Doctors prescribing treatment with cannabis derivatives face lawsuits

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The delay by the CFM (Federal Council of Medicine) in updating its rules on the use of substances derived from cannabis has left doctors who prescribe this type of treatment exposed to lawsuits.

In 2014, Anvisa (Agência de Vigilância Sanitária) authorized for the first time the import of CBD (Cannabidiol, a non-psychoactive substance derived from cannabis) for treatment and, since then, has been expanding the range of permitted drugs.

But the CFM, which regulates medical activity in the country, has not accompanied the agency in these changes. In practice, this means that healthcare professionals can legally prescribe treatments based on cannabis substances, but they run the risk of being sued by regional boards of medicine for doing so.

At the limit, these actions can lead to the revocation of professional registration, preventing the person from practicing medicine in the country — although, to date, there is no record that anyone has actually been punished in this way.

The issue revolves around CFM norm 2113, published in 2014 and which classifies the cannabis as experimental therapy.

“As there were no scientific studies of great impact to prove the treatment, the CFM found itself obliged to guide doctors”, says neurologist Lécio Figueira Pinto, vice president of the Brazilian Association of Epilepsy. “That’s why it edited the norm 2113, which after eight years needs to be updated.”

The rule guides treatment only in cases of refractory childhood epilepsy (which does not respond to conventional treatment) and congenital epilepsy. It also limits prescribing to neurologists and psychiatrists. In practice, however, the substances are indicated by doctors of different specialties and for other unforeseen purposes, such as cancer, chronic pain, and depression.

Sought by the report, the CFM did not report the number of investigations or cases opened due to the prescription of Cannabis. Thus, the cases end up being disclosed by the doctors themselves, usually on social networks.

That’s what happened to Paulo Fleury, 58, who specializes in preventive and social medicine, author of research on the efficiency of Cannabis in the treatment of autistic children.

“I am being sued by the Regional Board of Medicine in two states for prescribing marijuana, cannabinoids, THC and CBD. And for publicizing this therapeutic alternative for various health problems, in particular autism,” he wrote.

Known as Dr. Green by internet users, Fleury often gives conferences around Brazil on cannabis therapy and openly defends the planting of cannabis for medicinal use.

Vitor Ceribino, Fleury’s lawyer, explains: “Cremeb (Regional Council of Medicine of the State of Bahia) opened an investigation because he prescribed cannabis for autism, publicized the treatment on social media and prescribed it outside of the operating state”.

The doctor is from Minas Gerais and prescribed in Bahia. To do that, he’d need a special temporary permit, which he didn’t have.

For the lawyer, this determination lost meaning after telemedicine was released by CFM. Fleury is also accused of condoning drugs. The Bahia council says the investigation remains confidential.

The second complaint against the doctor was in the council of Paraná, and it has already evolved into a lawsuit. The entity also said that it cannot provide information about the case.

For Fleury, the current CFM rules are outdated and no longer reflect reality.

To resolve this mismatch, the council held a public hearing on the subject and asked doctors to express their views on possible changes. But while the reformulation is not approved, the current rule remains in force.

The CFM also stated that it would not comment on the matter and did not want to detail which changes are being analyzed.

Since the council published the first rule eight years ago, there has been a boom in studies on the subject. On the basis of PubMed alone, a platform that brings together published scientific research, there are 28,000 works on the subject.

“The CFM should have updated the standard in 2016”, says psychiatrist Eliane Nunes, director of SBEC (Brazilian Society for Cannabis Studies).

She responds to an investigation for having prescribed oil with THC (Tetrahydrocannabidiol, a substance with psychoactive effect derived from marijuana) to a patient – who, soon after, won in the STJ (Superior Court of Justice) the right to cultivate the plant to produce his own oil.

Ophthalmologist Renan Abdalla, 38, from the Renasce clinic in Paraná, is another who is responding to the lawsuit for not having the required specialty to prescribe the substance.

“The complaint came shortly after the son of a patient posted on social media about the improvement of his father’s glaucoma with Cannabis”, says the doctor. “We live in legal uncertainty, while we wait for the regulation to be updated, both for scientific research and clinical practice.”

For Pinto, the CFM will have to expand the range of diseases treated with cannabisbut some care is needed.

“There are patients who go to the doctor to get a prescription for cannabis and not to receive a diagnosis, resulting in a dangerous reversal for health”, says the neurologist. “There is a high demand from patients and, in some cases, abuse in the prescription”.

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