A Look Back at Cannabis Europa Madrid 2020
Image credit: Dimitry B. (https://www.flickr.com/photos/ru_boff/5128058385)
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Cannabis Europa’s international conference programs provide a forum where scientific researchers, politicians, advocacy groups, and investors can come together to exchange and stay abreast of medical-cannabis-industry trends and developments. Since launching in 2018, it has held events in London, Paris, New York, Toronto and, most recently, Madrid, even though medical cannabis has not yet been legalized in Spain.
Legal or not, there are a number of well-established biomedical and pharmaceutical research projects on-going in laboratories across Spain, in both the academic and private sectors.
The truth is, even in the 20 European countries that do allow the usage of some form of medical cannabis, there is no guaranteed accessibility to treatments for patients.
The conference began with a keynote address by Dr Axel Gille, managing director of Aurora Europe and Aurora Deutschland, who painted a picture of a yet-to-be realized European medical-cannabis utopia, where governments, regulators, and insurers would work in harmony with doctors and researchers in order to assure patients safe and affordable access to therapeutic cannabis.
Two of the panels on the day’s agenda focused on current scientific and medical research on cannabis.
Bioengineering Cannabinoid-Based Medicines
- Dr José Luis Adrio, director of R&D, ADL Bionatur
- Dr Veronica Codesido Sampedro, manager of the breeding and cultivation department, Phytoplant Research
- Hannah Deacon, head of patient access, Lyphe Group
- Prof Manuel Guzmán, professor of biochemistry and molecular biology at the Complutense University of Madrid and vice president, the Spanish Observatory for Medicinal Cannabis (OECM)
- Dr Guillermo Moreno Sanz, author of numerous scientific articles and founder of Abagune Research (moderator)
Five panellists – two experts in bioengineering, two pharmacologists, and one patient advocate – all approaching the complex subject of medicinal cannabis from different disciplines and directions, still found consensus on core issues such as providing patients with access to safe and effective cannabis products and the education of medical professionals and regulators. Moderator Guillermo Moreno Sanz’s first question for the panel went straight to the heart of the matter.
What do you think cannabis-based medicines are?
“I believe in the possibilities of the plant,” said Veronica Codesido Sampedro. “In our company we have the breeding program, but we also have the extraction department and the analytical part. Nowadays, many people want to return to natural medicine and want nothing to do with chemicals. I believe in natural products and in the possibilities of the plant, but we need to try to standardize the flowers and look for better varieties and also new types of cannabinoids.”
Hannah Deacon said, “I was brought to medical cannabis by my son Alfie, who has epilepsy and was one of the first patients in the UK to be permitted to use cannabis oil legally. I now work as an advocate for patients in the UK who have no voice and so I can talk from a patient perspective: what patients want is a plant; they want whole-plant product. A lot of the families that I've worked with have been on pharmaceutical-based cannabis products, and they don't work as well.”
“I agree with my colleagues, although I have to say that I am an advocate of biotechnology,” José Luis Adrio responded. “We are working on the production of cannabinoids by biosynthesis using microorganisms, which I think will give us a very good chance to find new and more specific molecules for all kinds of indications. We have a challenge to produce these 100+ minor cannabinoids to make new chemical entities with different properties that we can insert into the molecules. There are hundreds of compounds that we haven't checked so far, so I am pretty sure that we're going to see a lot of improvements in pharmaceutical chemistry in the future.”
Do you see a viable model that will satisfy patients, pharmacists and doctors?
Deacon said, “I think the key is education for doctors because, at the moment, they don't understand the product and shouldn't be prescribing it. It’s probably a long way off, but once the doctors have been educated, they can speak to patients and this will open a route to compounding pharmacies.”
“We can already standardize flower; we know flower works,” Guillermo Moreno Sanz said. “To add another layer of control, we have pharmacists who can use the flower, the extract, or the purified compound to come up with a product. Doctors can talk to the pharmacist about how the compounds should be formulated or how the flower should be used and than advise the patients on how to take it. We don’t have to wait to have all the answers to implement these things.”
