The New Today

Commentary

Issues in the establishment of a therapeutic cannabis market in the Caribbean

CANNABIS (Cannabis sativa L). is a plant that contains over 80 different naturally occurring compounds called cannabinoids. Two well-known cannabinoids are cannabidiol (CBD) and tetrahydrocannabinol (THC). The main difference between the two cannabinoids is that THC has strong psychoactive effects, meaning it makes a person ‘high’, whereas CBD is thought to have an anti-psychoactive effect that controls or moderates the ‘high’ caused by the THC.

CBD is also thought to reduce some of the other negative effects that people can experience from THC, such as anxiety.

There are also cannabis-derived compounds, which are synthetic cannabinoids for medicinal use which mimic the effects of naturally occurring cannabinoids. These synthetic compounds are created in a laboratory and can be used to manufacture drug products.

DIFFERENCE BETWEEN MEDICAL AND RECREATIONAL CANNABIS
Medical cannabis treatment refers to cannabis that is administered specifically for medical purposes under supervision of a doctor, while recreational cannabis refers to the use of cannabis for nonmedical purposes. Medical cannabis is different from its recreational counterpart.

Unlike street-bought cannabis, it is grown at a medical cannabis farm under strict conditions, monitored for quality and consistency, and its application is overseen by medical professionals. This applies to all cannabis based medical products, not only dried flowers.

COMMERCIAL AND MEDICINAL USE OF CANNABIS IN THE CARIBBEAN
In the US, medical cannabis is a multi-billion-dollar industry. But is the Caribbean ready for commercial or medicinal cannabis? In the Caribbean, there has been no relaxing of rules for recreational cannabis, the change is purely medical.

While cannabis has been consumed for thousands of years, the medical-legal landscape surrounding its use has dramatically evolved over the past decades. Patients are turning to cannabis as a therapeutic option for several medical conditions.

Given the surge in interest over the past decades there exists a major gap in the literature with respect to understanding the products that are currently being consumed by patients.

JAMAICA:
In 2015, Jamaica became the first Caribbean country to decriminalise personal cannabis possession, legalise home cultivation and establish a commercial therapeutic cannabis market via the passage of the Dangerous Drugs Amendment Act (DDAA).

However, five years after passage of the DDAA, stakeholders have voiced frustration over the slowness of the implementation and early impacts of the reforms. Commentators and academics have raised concerns over the financial barriers faced by illegal cannabis farmers interested in entering the new legal industry.

The speed of the DDAA implementation has also been questioned, with standards for the cultivation, processing, packaging, and handling of cannabis products published in July 2020 and delays in releasing official regulations for cannabis exports.

Five years after the passing of the DDAA, the industry continues to operate under the “Interim Regulation.” However, it has evolved significantly over the years. While the possession and sale of cannabis for recreational purposes remain illegal, the country has decriminalised possession of up to two ounces (56.6 grams) of cannabis for personal use. Before this, those caught possessing marijuana could face imprisonment and a fine of up to $100 per ounce.

It is important to note that smoking cannabis in public places is still illegal and can result in a fine of JMD $500 (approximately $5 USD). Despite these changes, the sale and supply of cannabis for recreational purposes remain prohibited, making the weed legal in Jamaica only to a certain extent.

The cultivation of marijuana has also been partially legalised, with households allowed to grow up to five cannabis plants.

The Jamaican government established the Cannabis Licensing Authority (CLA) to administer and supervise the medical cannabis industry, manage cannabis cultivation for research purposes, and oversee the country’s hemp industry.

Companies in Jamaica can apply for a retail license for medicinal, scientific, or research purposes, but just a few dispensaries operate legally in the country.

ST VINCENT AND THE GRENADINES (SVG):
In SVG, cannabis is illegal for recreational use. However, possession of up to two ounces of cannabis flower has been decriminalised, and there is a medical cannabis programme established under the Medicinal Cannabis Industry Act.

DOMINICA:
Dominica has decriminalised the possession of small amounts of cannabis for personal use, but has not fully legalised the substance. Regarding specific cannabinoids, the situation is as follows: CBD: CBD is generally legal in Dominica, if it is derived from hemp containing less than 0.3% THC.

ST LUCIA:
In 2021, the government passed two major cannabis reforms. The first bill expunged individuals with criminal records for the possession of 30 grams of cannabis or less. The second amendment decriminalised the personal private use of small quantities of 30 grams of cannabis or less.

The Saint Lucian government is also planning the rollout of a public education campaign, medical marijuana programme, and legalising the cultivation of weed on the island. However, these initiatives are still in the process of being developed.

GRENADA:
Grenada’s current laws classify cannabis as a narcotic substance and ban its possession and use, regardless of whether it’s for medical or recreational purposes. However, the Grenada government recently announced its intention to legalise medical marijuana.

The Bill was expected to finish drafting for Parliament’s approval by the end of 2023, though the Bill may require additional revisions before it becomes law.

BARBADOS:
In Barbados, it is illegal for recreational use, but is in high demand, nonetheless. Medical use of cannabis was legalised in November 2019 through the Medicinal Cannabis Industry Bill. A second bill that was passed, the Sacramental Cannabis Bill, allows the spiritual use of cannabis by registered Rastafarians.

TRINIDAD AND TOBAGO:
The Government of the Republic of Trinidad and Tobago (T&T), through the Dangerous Drug Act of 2019, decriminalised the possession of marijuana of a maximum of 30 grams of cannabis, 5 grams of cannabis resin and allows for the cultivation of four female trees per household as of April 2023.

