WHAT’S THE SCORE? Medical cannabis in the Philippines
Art+ asks a cannabis researcher, a dentist mother seeking to alleviate her daughter’s suffering from epilepsy, a medical doctor, and a former cannabis regulator in the US about their views on legalizing the medical use of a naturally growing substance
Words Pocholo Concepcion
Illustrations Jennefer Sneddon
Feb 16, 2024
The bad rap associated with cannabis — the scientific name of marijuana — is long gone. While the substance is still illegal in many countries, more nations have recognized its medicinal properties that have freed the plant from restrictions and enabled it to be accessible to the public.
At least 48 countries worldwide have legalized the medical use of cannabis. In America, 38 states, four territories, and the District of Columbia (D.C.) have done the same, with California leading the way in 1996.
In the Philippines, the Senate and House of Representatives are said to be determined to approve a medical cannabis bill, after their respective Technical Working Groups — composed of committees on health and demography, public order and dangerous drugs, and finance — conducted hearings, consultations, and deliberations attended by cannabis advocate groups to prune out the problematic provisions of nine different bills.
“The mechanisms are less convoluted and complicated. The private sector can now participate in any phase of the value chain from research, importation, cultivation, extraction, manufacturing, distribution, and retailing,” Chuck Manansala, a Congress resource person engaged in cannabis research, told Art+.
The bill is due for a Second Reading, to be followed by a Third Reading before passing into law.
Meantime, Art+ asked Manansala, along with Donnabel Cunanan, a dentist mother seeking an alternative to alleviate her daughter’s suffering from epilepsy; Gem Mutia, a medical doctor who’s been abreast of cannabis’ clinically proven indications; and Zarah Cruz, a former program specialist at the Office of Cannabis Management in Sacramento, California, about their views on legalizing the medical use of a naturally growing substance.
Chuck Manansala
President, Masikhay Research Center
Art+: You’ve been attending the Senate and Lower House sessions as a resource person on the bill to legalize medical cannabis. What’s the status of the bill?
Chuck Manansala: The Technical Working Groups (TWG) have done their job and are now getting signatures for their committee reports. In the Senate, the Joint TWG was held by the Senate Committee on Health and Demography, the Committee on Public Order and Dangerous Drugs, and the Committee on Finance. In the House of Representatives, the Joint TWG was conducted by the Committee on Dangerous Drugs and the Committee on Health.
After getting signatures, the next move in both the Upper and Lower Houses is to present the bill on the floor for the Second Reading. If it passes this stage, it will proceed to the Third Reading where the decision is made to approve or disapprove the bill.
Then there will be a bicameral conference between the Houses. Amendments and changes may be made. After both Houses give their final approval, a final copy of the bill, known as the “enrolled bill,” shall be printed, and certified as correct by the Secretary of the Senate and the Secretary General of the House of Representatives. And then it will be signed by the Speaker of the House and the Senate President.
A bill may become a law even without the President’s signature, if the President does not sign a bill within 30 days from receipt in his office. A bill may also become a law without the President’s signature if Congress overrides a presidential veto by a two-thirds vote.
You said there are nine different bills on medical cannabis filed in both Houses, and that you saw the defects and conflicting clauses in these bills. Can you elaborate? Which among the bills do you think is the best and most beneficial to the people, and why so?
It is not relevant anymore to discuss the different bills because the Senate and House committees involved have created their committee reports that consolidate the comments in the Joint TWGs. Until we see the bills to be presented in the Second Reading, we cannot comment on specific provisions.
However, it may be relevant to point out that the substitute bills taken up in the Joint TWGs, and the comments and amendments suggested, are way better than all previous bills. The mechanisms are less convoluted and complicated. The private sector can now participate in any phase of the value chain from research, importation, cultivation, extraction, manufacturing, distribution, and retailing.
Most importantly, the substitute bills are more scientific in that they recognize that other cannabinoids have medicinal and therapeutic properties and do not limit the definition of medical cannabis only to Cannabidiol or CBD. Our aim has always been and will always be to fight for access to medical cannabis that is affordable, safe, and available.
