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Akerele: We need to discourage growing of cannabis

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Akerele

The immediate past President of Resident Doctors Association at the Federal Neuro-psychiatric Hospital, Yaba, Lagos, and psychiatrist, Dr. Raliat Akerele, in this interview with GERALDINE AKUTU, said for medical marijuana to be effective in Nigeria, the government should fund large-scale research into the crop.

Can you explain the gradual adoption of marijuana in health therapy?
MARIJUANA is a drug that has mind-altering effect and medicinal value. Its chemical name is cannabis sativa and it produces over 80 different species of cannabinoid. These are chemical constituents of the plant, but the ones that are more frequently produced in the plant is called tetrahydrocannabinol (THC) and cannabidiol (CBD).

The THC produces the mind-altering effect that makes people high, while the cannabinoid is the safer constituent, which is used in medication.

The use of cannabis sativa has been there for long and the first reference that people spoke about was in Chinese literature when they talked about using it for recreation. So, as far back as 2, 700BC, cannabis has been used for recreation and medical purposes in China. It was used to treat gout and rheumatism. These are things that affect the musculoskeletal system in the body.

The use spread from China to Asia and then East Africa, both for medical use and for recreational use.

Around 1910 to 1920, it was more used as a recreational drug. Even America had cannabis known as pharmacopeia listed in one of their medications to show that the medicinal value of cannabis has been known for a long time.

However, because people were seen to be high and committing crimes after using it, it was removed in 1941. It wasn’t until 1985 that pharmaceutical companies started making different preparations of cannabis again because some patients with chronic conditions were in need of cannabis. So, they got approval and started making different preparations.

Nigeria never tapped into the use of cannabis until recently. The medical conditions that cannabis is being used to treat include nausea and vomiting for cancer patients that are undergoing chemotherapy, patients with HIV/AIDS, chronic pain, epilepsy and glaucoma.

Developed countries have gone far in developing medical marijuana, but as you know, Nigeria and other conservative and traditional societies are reacting timidly and cautiously. Why?

This is because we don’t carry out the volume of research that developed countries do. If we do that, we would be aware of many other effects of cannabis apart from the mind-altering effect.

Not until recently, the only thing we talk about in Nigeria is about youths having psychotic episodes to the extent that they become less productive in the society after taking marijuana. As far back as 23 years ago, cannabis was legalised for medicinal use in the state of California, United States.

Another reason why we haven’t gone far in research into it is because our culture frowns at the use of psychoactive substances for whatever reason. People use tobacco known as utaba (snuff) here, which is a psychoactive substance, but the psychoactive substance in cannabis is higher.

Kolanut, mostly used by traditional people also has psychoactive substances and they don’t see anything wrong in it, but the level of psychoactive substance that is in cannabis is way higher. Our culture frowns at any finding that will improve mind-altering drugs so that they do not cause harm. That is why we haven’t gone far in this regard.

Also, the fact that people that smoked marijuana ‘saw things that others did not see,’ heard things, and acted out of character, made many people to see that marijuana-induced mind alteration as a spiritual problem. It is recently that we discovered that a lot of people that use cannabis are the ones that ended up with mental health challenge.

Do you think it should be legalised in the country?
If the Federal Government wants to legalise marijuana, then we need to do a lot of research into endocannabinoid. That will help to find out medications that would bind with receptors that will not cause mind-altering effects. Receptors are things in the body that drugs bind to. If that is done, it will make sense to legalise it in Nigeria.

How should government approach this development in science?
I would suggest that if government wants to key into it, it should fund large-scale research, where the safer components of marijuana (CBD) is used in different geo-political zones of the country to see the effects, with results generated and published to enable us weigh the benefits of this medication vis-à-vis the side effects. We are aware that there are other medications that can treat dire health conditions that medical marijuana are used for. So, a big research will, among other things, prove that the CBD part of cannabis, is effective for nausea, weight loss, epilepsy and so on.

