We’re going to talk about the therapeutic properties of Cannabis again, about what is happening in Italy – and not only – by interviewing doctor Carlo Privitera, Medical Surgeon, Specialist in general and Emergency Surgery. Over the last few years he has been continuing his Studies on the pharmaceutical properties of Cannabis and Cannabinoids!
Doctor Privitera, today in the media, on the web and in general, very much is said about Therapeutic Cannabis; from your point of view, how do you judge the state of things in Italy?
Schizophrenic. On the one hand a good legislation regulating the medical use of cannabis, on the other hand a bureaucracy which seems to be intended to place obstacles to the right of healthcare of the sick. Then there are generic doctors (to be distinguished from specialist doctors), for whom no scientific information and education exist and who often confuse patients with their fateful statements like “in your case, it cannot be used”, or even more hilarious “I don’t believe in it” (as if we were talking about a religion!).
Over the past few years you are increasing your knowledge with in-depth studies on the therapeutic properties of Cannabis and Cannabinoids, while assisting over a hundred patients. Which main points have become evident in your Research studies in relation to the efficacy of Cannabis?
The patients are now more than 800, but it’s still too early to talk about evidence (scientifically speaking): considering the substantial preclinical research done (which regards laboratory studies), only during the past few years research studies regarding the results obtained on humans are appearing and the work done on a high number of patients is even less available.
The evidence I can report here and now regards what we already know: cannabis is a risk-free substance, indicated for the treatment of various pathological conditions, due to the interaction between the drug and the complex endocannabinoid system, having its functionality almost always compromised in case of chronic diseases.
Which are the main doubts and needs patients express?
The perplexities of patients regard the risk of lack of the drug. Each year, due to “miscalculations”, the Government requires (and/or produces) a quantity of inflorescences which doesn’t at all satisfy the market, which has an increase rate exceeding 300%.And, as one might expect, each year the assigned sum is underestimated by at least 80%.
You are a promoter of the MediComm project, could you tell us more about it?
It’s the result of a reflection, which made me leave my hospital activities to try and make a small contribution to finding a solution for the 14% (in Sicily 24%) of Italians who do not have access to healthcare for financial reasons (ISTAT data).
Good old Hippocrates said: “I will adjust my standard of living for the good of the sick, according to my possibilities and judgement; I will refrain from causing damage and offence”: I haven’t been able to find all this anymore in the modern medical approach. What sense has it got how good at my job I am and how high my fee can be, if people are not able to afford my services?
“Progetto MediComm” is the first portal of “active medical tele-assistance” in Italy. We gather the clinical data of patients (and medical reports) to develop the best tailor-made treatment protocol the patient can get, using information technology which enables us to remain in contact with the patient constantly.
During outpatient checkups 90% of the information is lost (the patient forgets and the physician does not enquire). The tele-assistance system does not diagnose (diagnose is obtained from the patient, supplying medical certificates and instrumental investigation reports) which allows a reduction of costs of chronic patient management up to 80% (in a period in which truly few people can afford the drug, it’s a moral obligation of each operator to try and help everybody!).
Are there enough scientific research studies in Italy to assert that Cannabis can safely be used by the patients?
Fortunately for us we are in 2018 and “Italian studies” aren’t necessary. The World Health Organisation has established that medical cannabis is one of the safest medical drugs in the world, which has never generated major complications. In International medical literature (pubmed.org) one can find over 25 thousand articles relating to medical cannabis.
The Italian Law therefore allows prescription (in accordance with the Law 94/98 or the Di Bella Law), but this implicates that a doctor must study, thus complicating the matter very much.
What does it mean to work in the “Therapeutic Cannabis” sector in Italy today, which are the main difficulties for your professional category?
There are no difficulties, other than bureaucracy (and the confusion of bureaucrats), logistics, lack of the medical drug and the “religious” aspects, meaning the standpoint of those doctors (mentioned above), who prefer saying to the patient “they do not believe in cannabis” in order to avoid gathering information and get updated (as if we were talking about a religion instead of a Science!)
The only real difficulty is to have to face, each and every day, the so-called “war of the poor” conducted by patient associations and by anti-prohibitionists, physicians, pharmacists, who instead of joining forces, measure the respective “anatomic qualities”, by competing as in a race. This has, in the past few years, only brought to a slowdown in the actual defining process of an extremely complicated healthcare sector.
Furthermore, the battle is also (and I know I might sound unpleasant) against those who place products of uncertain quality, efficacy and safety on the market.
In short, the main difficulty we encounter is when we are forced to contradict what often, out of ignorance and in a misleading way, is imposed onto the consumers.
On the web a lot of information is circulating; the danger exists to frequently come across untrue or false information; Cannabis is not a “magic wand” that can be useful in any case and occasion. What do you advise individuals looking for Therapeutic Cannabis?
I always say: cannabis is not a panacea for each and every ailment and neither a medical drug able to cure all diseases; cannabis, however, is a drug able to cure all People.
In every disease, as said earlier, we can find a reduction in functionality of the endocannabinoid system; therefore “restoring” these molecules (of natural origin) tend to re-establish, as far as possible in relation to the clinical condition, the normal functioning of the Central Nerve System and the Immune System.
Moreover, medical cannabis can be associated to conventional drugs with a dual purpose: reduce the dosage of the chemical drug (cannabinoids increase the therapeutic efficacy of the other medicines) and improve the results (one could think in the field of oncology, about those studies demonstrating the benefits of the association of cannabinoids and the protocols of chemo/radio therapies, both for the containment of the side effects of these lather and in relation to better oncological results).
Without entering into specific details regarding Italian political events, from your point of view, which could be the most efficient measures the Institutions should adopt to encourage the sector and the professionals?
I will try to make a list:
By now the old but ever-current Italian paradigm, which expresses that if I’m not able to do something, nobody should do it, verges on the absurd (any reference to the Ministerial management of the pilot project ended in October 2017 is purely random).
Medical cannabis business produces, Worldwide, billions of dollars (or euros) for the simple fact that the production is not in the hands of a public employee but of private companies, which have much more interest in doing a good job, both in terms of quality and financially speaking (Market laws).
It’s absurd how the State entered the market in a ruthless manner, imposing the sales price of the inflorescences and subsequently concluding an agreement for 100 kg of Canadian cannabis at 5,60€/g (to which obviously the cost of the supply chain must be added).
Rather than authorizing the production inside the national boundaries, possibly managed and regulated by the ICFM (Italian chemical and pharmaceutical institute) in Florence, they prefer to continue denying the right for healthcare of Individuals.
Physicians must be educated with compulsory training (if possible not held by those who have studied cannabis in some short articles of the “Corriere della Sera” (local newspaper). (n.b.: Specialist doctors have a natural impulse towards knowledge which push them to study continuosly, generic doctors….are generic doctors!)
The heads of Ministries and Hospitals should remember how to calculate the social impact of a pathology (i.e. healthcare costs + loss of productivity) rather than closing the various issues in sealed spending allotments.
Let I explain myself better: a patient with fibromyalgia, for example, is able to return to his working activity: translated in more immediate terms: not only does he not force the State to pay hundreds of euros a month for his pain treatment, but he also gets back to work again (and, in the best of cases, pays taxes as well).
Every other discussion related to the possible solutions cannot be dealt with until the State will not have accepted that too many individuals are sick and too many of them need this medical drug. As long as the production by private companies will not be regulated and unblocked in Italy I think, sadly enough, that there will not be a solution which is actually applicable.
Interview by Giuseppe Cantelmi
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