nations recently made important changes to the classification of cannabis: in recognition of the medicinal value of this psychoactive substance, it was removed from the most strictly controlled Single Convention's list No. IV. The principal aim of this monograph is to compare the peculiarities of legal frameworks regarding medicinal cannabis use in Lithuania and other countries and provide conclusions and recommendations regarding optimal legal regime in Lithuania. The following objectives were set: (1) to review the historical development and the scientific literature regarding cannabis use for medical purposes; (2) to analyse the peculiarities of medicinal cannabis use in chosen countries and to identify the key models of existing legal regimes as well as examples of best practices; (3) to analyse the legal regulation of cannabis use for medicinal purposes in Lithuania, assess the opportunities it provides, identify chief shortcomings and regulatory barriers; (4) to provide evidence-based recommendations on the optimal model of the use of cannabis and cannabis-derived products for medicinal purposes in Lithuania and the possibilities for improving the current legal regulation. The relevance of this monograph is supported by specific local conditions. Starting in May 2019, medicinal use of cannabis-based medicines in Lithuania was, in theory, allowed by law. Unfortunately, till this day not a single cannabis-based drug is available in the Lithuanian market. In the light of recent developments in international law, we must consider rescheduling cannabis at the national level, moving it from the most stringent schedule I of narcotic and psychotropic substances to the less strict schedule II, referring to schedules approved by the Minister of Health. This would greatly facilitate the use of cannabis for medical purposes and would not affect the fight against the illicit traffic of cannabis. On the other hand, if the existing national scheduling of psychoactive substances were to remains unchanged, the provisions of the Law on the Control of Narcotic Drugs and Psychotropic Substances could be adjusted to provide possibilities to produce extemporaneous medicinal products containing schedule I substances, thus legally enabling the pharmaceutical industry to produce such cannabis-based medicines. To avoid the emergence of a black market for recreational cannabis use, medicinal products containing cannabis and cannabinoids should only be allowed on prescription and under the supervision of doctors during the treatment process. It would be appropriate to provide training for prescribers and information on the use of cannabis for medical purposes to patients. Other countries' practice shows that even with cannabis or cannabinoid treatment options available, doctors are not always inclined to prescribe them, thus undermining patients' legitimate expectations of a suitable treatment. In addition, such training is also needed to avoid over-prescribing medical cannabis to individuals who do not need such treatment. If Lithuania seeks to cultivate cannabis plants to produce medicinal cannabis, following the requirements of the Single Convention, it should establish a special body, the National cannabis agency. Whether this should be an independent body or a division of an existing body is a matter of debate. Considering the best practices of other countries and the institutional framework of Lithuania, it would be expedient to assign the functions of the National cannabis agency to the State Medicines Control Agency of Lithuania.