Interview: Doctor's orders

Paola Cubillos, M.D., N.D.

Paola Cubillos is an experienced physician and medicinal cannabis advocate. Colombian by birth, she studied and worked in Toronto for several years before returning to Medellín to work as an integrative physician at the Las Américas Hospital and to further medical cannabis research in the country.

CCI: Have you seen a change in the attitude of the country’s health authorities towards cannabis under the new government?

PC: The previous Minister of Health, Alejandro Gaviria, began the Colombian discussion about medicinal cannabis that went beyond the usual focus on numbers and the sustainability of the system. He is a strong advocate for decriminalization. The new minister has been less vocal about cannabis but I don’t think there will be any slowing of the medicinal cannabis industry. However, there is clearly a cognitive dissonance between the government’s move to prosecute people carrying pot in their pockets while at the same time allowing corporations to benefit. The commercial push is taking priority at the moment.

CCI: How have medical professionals reacted to the growth of the industry?

PC: I think doctors are curious. Some of them have had experience using cannabis on their patients and are recommending it, without knowing exactly how it works and why. Its difficult to say what triggers a cannabis recommendation at the moment. Colombian pharmacies are interested in providing magistral formulas to begin with, whereby pharmacies prepare a certain ratio of CBD vs. THC oil for each individual patient. It brings in money and it’s approved by INVIMA, the drug approval body, so why not?

CCI: What progress has been made regarding the approval process for cannabis treatments in Colombia?

PC: INVIMA are learning as they go and they are listening to the suggestions made by Asocolcanna so both the government and the industry are learning from one another. Asocolcanna successfully petitioned for cannabis to be included as a phytotherapeutic plant, which happened in December last year. This is a big change.

CCI: Does that mean that cannabis medicines must pass through the same stringent and lengthy approval systems that INVIMA applies to other medical drugs?

PC: The original intent of the legislation was for R&D to happen in Colombia. However, the fastest and easiest route to market is to use evidence from other approved medicinal cannabis products available internationally. We’ll see a lot of companies trying to replicate GW Pharmaceutical products in the form of sprays and sublingual oils. The other path is creating pharmaceutical compounds at different concentrations, but this will require going through phases 1, 2 and 3 of clinical trials, which is a very long pipeline.

There is a cognitive dissonance between the government’s move to prosecute people carrying pot while at the same time allowing corporations to benefit

CCI: What should the government and private sector do to educate patients about cannabis?

PC: We need demand-driven legislation. The National Academy of Scientists report outlined a few cases in which evidence was strong: in chronic pain cases, pain and spasticity related to MSE, fibromyalgia, and nausea related to chemotherapy. So, there’s a lot of noise creating acceptance and enthusiasm for cannabis as medicine but the scientific rationale is not necessarily there. The main problem I see is, because we’re a little more relaxed with ethical rules, there is no conscience. So nothing to try to separate the real benefits from what’s not in commercial interest. You’re going to find a lot of doctors interested in the industry just to benefit from the financial boom, it’s easy for companies to buy them.