Medical Cannabis in Thailand
Abstract
This paper will explore the history of cannabis in Thailand because cannabis has been used for a long time, also have Thai ancient cannabis formula wrote in Thai herbal medicine textbook from 300 years ago. On 18 February 2019, for the first time Thailand legalized medical marijuana use and be the first country in Southeast Asia. This article will review the effects of medical marijuana on cancer patients; case studies Cancer hopes village Thailand, is a nonprofit organization created in the US and help the underprivileged in Thailand. A systematic review of the evidence of cannabis research-based journal articles published within the last 5 years. Explores the law and regulation, transitional to legalized medical cannabis in Thailand, current trend use of cannabis for strictly medical reasons has both pros and cons. Use quantitative research to correct data from a selected sample of 4 cause study in cancer patients such as the medical history of patients, occupation, activity in daily life, dietary, blood test, and tumor marker. Implementation of a medical recommendation process in Thailand, how patients get cannabis under doctor prescription because patients cannot buy cannabis in the market, only from Thai public ministry of health and the sessions are organized by the department of medical services and the department for the development of Thai and alternative medicine (DTAM) will be legal to provide medical cannabis. Implementation process to support patient safe access. Education and coaching patients. Use of holistic modalities and Thai medicine to support endocannabinoid system health. Safety and legal issues. Consider professional standards and ethical concerns. Finally using social media such as Facebook to the evaluated impact of Thai people.
Literature review
Medical marijuana for cancer (MD, 2014)
Literature has shown cannabis can be helpful for cancer patients but not overall because depend on people some patients get better than previous therapy for example 14 of 15 patients has reduction in nausea compared with placebo, some study shows no improvement compared with placebo. All the studies that smoked marijuana found relieving pain than placebo medicine. Smoked marijuana help increases caloric intake and cannabinoid receptors have been found on cancer cells and shown evidence of antitumoral effects in glioma, hepatocellular carcinoma, prostate cancer, lung cancer, cholangiocarcinoma, breast cancer, and melanoma. Still have harms of marijuana such as smoked marijuana contains carcinogens, lung problems, neuropsychiatric, long term use can lead to cannabinoid hyperemesis syndrome. I believe some study has bias and I believe marijuana still need more research about cancer such as high-quality study, focus on strain and terpene, the specific administer and bioactive components. This study offers an insightful review of clinical trials of cannabinoids as anticancer agents.
The Medical Necessity for Medicinal Cannabis: Prospective, Observational Study Evaluating the Treatment in Cancer Patients on Supportive or Palliative Care. (Gil Bar-Sela, 2013)
Literature shown the 211 patients who had the first interview, only 131 had the second interview, 25 of whom stopped treatment after less than a week. All cancer or anticancer treatment-related symptoms showed significant improvement (P<0.001). No significant side effects except for memory lessening in patients with prolonged cannabis use (P=0.002) were noted. In the discussion, I believe cancer patients in hospice period it means last stage cancer they pass away in a short period and physicians are prescribing the cannabis too late because they use chemotherapy and other strong medication first until no choice, they will give cannabis to patients. It was a study in 2013 that time might have law and recreation limitations and I believe now 2020 cannabis can help a lot of cancer patients. This study offers insight into the positive effects of cannabis on various cancer-related symptoms are tempered by reliance on self-reporting for many of the variables. Although studies with a control group are missing, the improvement in symptoms should push the use of cannabis in the palliative treatment of oncology patients.
The medicinal use of cannabis and cannabinoids--an international cross-sectional survey on administration forms (Arno Hazekamp, 2013) Literature has shown that of 953 participants, 94.8% reported having tried at least one form of inhaled administration, 68.5% had experience with some form of oral or sublingual administration, and 5% topical use included lotions, oils, and skin creams containing powdered cannabis or extracts. Discussion of this study should ask a more detailed question about the products and newest route administration such as Vaporizing, edibles, oral, topicals, transdermal, and rectum. However, different countries have different law and recreation such as Thailand they control CBD need to contain THC under 0.1%, it means cannot compare to other countries that control THC under 0.3%. This study offers an insight survey that presents a broad picture of the current state of cannabinoid-based medicines use. The reported data may be useful to guide the development of safe and effective cannabinoid-based medications that meet the needs of patients.