Also, we cannot totally stop people from using cannabis for recreational purposes. But to ensure that the substance is not abused, the variety of plant cultivated must have a higher ratio of CBD component compared to THC. So, even if people want to use it recreationally, it will still be safe. If that is controlled, the mind-altering effect will reduce drastically.

The United States Food and Drug Administration agency has actually approved marinol and syndros for nausea, and loss of appetite in people with HIV/AIDS. About 28 states in the US now have cannabis under their medical uses. We don’t have such in Nigeria.

For a drug to be solely for medicinal use, it has to have high concentration of CBD compared to THC. The US has been able to achieve that but we don’t have that quality of research in Nigeria. That’s why we have not got to that stage.

What researches should government begin with, considering that Nigeria’s soil is rich to grow marijuana for export. What should stakeholders do?
Stakeholders, for me are people that grow the plant, those that sell the medication, as well as those that transport it. Anybody that is in the production and supply of cannabis, including federal and state governments are all stakeholders. If the government wants to go into cannabis production, it must necessarily invest a lot in its research.

Considering widespread substance abuse, would it not be a nice idea for the Federal Government to support a state that plans to bolster its internally generated revenue as a result of marijuana’s medicinal use?
The Federal Government should support responsibly. It has to inquire whether the state government has done its research on the safe components of marijuana, as well as make sure that it controls its cultivation.

Anybody can plant cannabis, but if not properly monitored, people might plant cannabis with more of THC components, instead of the CBD, which is for medical use.

If the state is going to control those that are planting the medical cannabis, the Federal Government can actually support them by improving their internally generated revenue since they are having difficulty in paying workers’ salaries. Increasing taxation is a way of discouraging cannabis for recreational use. If the tax on cannabis is increased, especially the one for recreational use, it would be controlled.

If now is not the right time to tap into benefits offered by large-scale marijuana cultivation, when would the right time, considering Nigeria is said to be the highest consumer in the world (about 20.3million people) even when its still an illicit substance?
The right time to tap into it would be after the Federal Government has done a thorough research on how CBD can benefit black people; seen that it is quite effective; and found alternative methods of ensuring that the specie that we grow has more of the CBD component than the THC component, which have mind-altering effect in case the supply structure is not controlled as it should be.

Government should also make available, enough funding for the management of substance abuse, especially cannabis, and subsidise treatment so that patients that show symptoms can be managed. When it has put all these in place, then it can tap into large-scale production of marijuana. But if it taps into its production when all mentioned above are not done, it means that it would be going into planting and cultivating cannabis that is high in THC, and we would end up having more youths that are addicts, unproductive, and down with mental health issues, as well as a depleted workforce.

Some experts are not against exploring the positive use of marijuana, but they insist there must be a strict policy in place for controlled demand/prescription. Can’t this be a workable idea in our clime?
Nigeria is a country that has a lot of laws governing different things, but it is the enforcement that is the problem. If cannabis production is licensed, anyone that grows it illegally should be punished seriously.

Monitoring and evaluation is paramount if success must be achieved because a lot of people are ready to buy their way and escape punishment when they are found culpable.

License for the importation of marijuana-based medication should be well-monitored, medicinal marijuana should only be bought with prescription, and where it is cultivated, monitoring should be intense. The National Drug Law Enforcement Agency should be well- remunerated so that its personnel do not take kick-backs and fail to do their jobs. All these are doable.

As the resort to herbal drugs gains ground, medical marijuana some say can become a cost effective way of addressing some ailments. Is this not enough reason to allow the country give the idea a shot?
Unfortunately, medical marijuana is not cost effective. For instance the Marinol that I mentioned earlier that is approved by the U.S food and drug administration agency cost about $692 for 60 capsules of 2.5mg, which is about the lowest miligram.

That means one tablet of Marinol is $11, which is about N4, 000. I don’t see how that is cost effective.

If government wants to subsidise, which it has not been doing for a lot of drugs (apart from Malaria, HIV, Tuberculosis) and some communicable diseases drugs, then it is okay. So, I disagree with the claim that we should go into marijuana-based drugs because they are cost effective. They are not.


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