Carlos Poiares: “Using cannabis is part of fundamental rights”

Carlos Poiares has a degree in Law but a PhD in Psychology and was for 10 years coordinator of the area of ​​Criminal Psychology and Deviant Behavior at the Universidade Lusófona de Lisboa.

Vice-Rector of Universidade Lusófona since 2013 and a leading figure in terms of drug policies, he believes that the regulation of cannabis for therapeutic purposes is already late and that this is currently a public health issue.

In an interview with Cannapress, Carlos Poiares states that it is part of our fundamental rights to use cannabis or any other substance under medical prescription and for the treatment of a health condition, so it is urgent to legislate in this regard.

Twelve years ago, in an interview in which he spoke about deviant behavior, he said “either if you do something now or ten years from now it will be too late”. What happened in 12 years, did anything happen?
I think it was a lot of wasted time. It is normal that there are transgressive and deviant behaviors, but the fact that we know that this happens implies that we work on the situation and we in Portugal had a very good start to prevention campaigns and field work, but there were times when, or for budgetary difficulties or political choices, if this work has been reduced. We left the consumption of alcohol uncovered and the consequence was an increase in the consumption of alcoholic beverages at increasingly earlier ages. We have to bet a lot on education, but not only on formal education, but also on the informal side, in full citizenship. When we talk about prevention, it is also about people being interested in the environment in which they live and we see today that young people are only interested in the immediate and are disinterested, for example, in major issues such as political activity. I'm not saying that they are guilty of this, perhaps the level of politics being done is not attractive either, but this is a lack of responsibility, it's basically a “you play and I'll pass my turn”. And when we see this, something is sure to go wrong for years to come.

Carlos Poiares has been the vice-rector of Universidade Lusófona since 2013

This still happens today with cannabis, for example.
It happens. And we have a facility today, which is the fact that consumption or possession for consumption in legally prescribed quantities is not criminalized. I think that this decriminalization was extremely positive, there was an attempt to emphasize the work of prevention, both primary and secondary. In this sense, there is a large collection of situations that open up, and at the moment there is the hypothesis of legalizing the consumption of cannabis for medical purposes. We are witnessing a bit of anguish over the new reality, that is, there are people who are reacting emotionally at the moment, and drugs always appeal to an affective-emotional reaction, but we are also witnessing the discourse of “I don't know very well what which is, it is best to do nothing”. Drugs have always had this problem.

How do you see the fact that there are still people, especially doctors, who claim that there is no scientific evidence in relation to medical cannabis.
They will have their reasons, which I don't know, but what we already know is that there are scientific publications and studies in the field that show that in certain types of pathologies there are advantages in the use of cannabis. I believe that we have a combat situation here that will be overcome in the short term, because naturally there will always be the adaptation of the pharmaceutical industry to this new reality and when that happens there will be a discourse that will decrease in density. We know that morphine has been used for medical purposes for centuries, there is nothing new there. What's new is another substance, more accessible than opiates from the point of view of acquisition and price, and simultaneously very much associated with a playful-recreational vision - and here I would say that a vision even of pleasures, and each one has the pleasures you want. But in our millenary cultural tradition there is always a negative reaction to what can give pleasure, there is a fight against the pleasure of others. There was a time when you could say “there is no evidence, there is no clinical information to justify medical cannabis”, but nowadays that can no longer be said. Therefore, we are faced with an option of a political nature and drugs have always been a divisive issue within the parties themselves. But here we are talking about something that people cannot forget, which is the contribution to health and well-being that can come from cannabis. This measure is mainly aimed at medical issues.

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]”When regulation fails and there is a persistent stubbornness of public authorities in not legislating, the ideal conditions for hiding, with prosperity for many people”[/perfectpullquote]

Did you have access to any of the bills that are under discussion?
I know of some documents, namely the open letter that I had the opportunity to sign. There are some doubts that I believe may have created confusion, namely the authorization of personal cultivation, although we know that there is cultivation in several places, it seems that even in some public gardens. I think the project is sensible, it is prudent, it cannot be said that it was done on the knee. I think it was technically thought out, not just in the legal technique, but technically and scientifically thought about the issues raised by the consumption of cannabis. So, it wasn't one of those laws that are made in a moment while I'm having coffee, but the situation of that bill has matured and there is material for the deputies to discuss. In other words, it is not a law made from a fantasy, it is a project that entered Parliament supported by technical-scientific knowledge.

the self-cultivation it is foreseen in these projects for strictly medicinal consumption, with a medical prescription and license granted by the competent authorities for the person who has a pathology and who, together with the doctor, defines its treatment and cultivation of an amount with defined limits.
Therein lies the more complicated issue, for several reasons. One of them is because it is difficult to ensure that consumption is solely for medical purposes, and then also to guarantee the quality of the product. I don't think it will be exactly like planting a basil plant and waiting for it to develop. There needs to be some control, a control over the quality of the product, and I don't know if that system… it may be my ignorance, but I don't know if there are conditions for the necessary control to be carried out.

