Issue link: https://maltatoday.uberflip.com/i/1028264
NEWS 10 maltatoday | SUNDAY • 16 SEPTEMBER 2018 DAVID HUDSON THE Superintendence of Public Health has instructed doctors to consider each patient eligible for medical cannabis for their driving ability when under the in- fluence – a situation that could result in these patients having to choose between their marijuana prescription or their driving licence. Psychotropic drugs alter neurological function, impairing perception and reac- tion time, which would make motorists under the influence a liability. But how big is the case for confiscating patients' driving licences, especially if the marijuana strain and dosage are being prescribed by professional doctors? Alcohol is legal and so is medical mari- juana. Drunk driving isn't. Unlike cannabis, it is fairly easy to track the level of alcoholic intoxication and how this affects brain and bodily func- tions. So how would anyone define or es- timate cannabis 'intoxication' that feels… "just a little high?" There is no equivalent to a breathalyser to determine the psy- choactive content in cannabis. Cannabis affects everyone differently, which is why the law should cater for the lowest common denominator. If the smallest possible dose of cannabis severe- ly impairs a patient's driving, then the law must accommodate and make it illegal to drive under the influence of that smallest possible dose. This is the case in Canada where as re- cently as last July, legislation was altered so that anyone suspected of driving un- der the influence of cannabis would be subject to a saliva test and if taken to the police station, provide blood and urine samples. Any trace of the substance would lead to charges. It is an obviously undesirable situation that could signifi- cantly slow down processing. Is Malta's stricter alternative prefer- able? Is confiscating a driving licence the responsible thing to do? The problem with cannabis is that street-level knowledge reigns supreme. It is subjected to what in psychology is called an "availability cascade". It's a self-reinforcing cycle that gains traction in popular discourse and shapes belief. What we know about cannabis in Malta is through the word-of-mouth recount- ing of experiences with the illegal drug. The truth is that very little is known about the overall affects of marijuana, and the general consensus is that me- dicinal drugs are considered unsafe until proven otherwise. So far, it hasn't been proven otherwise in certain situations; we still do not know, for example, about the long-term effects of the chronic use of Cannabidiol, the concentrated sol- vent extract that is being given to pa- tients. While the World Health Organi- sation has said that "to date, there is no evidence… or any public health-related problems associated with the use of pure CBD", the risks have little to do with the compound itself and more with its con- tamination, an event that is sometimes deliberate to increase yield and potency and sometimes accidental when agents like moulds and metals enter the plant. Dutch coffee shops were found to sell cannabis products containing pesticides. The oil may also contain traces of tet- rahydrocannabinol (THC), the psycho- active constituent of cannabis, so that consumers would be ostensibly exposing themselves to the adverse effects of the psychotropic compound, such as intoxi- cation, panic attacks and disorientation. The Democratic Party MP, Godfrey Farrugia, a GP, had spoken about this issue before in Parliament. "The fasci- nating thing is that all these compounds work synergistically together, so when single compounds are isolated from the plant, they are not as effective. CBD alone can never be as effective as CBD with a bit of THC," he told MaltaToday. Farrugia still believes that cannabinoids are "remarkably safe" and that they are a safe and effective medicine. He did contend, however, that psycho- sis could take place when patients exceed the prescribed dose. "Police Authorities have the right to revoke driving licences if persons misuse medicinal drugs, can- nabis included." Staying at home with cannabis There is no question that the THC constituent in cannabis impairs cogni- tion, psychomotor function and actual driving performance. Several scientific reports and studies carried out by Euro- pean and American universities came to such a conclusion. A 2004 epidemiologi- cal study at Maastricht University found that drivers who had THC in their blood, particularly at higher doses, are about three to seven times more likely to be responsible for crashing as compared to drivers who had not consumed the drug. The conclusion was that the recent use of cannabis may increase crash risk but past use of cannabis does not. But pure CBD, unless contaminated, is not psychoactive and does not contrib- ute to these effects. In other words, CBD does not get you high. In 2011, the British Journal of Pharma- cology published a study that found that the synergy between CBD and THC re- sulted in CBD modulating and dimin- ishing the psychoactive effects of THC. CBD isn't the only product given to pa- tients, however, as the cannabis Indica strain – which is reported to cause what is known as "couchlock", a sensation so relaxing that a condition of paralysis might be induced – is also usually hand- ed out as treatment, which can contain a high proportion of THC. How it reacts with CBD might coun- teract its mind-altering and "couch- locking" component but further re- search is required. According to many licensed produc- ers across the world, medical cannabis is presented to patients in a form that can either be inhaled through vapour or smoke, or oil that is ingested. The difference between the two methods is that the latter will be processed through the liver and has a much slower onset time but the effects will last much longer, for up to four hours. If inhaled, the effect is almost im- mediate but does not last as long. Several surveys have shown that the average dose of medi- cal marijuana is 1 to 3 grams such a conclusion. A 2004 epidemiologi- cal study at Maastricht University found that drivers who had THC in their blood, particularly at higher doses, are about three to seven times more likely to be responsible for crashing as compared to drivers who had not consumed the drug. The conclusion was that the recent use of cannabis may increase crash risk but past But pure CBD, unless contaminated, is not psychoactive and does not contrib- ute to these effects. In other words, CBD In 2011, the British Journal of Pharma- cology published a study that found that the synergy between CBD and THC re- sulted in CBD modulating and dimin- ishing the psychoactive effects of THC. CBD isn't the only product given to pa- tients, however, as the cannabis Indica strain – which is reported to cause what is known as "couchlock", a sensation so relaxing that a condition of paralysis According to many licensed produc- ers across the world, medical cannabis is presented to patients in a form that can either be inhaled through vapour or smoke, or oil that is ingested. The difference between the two methods is that the latter will be processed through the liver and has a much slower onset time but the effects will last much longer, for up to four hours. If inhaled, the effect is almost im- mediate but does not last as long. Several surveys have shown that the average dose of medi- cal marijuana is 1 to 3 grams If doctors take away driving licences from medical marijuana patients, would their 'caution' be discriminatory when other patients on other forms of medication are treated differently? High times on the road Researchers have theorised that patients with access to medical marijuana may have substituted cannabis at home for alcohol in bars, and stayed off the roads