Is there a timetable for the bill to be passed into law?
The Senate and House of Representatives have a process. We feel that the authors of the bill intend to have the law passed as soon as possible within their legislative processes. They have committed to us that they will do what needs to be done to have a medical cannabis law very soon.
How soon is hard to predict. And the issue of the people’s initiative and charter change will steal time from the medical cannabis deliberations.
What scenario do you foresee once the Philippines legalizes medical cannabis — will the government control everything, or will it allow private enterprise to join in the creation of a profitable and self-sustaining industry that promotes health and well-being for all Filipinos who need access to the medicine?
The government monopoly is gone on the substitute bills and latest discussions in the TWGs. The private sector will be allowed to participate. But the government, of course, retains the power to regulate the entire medical cannabis ecosystem.
Dr. Donnabel Cunanan
Dentist, cofounder of Philippine Cannabis Compassion Society
When did you first hear about cannabis as medicine?
Ten years ago, my daughter was diagnosed with an intractable form of epilepsy known as Dravet Syndrome. She was having seizures more than 50 to 60 times daily, and our pediatric neurologist told us that there was no cure. While researching and looking for an alternative medicine, I chanced upon Jun and Myca Yutuc discussing cannabis on national television. They were the very first medical cannabis advocates in the Philippines for their daughter, Moon Jayden, who was also suffering from seizures.
When Moon Jayden died, we decided to do something. We founded the Philippine Cannabis Compassion Society or PCCS with other parents and advocates. Eventually we came to be known as Cannahopefuls Inc.
Why did you think it was worth trying cannabis on your child?
Based on research, cannabis caused a drastic decrease of seizures in epileptic patients by 70 to 90 percent! I was hopeful it would also help my daughter.
Would you say it’s effective compared to conventional medicines? What does it do to your child?
I can’t say it’s 100-percent more effective, but it’s a better option especially for patients who are not responsive to synthetic medicines. Cannabis helps patients lead an improved quality of life, with less organ toxicity or side effects, compared to conventional medicines. It can also supplement chemotherapy for cancer patients.
You’ve been involved in advocacy groups to legalize medical cannabis. Do you think your efforts are now paying off as lawmakers consider passing a bill to make the substance easily accessible?
Yes! Our efforts are now being rewarded as lawmakers consider passing a bill both in the Senate and House ofRepresentatives.
What provisions do you want, should the bill pass into law?
We are happy with the substitute bills being discussed in the Upper and Lower Houses. We were able to add the provisions we wanted. We’re just waiting for the committee report anytime soon.
Dr. Gem Mutia, M.D.
Founder, Philippine Society of Cannabinoid Medicine
Art+: When did you first learn about the healing properties of cannabis, and what convinced you that it’s medicine, indeed?
Dr. Gem Mutia: I first learned about its medical properties inadvertently during first year medical school, when I was assigned to report on it as a drug of abuse. Years later, I would delve deeper into its therapeutic properties when my sister was afflicted with stomach cancer.
Sixteen years after I stumbled upon its unreported, dismissed, almost hidden healing powers, more and more clinically proven indications have been approved, and more and more countries have rectified their misguided policies.
But the medical profession in the Philippines is divided on the issue. Why do you think the majority of Filipino doctors are skeptical, if not totally unconvinced, that it's time to consider cannabis as medicine?
Majority of doctors are unconvinced simply because they know only one side of the coin. Medical students study cannabis only as a drug of abuse. Once they become clinicians, prohibition will make it impossible for them to utilize cannabis in the clinics.
The prohibition of cannabis, together with the difficulties of patenting a plant, has given little motivation for drug companies to conduct the clinical trials needed to confirm the plant’s benefits.
Sadly, continuing medical education is an industry-driven endeavor. The lack of a medical cannabis industry is the reason doctors remain ignorant of its medical benefits.