Are standardized clinical trials the way to go?
Manuel Guzmán said, “We have to achieve good standardization. Products have to be clean. We have to do randomized control trials, comparing extracts with purified compounds or predefined mixtures and clinical science has to get to know whether they are actually better or not for different types of patients.”
Deacon said, “There is a lot of talk in the UK at the moment about how trials must happen before access happens. Well, that's really not okay as far as I'm concerned. There are 23,000 children in the UK with epilepsy and do they all then suffer for the next 10 years until we can complete trials, until we can standardize some product that we don't even know will be better than what we already have?”
The Uncharted Territories of Cannabinoid Research
- Dr Viola Brugnatelli, scientific director of Cannabiscienza, an e-learning academy for Italian health care professionals on medical cannabis and the endocannabinoid system.
- Prof José Javier Fernández-Ruiz, professor in the department of biochemistry and molecular biology, faculty of medicine at the Complutense University of Madrid
- Dr Bruno Maia, specialist in neurology and critical care medicine at the Hospital Centre of Central Lisbon
- Hélène Moore, managing director of Aurora France
- Michael Power, journalist (moderator)
The discussion on uncharted territories turned out to be very wide-ranging. Journalist Michael Powell invited panellists to share their own experiences and respond to questions about new developments and treatments in cannabis-based medicines, the importance of the endocannabinoid system, how to address the problems of bureaucracy and, finally, the matter of evidence.
What are you working on that can truly be considered uncharted territory?
“We have an entire module at the University of Padua on raw cannabis, which is generally defined as just the dry flowers, but there is so much more beyond that,” Viola Brugnatelli replied. “My interest is to really look at what there is and ways we can use it. Take, for example, the seeds of the plant. Since they do not produce cannabinoids, certain concerns on a legislative level are removed and we can use and understand the other compounds that actually can be there."
"Through the sprouting process there is a permeation of some flavonoids that are absolutely unique to the cannabis plant, like cannaflavins," she continued. "We know that cannaflavins function as an anti-inflammatory, yet I don't know anyone who has ever received a recommendation to grow sprouts or to buy them at a pharmacy, even though CFA has been proven and shown to have more efficacy than some pharmaceutical drugs that we use. So my main interest is in looking at something that is beyond just the trichomes and actually assessing the entirety of these plants, starting from the roots and going all the way up.”
Hélène Moore said, “We all know that in most medical schools the endocannabinoid system is just starting to be taught. Nobody knows how it works and what it does. We’re just in the early stages of discovering what it is, but I think it will revolutionize medicine. Right now, we are commercializing the first generation of products, full spectrum mostly, but there will be more and more research leading to more interesting molecules and drugs that will one day lead to curing something.”
What about the procedural log-jam impeding regulation of medicinal cannabis?
“When we talk about the regulatory agencies, that's a huge problem because they are accustomed to a certain bureaucracy in approving medications from the farming industry,” said Bruno Maia. “Also, because regulatory agencies are by definition conservative. They designed the procedures and they apply the same ones to all medications. And now here we have cannabis, something new, something with more than 400 substances that act differently on our bodies, so the traditional clinical-trial model, with clear answers about benefits and side effects, does not apply here as it applies to other medications. We have to update this bureaucracy and these regulatory obstacles.”
What kind of evidence is there about the efficacy of medicinal cannabis?
“We have research on genetics, preclinical research into different cannabinoids, and clinical research with patients collaborating face-to-face with doctors and clinicians,” said Moore. “All of this provides us with data points to better understand how medical cannabis, specifically full-spectrum extracts, can and do provide patients with a better life. The true uncharted territory here is to convince authorities and regulatory bodies even to consider this real-world evidence.”
Maia said, “Doctors are always asking for evidence, yet people have been using cannabis all across the planet for centuries. This is evidence, whether we like it or not. How do we go from users back to the lab? Let’s hear what the patients actually report about using cannabis; let’s give them a voice.”