1. Implications of cannabis international regulation and its impact on medicinal use
Dra. Leticia Cuñetti
June 2018

2. June 2018
I declare that I have no conflicts of interest to make this presentation.
Dra. Leticia Cuñetti Delmonte

3. Chronic pain is a major therapeutic problem in patients with kidney transplant due to the nephrotoxicity of NSAIDs
In 2013, Law approves the use of cannabis for medicinal purposes in Uruguay
There is a benefit in the modulation of eCS in the treatment of chronic pain
JAMA.2015;313(24): doi: /jama

5. We had good results in pain control and in the limitation perception
The adverse effects were mostly mild.

6. Studies that evaluate cannabis toxicity as an abuse substance
can not be extrapolated to evaluate safety of Cannabis-based medicines
% Effect
They allow to set follow-up strategies to evaluate possible adverse effects
Lo q dice

7. Common adverse effects reported in cannabinoid treatments
Safety profile in therapeutics is already known and well documented
JAMA.2015;313(24): doi: /jama

8. In Uruguay, cannabis recreational use is not a main public health problem
Currently the biggest problem is access to quality controlled cannabinoids´ products
for the relief of neurological diseases, cancer related disorders or chronic pain
The high cost of regulated products with adequate quality controls has determined a
black market of supposed medicinal products without quality control or medical follow-up

9. Great variability of effect according to the preparation, route of administration, amount and proportion of different cannabinoids
It is imperative the accessibility to quality controlled products in order to make a rational prescription

10. Presentations available in Uruguay
Cannabis Sativa L extract solutions
Epidiolex ® 2% CBD solution 2 gr CBD / 100 ml
10 ml mg CBD / ml
Charlotte’s Web ® CBD: THC (30:1) solution 6 gr CBD / 100 ml
100 ml mg CBD / ml : 2 mg THC / ml
Medropharm M 1337 ® CBD 5,35% :0,2%THC solution 5,35 gr CBD / 100 ml
30 ml y 100 ml 53,5 mg CBD / ml: 0,2 mg THC / ml
Medropharm M 1661 ® CBD 5,25% (0,2%THC) solution 5,25 gr CBD / 100 ml
30 y 100 ml 52,5 mg CBD / ml :0,2 mg THC / ml
Medropharm M 1771 ® CBD 7,5% - 0,9% THC solution 7,5 gr CBD / 100 ml
30 ml mg CBD / ml :9 mg THC / ml
The main problem to regulated preparations accessibility is high cost

11. Our main objective as doctors is to achieve universal access to these medicines that
alleviate chronic pain and neurological and cancer-related conditions for
a significant number of patients.
This will only be achieved if these medicines of proven efficacy and safety are included in
the national therapeutic formulary (FTN).
The main limitation of the medicinal use of cannabinoids even in Uruguay is the current
classification of cannabis in the international drug conventions.
This classification determines great difficulties in prescribing, investigating its medicinal uses
and also makes it very difficult to include it within any FTN making its use only available for
the rich ones or in the black market without medical follow-up .

12. GREAT RESPONSIBILITY: as regulators
as doctors
as researchers
as members of our society