Simply put, doctors don’t know about its benefits because there are no medical representatives talking to them about it, and no drug companies are sponsoring medical conventions.
You are part of advocacy groups lobbying in Congress for the passage of a medical cannabis law. What do you think are the most important provisions that lawmakers should consider in the crafting of this law?
The ideal medical cannabis program should require that the drug be prescribed by a physician and dispensed by a pharmacist. One Senate bill and five house bills already contain the former, but not the latter.
Efforts should also be made to prevent a monopoly, to have a competitive/affordable price, or else we risk legitimate patients resorting to unregulated, unsafe, black-market products.
Are you also in favor of decriminalizing, if not legalizing, cannabis in general? Why or why not?
Although we do not encourage non medical use, we strongly condemn the stigmatization, criminalization, and execution of cannabis users. Prohibition causes more harm by preventing those with problematic cannabis use from getting treatment. Encounters with law enforcement could also be more harmful than the effects of the drug itself.
Cannabis use and abuse should be addressed by the health system, not the criminal justice system.
It is so tragic and ironic that those who swore to “Do no harm” actively support the criminalization of a substance less dangerous than alcohol, tobacco, and other prescription drugs.
We stand with other medical organizations such as the American Medical Association, American Society of Addiction Medicine, Canadian Association of Mental Health, among others, in the abolition of criminal penalties for the possession of cannabis for personal use.
Zarah Cruz
Former program specialist, City of Sacramento’s Office of Cannabis Management
Tell us about your work in the Office of Cannabis Management in Sacramento, California.
I had the opportunity to serve as the program specialist for the City of Sacramento’s Office of Cannabis Management for almost seven years. I joined the department in Jan. 2017 as the first employee of the department and built it with a staff of nine before I retired in Sept. 2023.
In my first year with the department, I focused on developing the regulations, i.e. for the entire supply chain (from seed to sale) and enforcement mechanisms against illegal or unlicensed cannabis businesses. I was also responsible for helping establish a social equity program, a partnership between the State and local government to provide entrepreneurship opportunities for victims and families of the War on Drugs.The State provides the funding while the locals provide the technical training and expedited licensing services.
What were the most significant things you have observed in the cannabis laws in Sacramento, as well as in the United States in general?
When regulators at the State and the local level began developing the regulations in 2017, there were no subject matter experts or playbooks that could be used as resources. We used to jokingly describe as efforts as “we are building the plane as we’re flying it.” In the effort to develop regulations for a brand-new industry, with many of the players barely evolving from years and years of operating in the black market, regulators chose to err on the side of caution.
As a result, the early versions of the regulations reflect the heavy hand of regulators. Many of the jurisdictions throughout California (and later also observed in other parts of the US), tend to impose high taxes from the get-go, to appease reluctant politicians, homeowners and citizens in general, to allow cannabis facilities into their cities. Also, because cannabis is an untested type of business, jurisdictions also established stricter zoning and land use regulations, building and business license requirements and imposed heftier fines for violators.
The cost of regulations became too costly that, eventually, many amateur entrepreneurs hoping to strike gold in a brand-new industry ended up discarding their plans even before they could open their doors. Some of those who came from underground returned to their underground operations where they had loyal customers who hardly cared if products were manufactured in a safe environment or paid their taxes.
Any downsides or complications so far?
The high cost of regulations eventually created a challenge for the legal market, which often had to compete, with unsuccessful results, with the black market. For the jurisdictions that regulate cannabis, a failing legal market means a loss in revenues. And lower revenues negatively impact enforcement actions against illegal operators, thus allowing the black market to thrive.
Some jurisdictions in California are now amending their tax laws, loosening up some of the tedious licensing requirements and creating incentives to make it competitive for the legal market to survive.
What’s your personal view of cannabis, whether medical or recreational?
