Issue link: https://maltatoday.uberflip.com/i/1028264
11 NEWS maltatoday | SUNDAY • 16 SEPTEMBER 2018 per day when smoked or vaporised. A 2008 French study on the correla- tion between medications and traffic accidents concluded that since 1999 a high prevalence of cannabis was found in the blood of injured or killed driv- ers. On the other hand, Columbia Uni- versity's Mailman School of Public Health in New York said that its re- search showed that since medical mar- ijuana was legalised in 28 states, there was a reduction in road fatalities. The researchers still cautioned that mari- juana impairs driving, and theorised that this result might reflect the fact that patients with access to medical marijuana may have substituted can- nabis at home for alcohol in bars and have stayed off the roads. Valium yes, cannabis no What all these studies ultimately prove is that the situation concerning medical cannabis is still a tentative one and until further tests and experimen- tations are carried out – without risk- ing human life – it is not safe to say with certainty whether driving under the influence of CBD and other medi- cal strains is a hazard that merits the confiscation of driving licences. Even Israel, the global leader in medical mari- juana, is still carrying out tests. While the greatest evidence of CBD's healing properties is in reducing chronic pain, n a u s e a a n d vomiting during chemotherapy ses- sions, and spasticity related to multi- ple sclerosis, leading doctor and mari- juana expert in Israel, Dr Adi Aran, is experimenting with medical cannabis as a treatment for children with au- tism. He does contend that there is still a lot of stigma surrounding the product and says that "CBD is not a drug. It's medication." However, he is not able to account for what might happen af- ter long-term use or what happens to each patient when he or she operates vehicles and other machinery. This is a trial by human testing. The legal inconsistency in Malta lies in the fact that other psycho- tropic medications are not treated in the same way or, at least, that's what community-based pressure group, Re- Leaf, insists: Why is a patient on Va- lium not submitted to the same tests that a person requiring marijuana is? Why is someone on sleeping pills not subject to tests on his driving abilities when the same cannot be said of medi- cal marijuana patients? The consumer medicine informa- tion leaflet that comes with Valium, which contains the active ingredient diazepam, warns readers not to drive or operate machinery until they know how the medication affects them. It may cause drowsiness and dizziness and may severely impair alertness but it's not the same for everybody. Speaking to MaltaToday, Superin- tendent of Public Health, Charmaine Gauci, said that the Superintendence of Public Health has a responsibility towards drivers and the conditions on the road. "All we did was remind the doctors of this country to evaluate their patients vis-à-vis their driving abilities. This is done with regards to other medica- tions and medical conditions." Thanks to the 2018 amendment to the 2015 Drug Dependence Act, pa- tients can now obtain a prescription for medical cannabis from any li- censed doctor and this does not have to be approved by the local medicines Authority or the EU's watchdog. "Foreign markets were prescrib- ing medication that was approved by the Good Manufacturing Prac- tice (GMP), so we followed suit," Gauci said. She said that the Su- perintendence of Public Health encouraged Maltese wholesale dealers to bring this medicine from overseas and make it available on the market. "The prescription process involves a specific appli- cation that might be ap- proved by any prescrib- ing doctor in the country. This named-patient appli- cation is sent to us, the Su- perintendence of Public Health, for our evalu- ation. We may grant permission to the rel- evant doctor to issue the prescription. This prescription is written like any other prescrip- tion of psychotropic medi- cation and narcotic drugs – known as green prescrip- tion – according to the law. The doctor then fills the control card." Gauci says the authority referred doctors to Article 34, 45A of the Driv- ing Licences Regulation to consider the patient's driving ability according- ly. The law states that "driving licences shall not be issued to, or renewed for, applicants or drivers who regularly use psychotropic substances in whatever form, which can hamper the ability to drive safely where the quantities ab- sorbed are such as to have an adverse affect on driving." This law ultimately calls upon police authority and not the Superintendence of Public Health. "When you prescribe psychotropic drugs that might have an impact on driving, you need to do so with respon- sibility," Gauci said. "Only a doctor can adequately evaluate a patient – he is the one who knows what dosage was prescribed, when this was prescribed, what the body weight of the patient in question is – all aspects which carry weight when it comes to a patient's driving ability." The saying that everyone is wise after the event is becoming increasingly ap- plicable to Malta, with trial and error situations resulting in senseless trag- edies. On social media several have commented their own driving expe- riences under the influence of heav- ier medications than CBD, and that they've never been in a road accident. Just a question of time But the point isn't whether driving under the influence leads to an acci- dent but whether it increases the risk of one. ReLeaf's response to the con- troversy related more to the fact that other medications are not treated with the same scrutiny. "Valium and other medications can have stronger effects and can cause drowsiness but