Portuguese Medical Cannabis pt 2
As the cannabis laws around our own country are constantly changing and evolving, cannabis laws and regulations around the world are changing as well. I’ll admit that as a born and raised American, my knowledge of cannabis laws outside of my state, let alone the country, were very limited to say the least. Now, however, I have a somewhat unique insight to the changing cannabis laws in Portugal, thanks to my mom who has been living there since 2019.
It’s kind of fitting that we’re covering Portugal’s cannabis laws, as this year marks the 20 year anniversary of Portugal decriminalizing the personal possession of all drugs in 2001. Amounts are variable by substance, for example up to 25 grams of flower is considered personal use cannabis, and possession or use of substances most in the US consider drugs is no longer punishable by imprisonment or a criminal record – and the often attached social stigma a drug offense can have. This doesn’t mean that drug use is legal in Portugal, and if caught, they will still be confiscated and you may face a penalty like community service or a fine. These penalties are decided by the Commissions for the Dissuasion of Drug Addiction, a panel of health, legal and social workers at the district level that evaluate cases and, in some high risk cases, may recommend non mandatory referrals to treatment services, though most cases are considered low risk and no further action is taken.
This radical approach to drug policy has transformed Portugal, in my opinion, for the better. Their imprisonment rate for drug related offenses dropped from 40% to around 15%, due to the health focused shift in approach to their drug policies. In 2001, they had almost 1,300 new cases of HIV attributed to injection drug use. Despite having only 2% of the EU population, in 2001 and 2002 they made up over 50% of new HIV cases. In 2019, Portugal reported 16 new cases of HIV due to injection drug use, now 1.68% of the EU total. Not only did they shift away from imprisonment, they also implemented needle exchange and other community harm reduction programs.
Now, in 2021, patients in Portugal who feel as if they have exhausted all of their other treatment options, can be legally prescribed cannabis by their doctor. This law was passed in 2018, but it has taken until April of 2021 for patients to have access to their legal, medical cannabis – you can check out last month’s issue for an overview on how Portugal is getting its medical cannabis! Fortunately for me, my window into Portugal has given me a little insight to the experiences of new medical cannabis patients there, and now I get to pass these little nugs of knowledge on to you. It can never hurt to have a little more cannabis info in your back pocket if you might need it!
You might have noticed before that I mentioned specifically patients who feel like they have exhausted all of their other treatment options, and I did that on purpose. While I’m not familiar with the specific wording of all of the medical cannabis laws and regulations across the country, in my experience at the co-op there were generally two types of patients. There were patients who had found through recreational use that cannabis was effectively treating or managing symptoms or illnesses that they dealt with regularly, and there were patients who had tried everything and cannabis was their hail mary. I think this is an important distinction to make because the Portuguese medical cannabis law makes this distinction as well. How this will be implemented by doctors in the future is yet to be seen.
Portuguese doctors can now legally prescribe cannabis or cannabis based medicine to patients who have not responded to traditional treatments or therapies, or who may be having adverse reactions to their treatments. Cannabis has also been cleared to treat chronic pain, particularly associated with nervous system issues or cancer, spinal cord injuries, multiple sclerosis and nausea related to the treatment of cancer, AIDS or Hepatitis C, and as an appetite stimulant. It seems as if they are treating cannabis as a supplement to traditional treatments, which I can’t say is all that bad of an approach.
Once you’re able to obtain a prescription from your doctor, you take it to your pharmacy, just like any other prescription. Now, I can’t really speak from personal experience because I honestly cannot remember the last time I had to take or pick up a prescription from a pharmacy, so I don’t know if there are some that they just have around, with not much waiting involved. Is that even a thing? Anyway, in Portugal at least, I know they don’t keep the medical cannabis behind the counter. Once the prescription is dropped off, the “order” I presume, is sent off to Tilray, Portugal’s local giant multinational medical cannabis manufacturers.
Unlike medical dispensaries in the US, there are no choices. The only available cannabis flower at the time I’m writing this is a hybrid variety, which makes a certain kind of sense. If you don’t have the ability to choose between a predominantly indica or sativa, having a hybrid of the two is a reasonable compromise. There’s also a big difference in cannabis culture between the US and Portugal, from what I understand, and having variety when it comes to medical cannabis for patients is something we’re accustomed to here. The normalcy of an array of options has worked well for many patients in the States, giving them the ability to find what strains and methods work best for their specific needs, but the efficacy of a single hybrid strain available to all Portuguese patients is another thing on the “wait and see” list.
So far, prescriptions are only allowed in 15 gram amounts and cost approximately $150 USD, which seems pretty reasonable to me. The packaging is a white and nondescript zipper envelope, and looks kind of how you would imagine medical cannabis packaging to look. The sticker on the front touts 18% THC and Tilray’s name and logo, as well as some other things in Portuguese that I can’t translate but imagine are informative and/or regulatory. Now, this only applies to medical cannabis flower prescriptions, as there is even less information available about the cannabis based medicines and preparations that are also legal under the new laws.
Now it goes without saying, but there is black market cannabis in Portugal. Shocking, I know, but it has to come from somewhere. Where there isn’t a legal regulated market for something – and often when there is – a black market for it usually exists, and the general feeling I get is that black market cannabis in Portugal isn’t all that great. A pretty average minimum THC percentage for medical cannabis is around 15% or higher, and if I had to guess, a lot of low quality black market cannabis in Portugal is somewhere under, if not well under, 10% THC. Tilray’s medical cannabis testing at 18% THC is a pretty good difference in quality, and therefore effectiveness in a lot of situations. It’s safe to assume that with the increased knowledge the world has gained about medical cannabis that there are going to be patients who seek it out regardless of its legal status, and this significant increase in quality I think will be a welcome benefit of legalized medical cannabis.
In addition to the increase in quality, some Portuguese patients can get excited about the prospect of their insurance helping with the cost. In my understanding, in some cases, Portuguese National insurance may cover up to 90% of the cost of your prescription, up to 500 Euros per year. Prescriptions can be renewed at the pharmacy weekly, if need be, and patients can pay out of pocket for refills beyond the insurance reimbursement limit.
Portugal is now another in a list of countries and states who are taking the necessary steps to give patients legal access to a plant that has been helping people for centuries, but we have yet to see how patients across the country will respond, not only to the legislation but it’s implementation and the quality and consistency of medication. Will Tilray be able to supply it’s patients with the same quality of medication they will, undoubtedly, become accustomed to? Will patients be able to easily obtain and refill their prescriptions as needed? Only time will tell and I promise I’ll be the one to tell you.
Kelly Mahoney worked at a medical cannabis Co-op with her mother, Laura Mastropietro, dealing mainly with helping new patients acquire their medical cards and helping them find the best strains and methods. Diagnosed at a young age with spinal muscular atrophy, she was also a medical cannabis patient and still advocates for the incredible benefits, and downright fun, of cannabis. She now lives in a prohibition state as a cat mom and gamer wife.