The Federal Council of Medicine of Brazil (CFM in the Portuguese acronym) again exceeds the code of ethics of the profession and ignores the latest advances in medical science to impose an ideological ban to restrict the prescription of CBD for adult patients . The recent decision, unfortunately, comes as no surprise, as the CFM had already tarnished its reputation during the coronavirus crisis by being sued for collective damages by Brazil’s Office of the Public Defender for allowing doctors to prescribe hydroxychloroquine for the ” early treatment” of COVID-19, a baseless treatment that was publicly supported by Bolsonaro and his then-presidential friend Donald Trump.
The decision on cannabis was published in the Brazilian Federal Register on October 11, to be applied immediately and reviewed in just three years. It states that the “prescription of cannabidiol (CBD) is authorized as a medical therapy” only “for the treatment of epilepsy in childhood and adolescence refractory to conventional therapies in Dravet and Lennox-Gastaut syndrome and complex of tuberous sclerosis”. Therefore, its prescription for any other condition has been prohibited. In addition, physicians are prohibited from giving lectures and courses on the use of cannabidiol and/or cannabis-derived products outside of a scientific setting.
CFM’s decision comes against the backdrop of simultaneous growing demand for CBD products and right-wing propaganda against the legitimate medical benefits of cannabis. Between 2017 and 2021, the number of individual applications to import medicinal cannabis increased from 2,101 to 32,416, an increase of 1,442%. The growth in demand for medical cannabis has even led some of Bolsonaro’s cabinet ministers to issue publications denying that cannabis is a type of medicine.
CBD oil is not affordable for most Brazilian patients. The price of a bottle of 20 mg/ml in a popular pharmacy costs a quarter of the minimum wage. A bottle of 200/mg costs more than two minimum wages. Many patients and their families rely on medical cannabis associations to obtain their medications at a more affordable price. Source: Drug store Sao Paulo
While the medical cannabis bill is stalled in the Brazilian Congress without being sent to the Senate for final approval, and with Brazil’s big pharma controlling which few products are allowed on the restricted Brazilian medical cannabis market, the CFM is sending a message to society: opinions and ideology guide health policy, and science can be discredited with the stroke of a pen.
If the intention of the highest authority responsible for supervising and regulating medical practice in Brazil is to divert patients to the illegal market, then their mission will surely succeed. We know what happens when substances become banned and inaccessible through legal means: people turn to the illegal market. There are some people who are dedicated to supplying cannabis oil to patients in Brazil, regardless of their legal status, who are engaged in civil disobedience to ensure that people can still access their medicine. The problem, however, is that these well-intentioned citizens expose themselves to criminal penalties and, moreover, can only supply full-spectrum oil, which may not meet the needs of many patients. What we are witnessing here is, again, the criminalization of life-saving and restorative medicine, a medicine that has the power to restore life not only to the patients who use it but also to the family members who care for them.
The CBD ban is even more troubling news for the future of Brazilian drug policy, especially given the recent trend of traditional cannabis activists choosing to abandon their political positions on drug laws to cater to conservative voters . With the election of the most far-right Congress since Brazil’s re-democratization at the end of its military dictatorship in 1985, efforts to design and implement a more humane drug policy will be an uphill battle, even if Lula wins against Bolsonaro in the second return that will take place on October 30. Meanwhile, civil society is organizing, demanding long-overdue changes, with voters successfully voting at least a few pro-cannabis lawmakers into office at the state and federal level.
On Monday, October 17, recently re-elected deputy Paulo Teixeira (of Lula’s Workers’ Party), who chaired the special committee that voted on the medical cannabis bill, presented a legislative decree to reverse the recent decision of CFM. It is now imperative that the small cannabis group pressure Bolsonaro’s ally and the Speaker of the Chamber of Deputies, Arthur Lira, to unblock the frozen medical cannabis bill in Congress. It’s time for the Brazilian institutions to work for the people again, instead of serving the ideological agenda of the current president and his cronies.