the driv- ing licence is not revoked for these pa- tients. It is therefore discriminatory," Graziella Calleja, ReLeaf co-founder, told MaltaToday. Calleja agrees that further research is required into the overall effects of cannabis. "Since we do not have any local statistics and record keeping, we should start compiling research on the substance. It should be done on all as- pects of cannabis, for example on its creative psychoactive effect." She also said, however, that since there is no regulated market at the moment, it would be hard to analyse the quality of the product and its health and psycho- logical effects. Gauci's response contradicted Re- Leaf's claim that other substances are treated differently. "All doctors who prescribe medication in whatever form, which can hamper the ability of a person to operate machinery or drive safely, are obliged to inform the Police about such prescription." She claimed that since the 2018 amendment, there are 39 patients currently on medical marijuana. "Patients who venture beyond the remit as indicated for therapeutic use for all green prescription medicines have their driving licenses revoked," Godfrey Farrugia told MaltaToday. "We are not reinventing the wheel… persons who abuse the drug control system are earmarked by the Superin- tendent of Public Health for his own safety and for the safety of others." Farrugia argued that cannabis-as- medicine is a still an ongoing process – whether it impairs driving depends on many factors. "It depends on inher- ent tolerance, drug interactions, aller- gic reactions... it is not a case of one size fits all. Professional discretion is essential." But ReLeaf disagrees with the pro- cess with which medical marijuana is prescribed. "A doctor's analysis and prescription should be enough for a patient to qualify," they said. "Patients should not have to wait to get approv- al from the Superintendent of Public Health." They also suggest that more illnesses should be recognised to qualify for the cannabis medication, such as depres- sion, anxiety disorders, glaucoma and irritable bowel syndrome. While ReLeaf are pushing for the au- thorities' responsibility to patients who merit effective medication and for fur- ther research to be adequately carried out to reap the outmost benefits from the product, the Superintendence of Public Health is likewise evincing re- sponsibility to users of this substance and the public at large since it is a ten- tative medication very recently added to the market. It seems that both well- intentioned opinions are at logger- heads over an issue of priority, which at first glance seems, for both sides, to be the public health. Until further research is conducted, the Superintendence of Public Health is working within the confines of the law and asking doctors to consider the driving abilities of the patients before prescribing the medication. Whether the law should be amended should not be a question of trial and er- ror but a question of professional opin- ion. If doctors are a little lenient when it comes to diazepam and driving, it should be because Valium has been on the market for over 50 years and is a well-researched product. So, it's only a matter of time before patients using medical marijuana start enjoying the same clemency. and until further tests and experimen- tations are carried out – without risk- ing human life – it is not safe to say with certainty whether driving under the influence of CBD and other medi- cal strains is a hazard that merits the confiscation of driving licences. Even Israel, the global leader in medical mari- juana, is still carrying out tests. While the greatest evidence of CBD's healing properties is in reducing chronic pain, n a u s e a a n d Why is someone on sleeping pills not subject to tests on his driving abilities when the same cannot be said of medi- cal marijuana patients? The consumer medicine informa- tion leaflet that comes with Valium, which contains the active ingredient diazepam, warns readers not to drive or operate machinery until they know how the medication affects them. It may cause drowsiness and dizziness and may severely impair alertness but it's not the same for everybody. Speaking to MaltaToday, Superin- tendent of Public Health, Charmaine Gauci, said that the Superintendence of Public Health has a responsibility towards drivers and the conditions on the road. "All we did was remind the doctors of this country to evaluate their patients vis-à-vis their driving abilities. This is done with regards to other medica- tions and medical conditions." Thanks to the 2018 amendment to the 2015 Drug Dependence Act, pa- tients can now obtain a prescription for medical cannabis from any li- censed doctor and this does not have to be approved by the local medicines Authority or the EU's watchdog. "Foreign markets were prescrib- ing medication that was approved by the Good Manufacturing Prac- tice (GMP), so we followed suit," Gauci said. She said that the Su- perintendence of Public Health encouraged Maltese wholesale dealers to bring this medicine from overseas and make it available on the market. "The prescription process involves a specific appli- cation that might be ap- proved by any prescrib- ing doctor in the country. This named-patient appli- cation is sent to us, the Su- perintendence of Public Health, for our evalu- ation. We may grant permission to the rel- evant doctor to issue the prescription. This prescription is written like any other prescrip- tion of psychotropic medi- cation and narcotic drugs – known as green prescrip- tion – according to the law. With cannabis, street-level knowledge reigns supreme… What we know about cannabis in Malta is through the word-of-mouth recounting of experiences with the illegal drug