Tuesday, August 6, 2019

Pot Luck

Reproduced from: http://www.indialegallive.com/cover-story-articles/focus/legalisation-of-cannabis-in-india-pot-luck-70299 (Give hyperlink here when posting), published August 4, 2019

In response to a PIL challenging the prohibition and criminalisation of the use of cannabis in India, the Delhi High Court has asked for a detailed report on the matter

By Dr KK Aggarwal

The Great Legalisation Movement India (GLMI) is a Bengaluru-based organisation dedicated to educating the masses on the benefits of cannabis and hemp. Its website proclaims, “Let’s educate the society. Cultivate the lands. Regulate the harvests. Medicate the people. And recreate the world!”

The organisation holds rallies, conferences and meetings with the goal of seeing widespread, actionable change, and to undo the damage of 31 years of cannabis prohibition.

There is not a single document which shows that cannabis is lethal to human beings, the GLMI claimed in a petition recently filed in the Delhi High Court, in its relentless pursuit to bring an end to various existing laws in India that prohibit and criminalise its use. The petition had challenged various sections of the Narcotic Drugs and Psychotropic Substances (NDPS) Act.

A bench of Justices GS Sistani and Jyoti Singh asked for more details on the matter, including on the aspect of regulation while raising concerns over rising drug abuse cases. This, even as on July 26, another High Court bench of Chief Justice DN Patel and Justice C Hari Shankar dismissed a petition that sought to legalise cannabis.

In India, cannabis preparations are known by the names, such as charas (resin), ganja (flower) and bhang (seeds and leaves). Cannabis is the most commonly used illegal psychoactive substance by an estimated 192 million people worldwide and roughly one in eight people who consume it regularly develops a cannabis-use disorder. Consumption of cannabis by teens is generally associated with their lower educational attainments and the frequent use of other drugs, but there is no concrete evidence to support this belief. However, individuals suffering from cannabis-use disorders often consume other psychoactive substances, especially alcohol and tobacco.

Cannabis if consumed without restraint impairs attention, concentration, episodic memory, associative learning and motor coordination. Long-term use of cannabis is also associated with impairment of verbal memory and cognitive processing speed, periodontal diseases, hyperemesis syndrome and even a lower sperm count.

Substantial evidence suggests that chronic cannabis use, especially during adolescence, is associated with schizophrenia. However, the mechanisms responsible for linking cannabis use and schizophrenia remain unclear. Some experts, though, believe that consumption of cannabis during childhood is a factor in developing schizophrenia later in life.

Those using cannabis day in and day out should also abstain from driving vehicles as there is a strong link between injuries and even deaths resulting from motor vehicle accidents and habitual cannabis-use.

The 1961 international treaty, “Single Convention on Narcotic Drugs”, placed cannabis in the category of hard drugs. During negotiations while evolving the treaty, India took the stand that marijuana (another name for cannabis) was an integral part of India’s social and religious customs.  The final draft of the treaty defined cannabis as the flowering or fruit tops of the cannabis plant from which the resin has not been extracted. This allowed India to carry on the tradition of large-scale consumption of bhang during several festivals. The treaty also gave India a 25-year period to clamp down on recreational drugs.

Towards the end of this exemption period, the Indian government passed the Narcotic Drugs and Psychotropic Substances (NDPS) Act in 1985. The Act maintained the same definition of cannabis, excluding bhang from its purview. According to NDPS, “cannabis (hemp)” means:

(a) Charas, the separated resin, in whatever form, whether crude or purified, obtained from the cannabis plant and also includes concentrated preparation and resin known as hashish oil or liquid hashish;

(b) Ganja, the flowering or fruiting tops of the cannabis plant (excluding the seeds and leaves when not accompanied by the tops), by whatever name they may be known or designated; and

(c) Any mixture, with or without any neutral material, of any of the above forms of cannabis or any drink prepared therefrom.

NDPS also banned the production and sale of cannabis resin and flowers, but permitted the use of leaves and seeds, allowing the states to regulate the latter.

The cultivation of cannabis for industrial purposes, such as making industrial hemp or for horticultural use is legal in India. The National Policy on Narcotic Drugs and Psychotropic Substances recognises cannabis as a source of biomass, fibre, and high-value oil. Government of India encourages research and cultivation of cannabis with low Delta-9-tetrahydrocannabinol (THC) content. THC is one of the more than 100 chemicals called cannabinoids found in the marijuana plant.