GUYANA:
In Guyana cannabis is illegal for all uses but is both grown and consumed in the nation. Possession of 15 grams or over can result in charges of drug trafficking.

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SURINAME:
Although a growing number of South American countries have legalised marijuana for medical purposes, cannabis (and its derivatives) remain illegal in Suriname. While law enforcement is reportedly relaxed about public marijuana use, drug-related offenses are known to incur severe penalties – including jail time.

BELIZE:
The use of cannabis in Belize is common and largely tolerated; however, possession can result in fines or imprisonment. Possession or use of 10 grams or less on private premises was decriminalised in November 2017.

Lastly, federal laws authorising the commercial production and exportation of hemp may one day lead to legal cannabis for recreational and medicinal use.

BAHAMAS:
The Bahamas has introduced a package of draft legislation to decriminalise cannabis for medical, research and religious purposes and to establish a legal medical marijuana industry.

However, all other licenses, including cultivation and retail, would be reserved for 100% Bahamian-owned businesses. The government plans to create a Cannabis Authority to oversee the regulation of the marijuana industry.

ST KITTS AND NEVIS:
On July 31, 2019, a bill was passed by the National Assembly to decriminalise up to 15 grams of cannabis, punishable by $50 fine. For public use the fine was set at $1000. In February 2020, the National Assembly of Saint Kitts and Nevis raised the allowed amount of cannabis to 56 grams.

ANTIGUA AND BARBUDA:
Cannabis in Antigua and Barbuda is illegal but decriminalised. The islands are not a major producer of cannabis, and instead import the drug from Jamaica and St. Vincent and the Grenadines.

In March 2018, the Misuse of Drugs (Amendment) Act 2018 amended the Misuse of Drugs Act to state that “a person who is in possession of a maximum of 15 grams of the drug cannabis or cannabis resin is not guilty of an offence.”

The amendment stopped short of legalising the drug as it does not remove legal penalties for the sale of cannabis.

MONTSERRAT:
Marijuana possession, drug use, sale, production, and trafficking are all against the law in Montserrat. Those violating these rules face severe penalties, including lengthy prison time and steep fines.

FDA AND APPROVAL OF MARIJUANA
According to the Food and Drug Administration (FDA) there has been an increasing interest in the potential utility of cannabis for a variety of medical conditions, as well as research on the potential adverse health effects from use of cannabis over the past ten years.

To date, it has not approved a marketing application for cannabis for the treatment of any disease or condition. The agency has, however, approved one cannabis-derived drug product: Epidiolex (cannabidiol), and three synthetic cannabis-related drug products: Marinol (dronabinol), Syndros (dronabinol), and Cesamet (nabilone).

These approved drug products are only available with a prescription from a licensed healthcare provider. Importantly, the FDA has not approved any other cannabis, cannabis-derived, or cannabidiol (CBD) products currently available on the market.

Epidiolex, which contains a treatment of seizures associated with Lennox-Gastaut syndrome or Drava purified form of the drug substance cannabidiol (CBD) was approved for the syndrome in patients 2 years of age and older. That means the FDA has concluded that this particular drug product is safe and effective for its intended use.

The agency also has approved Marinol and Syndros for therapeutic uses in the United States, including for nausea associated with cancer chemotherapy and for the treatment of anorexia associated with weight loss in AIDS patients.

Marinol and Syndros include the active ingredient dronabinol, a synthetic delta-9- tetrahydrocannabinol (THC) which is considered the psychoactive intoxicating component of cannabis (i.e., the component responsible for the “high” people may experience from using cannabis).

Another FDA-approved drug, Cesamet, contains the active ingredient nabilone, which has a chemical structure similar to THC and is synthetically derived. Cesamet, like dronabinol-containing products, is indicated for nausea associated with cancer chemotherapy.

FDA is aware that unapproved cannabis and/or unapproved cannabis-derived products are being used to treat several medical conditions including, AIDS wasting, epilepsy, neuropathic pain, spasticity associated with multiple sclerosis, and cancer and chemotherapy-induced nausea.

Caregivers and patients can be confident that FDA-approved drugs have been carefully evaluated for safety, efficacy, and quality, and are monitored by the FDA once they are on the market.

However, the use of unapproved cannabis and cannabis-derived products can have unpredictable and unintended consequences, including serious safety risks.

Also, there has been no FDA review of data from rigorous clinical trials to support that these unapproved products are safe and efficacious for the various therapeutic uses for which they are being used.

CONCLUSION
Medicinal cannabis, or medicinal marijuana, is a therapy that has garnered much national attention in recent years.

Controversies surrounding legal, ethical, and societal implications associated with use; safe administration, packaging, and dispensing; adverse health consequences and deaths attributed to marijuana intoxication; and therapeutic indications based on limited clinical data, represent some of the complexities associated with this treatment.

Marijuana is currently recognised by the U.S. Drug Enforcement Agency’s (DEA’s) Comprehensive Drug Abuse Prevention and Control Act (Controlled Substances Act) of 1970 as a Schedule I controlled substance, defined as having a high potential for abuse, not currently accepted for medicinal use in treatment in the United States, and a lack of accepted safety data for use of the treatment under medical supervision.

Cannabis is the most cultivated, trafficked, and abused illicit drug worldwide; according to the World Health Organisation (WHO), marijuana consumption has an annual prevalence rate of approximately 147 million individuals or nearly 2.5% of the global population.

Simeon Collins is a former Director of the Grenada Bureau of Standards and first Chief Executive Officer (CEO) of the Caribbean Agricultural Health and Food Safety Agency (CAHFSA), a CARICOM Institution. He is also a certified OSHA Auditor