Nurses caring for patients with life-limiting or terminal illnesses who use illegal cannabis face several legal and professional dilemmas. (de Vries & Green, 2012) Literature examines the legal, political, and ethical challenges raised using cannabis by people with life-limiting or terminal illnesses in their own homes and draws on the literature that debates its use in the context. For Life-limiting and terminal illnesses, the use of cannabis in oncology has focused on symptom management, specifically on managing nausea and vomiting associated with chemotherapy (Delmás, 2010; Cotter, 2009; Rocha et al, 2008). Examples of improvement in chronic non-cancer pain have also been noted (Howard et al, 2005). Cotter’s (2009) systematic review suggested that: Cannabis and synthetic oral THC are more effective than placebo in treating chemotherapy-induced nausea and vomiting from drugs of high emetic potential; Smoked cannabis and oral THC are equally efficacious in controlling symptoms of nausea and vomiting; When compared with traditional oral antiemetics, smoked cannabis and oral THC were found to be equally effective. However, this study has shown therapeutic use of cannabis improves the quality of life, on that time it’s used illegally under the Misuse of Drugs Act 1971. Nurses have a responsibility to be well informed about research on all medications taken by patients. I believe at that time patients might do not want to give informed to nurse or healthcare because they are scared of law and penalties for using cannabis. Nurses have to respond to keep informed about up-to-date research on the therapeutic use of cannabis while also making moral, ethical, and clinical judgments that are in the best interests of their patients.
Classification of Cannabis Plants Grown in Northern Thailand using Physico-Chemical Properties. (Prapatsorn Tipparat, 2014) This study has shown the Thai government has recognized the hemp may make useful contributions to the economy as an alternative crop. This study was conducted on both chemical and physical characters of Thai- grown cannabis for breeders to select the low intoxicant with high fiber producing cultivars. As a result, the variation of chemical features due to the distinct of THC and CBD content. THC content is found to correlate negatively to their physical characters such as plant height, stem diameter, and fiber weight, which will be helpful for a breeding program and into drugs in a future study. At that time Thailand has a hemp farm for crops under the royal project foundation but cannabis still illegal for medical use and recreational use. There is a lot of confusion about hemp and cannabis, hemp-derived products using techniques to emphasize the promotion of CBD from flowers of cannabis Sativa and cannabis Indica plant to get medical potential value. Should avoid cannabinoids derived from the seed and stalk of the hemp plant because less of medical value.
Assessment
In the past, marijuana was classified as a type 5 drug penalty under the sentencing drug act, BE 2522 (1979). Thailand has limited legal on marijuana use, resulting in no research and development of medical marijuana products until the Sentencing Drug Act No. 7 B.E. 2562 (2019) use the opportunity to distribute marijuana to patients for the benefit of treatment under the supervise and provide advice of medical professionals. Special access scheme for 5 groups of patients as a Palliative care, Neuropathic pain, Epilepsy, Psoriasis, and Parkinson. Department of Thai Traditional Medicine and Alternative Medicine provides 2 formula are Metta- Osot oil (THC 3 mg/drop) and Karuun-Osot oil (CBD 0.5mg/drop). Thai traditional medicine has 16 cannabis ancient formulas as 1) Sukhasaiaya (ยาศุขไสยาศน์) properties help sleep flourish rehabilitation of chronic disease patients. 2) Sanantripop (ยาน้ำมันสนั่นไตรภพ) benefits help reduce complications in patients with ovarian cancer, uterine cancer. Early-stage liver cancer and iron disease, or stiff stomach. 3) Destroys the Sumeru. (ยาทำลายพระสุเมรุ) help with convulsion, multiple sclerosis, epilepsy, all three symptoms are symptoms of paralysis from the blood vessels in the brain. 4) Tippayatikhun (ยาทัพยาธิคุณ) It is used to treat the symptoms of numbness in hands and feet of diabetic patients and swollen hands and feet in liver cancer. 5) Fix wind upper body (ยาแก้ลมขึ้นเบื้องสูง) properties wind go up to the upper body. 6) Insomnia or yellowing and fever medication (ยาแก้นอนไม่หลับหรือยาแก้ไข้ผอมเหลือง) Properties: Fix skinny yellow, trembling, fatigue, and cannot sleep. 