Although NDPS allows consumption of bhang, various states have their own laws banning or restricting its use. For example:

·         In Assam, the Assam Ganja and Bhang Prohibition Act, 1958, prohibits sale, purchase, possession and consumption of ganja and bhang.
·         In Maharashtra, Section 66(1)(b) of the Bombay Prohibition (BP) Act, 1949, bans manufacture, possession and consumption of bhang and bhang-containing substances without a license.
·         On February 21, 2017, Gujarat legalised bhang by removing it from the list of “intoxicating drugs” covered under Section 23 of the Gujarat Prohibition Act.

Medical marijuana is basically the same product as recreational marijuana, but it is used only for medical purposes. Each of the chemicals found in the marijuana plant has a different effect on the body. Besides THC, cannabidiol (CBD) is one of the main chemicals used in medicines.

Medical marijuana is used to treat a number of different conditions, including Alzheimer’s disease, loss of appetite, cancer, Crohn’s disease, eating disorders such as anorexia, epilepsy, glaucoma and mental health conditions like schizophrenia and post-traumatic stress disorder, multiple sclerosis, muscle spasms, nausea, pain and wasting syndrome (cachexia).

More than half of the states in USA have legalised medical marijuana in some form or the other and more are considering bills to do the same. The US Food and Drug Administration has approved marijuana for the treatment of two rare and severe forms of epilepsy—Dravet syndrome and Lennox-Gastaut syndrome.

There is substantial evidence to showcase the therapeutic effects of cannabis. It has the ability to alleviate chronic pain, nausea and vomiting due to chemotherapy, and spasticity (tight or stiff muscles) from multiple sclerosis. Cannabinoids are similar to chemicals the body makes that are involved in appetite, memory, movements and pain.

The US Food and Drug Administration has also approved two man-made cannabinoid medicines—dronabinol (Marinol, Syndros) and nabilone (Cesamet)—to treat nausea and vomiting from chemotherapy. The cannabidiol Epidiolex was approved in 2018 for treating seizures associated with two rare and severe forms of epilepsy— Lennox-Gastaut syndrome and Dravet syndrome.

In the light of poor scientific evidence related to the health benefits and therapeutic effectiveness of cannabis, more rigorous research involving larger samples is necessary before the government decides whether or not to legalise cannabis for medical purposes. Moreover, the existing standards of treatment must be compared with, while doing further research and this should also examine public health as well as the social and economic consequences of cannabis use.

In countries where cannabis is legalised for medicinal purposes, the following requirements should apply:

·         Provision of cannabis products for treatment must be in accordance with the UN Single Convention on Narcotic Drugs, 1961, including its rules on production, trade and distribution.
·         The cannabis products must clearly specify ingredients used, including the content of THC and CBD.
·         Cannabis must be prescribed by an authorised physician/prescriber in accordance with the best available evidence and in sync with the country’s regulatory framework. It is recommended that treatment with approved conventional drugs is undertaken before cannabis products are used.
·         Each individual physician must take responsibility for taking a decision regarding treatment with cannabis products, in accordance with the best available evidence and country-specific registered indications.
·         Cannabis for medical purposes must only be dispensed at pharmacies or by authorised dispensers in accordance with the country’s regulatory frameworks.
·         Effective control measures must be put in place to impede the illicit use of medical cannabis.
·         Public health surveillance systems must monitor the prevalence of cannabis use and trends in utilisation patterns are necessary.

It is time India takes a positive call on legalising cannabis. However, it is not that easy as there are several ticklish issues that need to be looked into.

These include:

·         No product can be banned in India unless it is lethal or poisonous. Even tobacco is not banned in India.
·         How can the government ban ganja when bhang is allowed? All these must be regulated. The government is trying to do the same for allowing tobacco but trying to ban nicotine vaping.
·         Any herb with medicinal values and available and cultivated in India should not be banned for medicinal purposes. It should rather be regulated.
·         Availability of bhang probably has kept a large section of the society from other addictive drugs.

Even the Constitution supports the contention that intoxicating drinks and drugs can be used for medicinal purposes. Article 47 of the Constitution clearly states that it is the “duty of the State to raise the level of nutrition and the standard of living and to improve public health…the State shall endeavour to bring about prohibition of the consumption except for medicinal purposes of intoxicating drinks and of drugs which are injurious to health”.

It is amply clear that the government could not ban cannabis under Article 47 and therefore brought in the NDPS Act. That is something that now needs to be re-looked into.

Dr KK Aggarwal
Padma Shri Awardee
President Elect Confederation of Medical Associations in Asia and Oceania   (CMAAO)
Group Editor-in-Chief IJCP Publications
President Heart Care Foundation of India
Past National President IMA

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