Is Jamaica ready For Medical Cannabis? A pharmacist's Perspective

Ron Strider

Well-Known Member
Medicinal cannabis has recently attracted much media attention in Jamaica and across the world. With the exception of a few countries, cannabinoids remain illegal — known for their adverse effects rather than their medicinal application and therapeutic benefit. However, there is mounting evidence demonstrating the therapeutic benefits of cannabis in alleviating neuropathic pain, improving multiple sclerosis spasticity, reducing chemotherapy-induced nausea and vomiting, and many other chronic conditions.

Many people are calling for the legalization of medicinal cannabis, including consumers, physicians and politicians. Pharmacists are the gatekeepers of medicines and future administrators/dispensers of cannabis to the public, but very little has been heard about the perspectives of pharmacists.

Natural and botanical products that will be consumed or used by humans will most definitely be cause for concern by the general public. As a registered pharmacist, I am acutely aware of the strict regulatory guidelines from the laboratory to the pharmacy that prescription drugs have to go through, and rightfully so, as this builds trust and confidence for both prescriber and patient. Natural and botanical products should pass through similar checks and balances if we are to have a very viable and successful medicinal cannabis business.

Unlike their pharmaceutical counterparts, products or medication derived from natural and botanical sources often contain a series of active principles. Further complicating this matter with regard to cannabis is the entourage effect, where a series of active principles work synergistically in their interaction with the body — the idea that the whole is greater than the sum of the parts. This results in the possibility of marginally different products having remarkably different effects on the body.

Although individual users and/or caregivers are responsible for choosing the optimal dose and “type” of cannabis product, accurate information regarding many aspects of consumer products can aid this decision process. For consumer products with regard to the cannabis industry, there are two primary categories of product testing: quality control and characterization .

There is strong supportive evidence that, in order to ensure public health and safety, all cannabis and cannabis-derived products intended for human consumption must be tested for safety and potency so that they may pass the scrutiny of the public, and the steps must be mandatory, ie sampling, testing and labelling. Being a natural and botanical product, cannabis is susceptible to some of the diseases and pests that affect our domestic agricultural crops, and hence the need for tests for microbes (pathogenic bacteria and fungi), pesticides, toxins, and residual solvents (accidental).

The above-mentioned can all have serious effects on the human body if we are exposed to them in varying concentrations, so rigorous laboratory testing should at least include the following: cannabinoids, microbial contaminants, pesticides, heavy metals and residual contaminants.

Samples of cannabis should be tested for:

A. Potency of the predominant active ingredients (ie Tetrahydrocannabinolic acid (THC), tetrahydrocannabinol (Δ9 THC); cannabidiol (CBD);

B. Most likely contaminants: microbiological organisms (pathogenic bacteria and fungus), pesticides, heavy metals)

C. Extract prepared with hydrocarbon or organic solvents must be tested for residual solvents .

D. Acceptable thresholds of pathogenic microbial contaminants such as

Shiga-toxin producing Escherichia coli (STEC) – bacteria

Salmonella species – bacteria

Aspergillus fumigatus, Aspergillus flavus, Aspergillus niger – fungus

E. Acceptable thresholds for pesticides

F. Acceptable thresholds for heavy metals, (arsenic, cadmium, lead, and mercury)

G. Residual solvents of volatile organic compounds, (butanes, heptanes, benzene, toluene, hex ane).

In the interest of public health, the labelling of the finished product is equally important, and the FDA recommends:

1) a statement identifying the commodity;

2) the name and place of business of the manufacturer, packer, or distributor; and

3) the net quantity of contents in terms of weight, measure, or numerical count (measurement must be in both metric and inch/pound units).

In the case of cannabis commodities, the Phyto Science Institute 2015 recommends that packages be labelled with:

1) a statement identifying the commodity including the particular strain(s) of cannabis;

2) the name and place of business of the cultivator, producer, or distributor, and the retail store;

3) the weight of cannabis container within the package in grams;

4) ingredients added during preparation, if not raw plant material;

5) amount of THC and CBD in mg;

6) dosage, serving size, and numbers of servings/package; and

7) safety handling and storage instructions.

Plant extracts, processed products, and raw flower material testing should include, at the very least, THC and CBD concentrations to inform users and caregivers of the primary cannabinoid content of the respective product being consumed. Ideally, the information offered with products would include full cannabinoid and terpene profiles as well as concentrations of the respective components in processed products.

This information is essential to dose and cultivar guidance. This becomes especially useful when a user experiences adverse effects with a particular cultivar. The search for a suitable combination of cannabinoids, terpenes, and CBD-to-THC ratio can be an informed search based on scientific information. Most importantly, users will be able to identify individual constituents contributing to the entourage effect associated with a particular cultivar. If the experience is positive, they may search for similar strains, and if the experience is negative, they can make an informed decision regarding an alternative strain.

The following questions must be answered in the interest of public health by the Ministry of Health pro bono publico (for the public good):

Does Jamaica have an existing product safety requirement for medical cannabis /products? If yes, what is it?

Does Jamaica have a laboratory that is ISO 17025-accredited to perform necessary tests?

What safety recommendations does the Ministry of Health think should be mandatory?

What recommendations does the Ministry of Health think should be optional?

How should compliance with the Ministry of Health recommendations be verified?

Who should perform sampling and testing, and at what stage in production?

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