7) Paisali Wind Therapy (ยาไพสาลี บำบัดโรคลม) properties: asthma, cough, often yawns, hiccup, insomnia. 8) Hemorrhoids and dermatitis (ยาทาริดสีดวงทวารหนักและโรคผิวหนัง) 9) Fix tendon and ligament (ยาแก้ลมแก้เส้น) benefits to relieve muscle tension along the body, reduces numbness in the hands and feet. 10) Apai Sali (ยาอไภยสาลี) properties for wind therapy (wind 80, 20 blood disorders, 20 hemorrhoids) 11) Amrita osot (ยาอัมฤตโอสถ) relieve muscles, hands, and feet numbness, and thinning due to degeneration. 12) Antipsychotics (ยาแก้โรคจิต) helps reduce mental anxiety and stress in the nervous system, making it easier to sleep. 13) Anti-Santakad, dry (ยาแก้สัณฑฆาต กล่อนแห้ง) benefits relieve constipation, aches, and pains throughout the body, Bloody urine, headache, dizziness, chest tightness. 14) Akkiniwakana (ยาอัคคินีวคณะ) anti-vomiting properties, nourish all 4 energy elements. 15) Fix wind Naowa Naree Vayo (ยาแก้ลมเนาวนารีวาโย) It relieves pain on the tip of the toe and wind spreads the neck, cannot move your neck. 16) Weapon Fire Medicine (ยาไฟอาวุธ) remedies for spleen, sputum, pain defecation of bloody mucus, exhaustion. no force, yellow skinny, and cough. (Medicine, 2019) Thailand just enacted a law governing medical marijuana use in 2019, current trends have both pros and cons about medical marijuana policy. There is a lack of understanding of the policies of those involved inconsistencies in providing and receiving services. The Ministry of Health said Marijuana is a drug, politicians say marijuana is an herb. doctors say marijuana can cure some diseases only. Meanwhile, medical marijuana investigators say marijuana is curable in many diseases, including cancer and public health researchers say it is an impact on health and society, etc. On the plus side, patients receiving medical marijuana are more accessible. On the negative side, the more misuse of medical marijuana, the more accidental deaths from marijuana use, the more marijuana use occurred among young people. (Bundit Sornpaisarn, 2019) I believe Thailand still needs more time for medical and recreational use because still leak of research and cannabis professional skills.
Use quantitative research to correct data from a selected sample participant of 4 cause study in cancer patients from cancer hope village a non-profit organization by interview and corrected the blood test to see the result after using cannabis. [i]First case: CN0025 Patient name: Mrs. Alitsa Phudphong Age:45 years old C/C Breast cancer, Subjective PI: Patient had breast cancer that spread to lymph nodes, she found out from annual health check in Charlotte, North Carolina hospital. The tumor was 1.5cm on the left side. The patient refused to do chemotherapy, but she did a breast preservation surgery at the cancer center in Georgia. The surgery went well and the results of the postoperative found 2 cancer tumors one normal cancer of 1.2 cm and the second piece is 2.1 cm. after that, the patients returned to normal life and take care of herself 3 months later she notified she found a lump under the axillar the size of a little finger. The doctor immediately ordered a detailed examination, CT scan, MRI, mammography, ultrasound, and biopsy and the result was a tumor 2.6cm stage 2. Symptoms started to become worse tumor get bigger and lose weight by 10 kg. She designs to use cannabis 25mg THC and CBD tincture 750mg. after use cannabis, for 3 days she feels a lot better no symptoms of fatigue, craving food, and overall body get better. After that, the tumor marker went down to normal. [ii]Second case: CN0002 Patient name: Mrs. Pieangkwan Senglee Age:7 years old C/C lung cancer, Subjective PI: April 23, 2019, her father design to use cannabis to help her daughter because has lumps in the lung about 2-3 cm. and other 2 spots, the doctor reported she had lung cancer. We provide cannabis carefully because she is still young with THC water-soluble and CBD tincture 750mg. After 7 days the symptoms improved and the lump in the lung reduced from 3cm to 0.2mm and the medical team informed that the surgery was not needed. [iii]Third case: CN0021 Patient name: Mrs. Wan Uttamo Age:87 years old C/C Nasopharynx cancer, Subjective PI: He had a stuffy nose, difficulty to breath and blood in the mucus. The doctor informed him that it was sinusitis. On Feb 21, 2020, the patients began to have pain in the cheekbones, swelling, stiffness, and