I was a California resident when medical cannabis was on the ballot in 1996 and Proposition 64 (Adult Use of Marijuana Act) was passed in 2016. I supported both measures. My personal views were later validated by personal stories from patients, research, and hard data that I had to rely on constantly in the course of my job as a cannabis regulator.
There is no shortage of literature that says cannabis, when used as a medicine, provides relief for a variety of ailments — from insomnia, migraine, rheumatoid arthritis, and fibromyalgia, to epileptic seizures which can sometimes be fatal. To read this type of research is one thing, but to be in the circle of patients who attest to how they were healed, often after pharmaceutical medicines have failed, and have regained the ability to live a normal life, has strengthened my conviction to share my knowledge and expertise in this subject to advocate for its legalization in the Philippines.
In the six years that I’ve worked in the cannabis space, I have not seen data to suggest that recreational cannabis has made a negative impact to public safety and order. In fact, in looking at public arrests data, which supports my personal observation, alcohol is the still the substance that is responsible for violent crimes such as date rapes, domestic abuse and public disorderly conduct. I believe that most people who have used alcohol and cannabis will agree that the former makes them aggressive, while the latter causes a calming effect that makes them want to relax, if not sleep.
Observers are saying that medical cannabis will soon be legalized in the Philippines. As a former journalist in Manila, and now a cannabis advocate, what provisions do you think are necessary to make the law work for the public?
I believe we have a lot of work to do as far as raising awareness on the medical benefits of cannabis. While public opinion has shifted, a good part of Philippine society still views cannabis as a type of drug that is smoked to get high. Under our law, cannabis is still classified as a dangerous substance that carries a heavy punishment even for personal possession and use. So, even if it is legalized solely for medical purposes, ifit is not reclassified, patients will still be reluctant to access it for fear of breaking the law.
I believe legislation should be passed in tandem — provide access, declassify it from the dangerous substance list and decriminalize it. In my experience, overregulation, which can be traced to government bias against a new industry which was previously associated with huge cash, was counterproductive and precluded small businesses from succeeding in the space.
It is, therefore, important that regulations reflect a balance between providing patients with safe and affordable cannabis-based drugs, while ensuring that we are not overtaxing and imposing unnecessary requirements for the industry. It is likewise good to invest in research.
How cannabis works in the human body
In 1964, Israeli chemist and cannabis researcher Dr. Raphael Mechoulam discovered that among numerous chemical compounds in the plant, only one is active: Delta9-tetrahydrocannabinol (THC), which is responsible for its psychoactive effects (the “high” that is felt when it is smoked).
Another compound, cannabidiol (CBD), acts on many of the same receptors as THC, but without the psychoactive side effects.
CBD is the main ingredient in medical cannabis oil.
Mechoulam said THC can be used as “an anti-vomiting and anti-nausea drug for cancer chemotherapy, and as an appetite-enhancing agent.”
He pointed out that THC was being tested to help patients suffering from multiple sclerosis, and that “recent work with cannabidiol in animal models of rheumatoid arthritis may lead to clinical investigations. A synthetic cannabinoid, HU-211 (Dexanabinol), is in advanced clinical stages of investigation as a neuroprotectant in head trauma.”
Later, in 1988, scientists Allyn Howlett and William Devane of St. Louis University Medical School in Missouri established what Mechoulam called “an important discovery about cannabis”: Inside the human brain itself is a receptor for THC, which they named CB1 (cannabinoid receptor No.1).
CB1 has been pinpointed for its compatibility, or its ability to interact with certain parts of the human brain called the endocannabinoid system.
The endocannabinoid system helps regulate sleep, appetite, digestion, hunger, mood, motor control, immune function, reproduction and fertility, pleasure and reward, pain, memory, and temperature regulation.
The discovery is what recreational users believe, based on their own experience, that cannabis induces a natural, or safe, interaction with the human body — since it also has elements of cannabis.
Medical cannabis comes in different forms, including vapor, capsules, lozenges, dermal patches, and oil.
In the Philippines, cannabis oil is made underground by private sources for people suffering from various ailments including cancer.