fatigue. He went to the hospital again the CT scan reported it was Nasopharynx cancer stage 3-4 which spread into the cheekbone. Patient design to use cannabis THC water-soluble, CBD tincture 750mg, and cannabis vape 50/50 CBD and THC, also take Turmeric to help with inflammation. Until March 27, 2020 doctor informed that the cancerous zygote had no spread anywhere but was in the same place and was slightly smaller. In this case study, we continue to follow up periodically. [iv] Last case study: CN0011 Patient name: Miss Kanunya Wichaidit Age:45 years old C/C Breast cancer 2 stages, Subjective PI: She has surgery in 2015 and received 6 times chemotherapy, radiation 30 times. 3 years later, she found a lump in the chest. She designs to use cannabis right away by using THC water-soluble, CBD 750mg, and herbal supplements. December 25, 2019, showing normal results and will following up periodically.
Plan
Medical recommendation process in Thailand, I would like to change the system and policy because patients can get medical cannabis under doctor prescription from medical cannabis of government clinic and only for special Access Scheme: SAS program. The government provides 16 ancient Thai formulas and DTAM ganja oil (Deja formula) tincture contain THC 0.1% in 5 ml only. The Thai government tries to control economic cannabis in monopoly, it is effective for the people that want to use cannabis for recreational and medical use. Cannabis patients cannot get high-quality products and limit the route of administration. They think tincture is medical use and smoking cannabis is recreational use. Patients cannot get the benefit and help to improve their symptoms, also it not strong enough to help with cancer patients.
For the implementation process to support patient safe access. It might be some barriers to the new cannabis user might feel scary and disorienting, start from low and slow and use under cannabis doctor prescription. They should give cannabis knowledge to patients; I will change the stigma by giving them the knowledge and evidence about cannabis research. New cannabis users should know and know how to control themselves. Patients might feel scared and disorienting, but we need to suggest them to start with an open mind as a “Set” or mindset, mood, and expectations if patients welling to use cannabis and “Setting” is the physical and social environment such as family member support the patients if they desire to use cannabis as medical use. Set and setting help patients to a comfortable and safe place to have a good experience with cannabis. The classic concept of the drug, set, and setting changed the language from “getting high” to “medicating”. I will educate patients with treatment for cannabis overdose, first tells patients to stay calm, try to control breathing 4-7-8 breathing techniques, and consume cannabidiol or CBD tincture to help patients not panic and sleep. If patients open mind to use THC, they need to follow the law and regulations on the state. Difference people deference effect, we cannot give exactly doses of cannabis to patients like Thailand doing right now, it is not efficient.
Education and coaching patients. Use of holistic modalities and Thai medicine to support endocannabinoid system health. As an acupuncturist, I would like to use Traditional Chinese Medicine (TCM) as a holistic modality to suggest people and help them upregulating the endocannabinoid system. TCM can help with the endocannabinoid system by balance homeostasis in the body, also maintain CB1 and CB2 receptors. The main problem such as chronic stress, insomnia, pain, fear, and anxiety can affect the CB1 receptor and chronic low immune system and inflammatory can affect the CB2 receptor. It is a negative impact and causes endocannabinoid deficiency. I would recommend the patient to do an activity such as social interaction, meditation, sing, dance, or arts. Also, maintain a balanced diet, BMI, and regular sleep. Take supplements such as omega-3 fatty acids and probiotics, do exercises such as Yoga and Thi-chi, Osteopathic manipulation such as acupuncture, Massage, or Chiropractic. It is a positive influence on endocannabinoid levels. Structure and functions of the body, mind, and spirit. Chinese medicine and Thai medicine are existing, and they are accepted easily because of the traditions of oriental medicine. We need to give them the knowledge and patients need to open minds to accept cannabis and holistic modality.
Consider professional standards and ethical concerns. Thailand should use the world standard to control THC under 0.3% not use their control THC under 0.1% because it cannot join the economic cannabis model. I do not see a different type of person who uses cannabis for medical use and recreation use because we are all human beings. People should stop stigma and prejudiced other people from their own biases because we do not know what they have been through. Cannabis users either medical or recreational should not be judge and I believe the world will be changed if people help each other, expand the true knowledge about cannabis in textbooks to teach the younger generation.
Evaluation
Almost all Thai people were using Facebook. (Statista, 2020) I will use a cannabis influence person in Thailand, who is “Ganja witch” in Thailand because they already have Fanclub by using social media as a Facebook to the evaluated cannabis law and regulation impact on Thai people. Posting the massage and Facebook live to give the audience information about the article of medical cannabis in Thailand case study with cancer patients. Considers potential barriers and challenges are Thai people do not love to read, it might be challenging to get impact from posting article, but video or webinar might make the audience more interesting. Also, the case study needs to follow up and used to a blood test to evaluate patients after using cannabis.
Conclusion
Medical cannabis in Thailand is the new thing for setting the system and policy. The current trend use of cannabis for strictly medical reasons has both pros and cons. Use quantitative research to correct data from a participant sample of 4 cause studies in cancer patients. Law and regulation, transitional to legalized medical cannabis in Thailand. Evidence on the therapeutic use of cannabis produces improvements in quality of life and increased use among people with life-limiting illnesses such as cancer patients. We have only one life and have the right to design what we want. Founder of Cancer hopes village said, “Life over law”.
References
Arno Hazekamp, M. A.-V. (2013). The medicinal use of cannabis and cannabinoids--an international cross-sectional survey on administration forms. Psychoactive drugs, 43(3), 199-210. doi:10.1080/02791072.2013.805976
de Vries, K., & Green, A. J. (2012, Feb 24). Therapeutic use of cannabis. Nursing time, 108(9), 12. Retrieved 12 3, 2020, from https://cdn.ps.emap.com/wp-content/uploads/sites/3/2012/02/120228-Disc-cannabis.pdf
Gil Bar-Sela, M. V. (2013, March 23). The Medical Necessity for Medicinal Cannabis: Prospective, Observational Study Evaluating the Treatment in Cancer Patients on Supportive or Palliative Care. (A. Santors, Ed.) Evidence-Based Complementary and Alternative Medicine, 2013, 8. Retrieved 11 19, 2020, from https://doi.org/10.1155/2013/510392
MD, J. L. (2014, December 10). Medical marijuana for cancer. American cancer society, INC, 65(2), 109-122. Retrieved 11 19, 2020, from https://doi.org/10.3322/caac.21260
Prapatsorn Tipparat, W. K. (2014). Classification of Cannabis Plants Grown in Northern Thailand using Physico-Chemical properties. Journal of Natural Sciences Research, 4(4), 1-9. Retrieved 12 3, 2020, from https://www.researchgate.net/publication/260654950_Classification_of_Cannabis_Plants_Grown_in_Northern_Thailand_using_Physico-Chemical_Properties
Statista. (2020). Number of Facebook users in Thailand from 2017 to 2025. Statista Research Department. Retrieved 12 03, 2020, from https://www.statista.com/statistics/490467/number-of-thailand-facebook-users/
Susan L. Calcaterra, A. N.-H. (2020, May 3). A population-based survey to assess the association between cannabis and quality of life among colorectal cancer survivors. BMC cancer, 1-6. doi:https://doi.org/10.1186/s12885-020-06887-1
Chiraphorn Bangsriwong
Instructor Rachel A. Parmelee
Medical Cannabis Guidelines & Professional Practice
Pacific College of Health and Science
12/10/2020