But at the moment this control is not done, everyone goes to the black market!
Of course, you can buy it anywhere, so it's worse. Now it was time to create the best conditions and, personally, I have nothing against the possibility of self-cultivation. In fact, the law itself, the last one, already had a shade on this aspect and this will always give the possibility of selling to other consumptions, of course. And we know that there is always a chance for everything, but that is why there are police authorities and courts. If an alleged self-cultivation for a particular purpose is diverted, then obviously the laws must work.

[perfectpullquote align=”left” cite=”” link=”” color=”” class=”” size=””]”The ideal situation is to buy legally. It will probably be cheaper, with better quality and there are no risks”[/perfectpullquote]

But don't you think that the last person to want to traffic will be the patient who has the doctor's prescription, who is registered with the Ministry of Health or INFARMED and who is, therefore, subject to inspection?
I have no doubt, there I have no doubt. If all these steps are well defined and there is a record, there will be no danger. Now, from a symbolic point of view, it is putting this as if it were almost the possibility of growing lettuce in the backyard, which it is not. And that's where it seemed to me that the opponents of this measure were grabbing the problem.

What happens is that there are people who already cultivate for medicinal purposes who are clogging up the courts and services, only to receive lesser sentences, but who are accused of organized crime and drug trafficking anyway. Basically, it would regulate this type of situation.
When regulation fails and there is a persistent stubbornness on the part of public authorities in not legislating on certain situations, ideal conditions are created for the situation to develop clandestinely, with prosperity for many people. Drug prohibitionism enriched many people, both those who repressed and those who trafficked. State intervention is fundamental here, a regulatory intervention, because what matters is regulation, creating conditions that allow legal use for the minimum well-being of people, preventing them from having to get involved in the black market. We have been wasting time, naturally we always spend some time thinking and then we move on to practice, but I hope that in Parliament, the fact that the project has been reduced to a specialty will not delay the process and that we will not be a year or two still talking about whether this matter can be resolved.

Imagine that at this point you were a patient who needed access to medical cannabis, what would be the ideal situation?
I don't think anyone has any doubts that the ideal situation is to buy legally. It will probably be cheaper, with better quality and you don't run the risks that appear marginally in these situations, obviously.

But there is a risk that is, if this is only in the hands of pharmacies, the price will be high and we have analyzed what has happened in other countries, where a gram can cost around €300 at the pharmacy. For this price people continue to go to the black market.
That part of pricing I hadn't even thought about it. Of course, there are always those who take advantage of both the legal loopholes in prohibitionism and the legal loopholes in liberalization, and there will always be those who are smart and knowledgeable in everything, who will find very adequate solutions for their own finances. But this is also part of what the State has to regulate, where it is made available, etc. I give a recent example, when methadone started to be made available to heroin addicts, Carmo and Trinity fell, all the prophets of doom came, the old men and the old women from Restelo all in procession to say the worst, and today we are verifying the advantages, which despite being a substance that replaces another and both can be considered drugs, after all it works. It's because? Because there has been a technical-scientific intervention, because the substance has been made available, and this is what we have to think about in terms of the product's commercialization framework. Where will it be made available? Can you buy it there at the kiosk, at the convenience store until 10 pm, or at the pharmacy? The price issue itself, because we also know that in a first phase prices can go up there, is that there are people who take advantage of the situation, but that is what has to be defined by the public authorities.

Do you think anyone has the right to decide about the life of a mother who cultivates to control the dozens of daily convulsions of her child who has, for example, refractory epilepsy? Or criminalizing a person in a wheelchair, with obvious mobility difficulties?
In a system where cannabis can be bought on any corner, and God knows what you buy, having it there like someone who has kale in the backyard is always an advantage, because at least you know what you're consuming. There are a number of issues that have to be resolved technically, much more human issues, from the person who is unable to move by their own means, the child who has convulsions, chronic pain, a series of pathologies that with each passing day aggravate. If we wait for an authorization that is political, we are harming the well-being of these people. And I'm no longer talking about the associated risks of going to buy on the black market, the product being tampered with or the possibility of being arrested for trafficking. It is a matter of the health and well-being of the sick person and the caregivers, which we sometimes tend to discard in the midst of all this.

[perfectpullquote align=”left” cite=”” link=”” color=”” class=”” size=””]”Commercial interests can never override science and what is the well-being of people”[ /perfectpullquote]

Most people who have an opinion on this matter are not aware, in fact, do not know the people who need access to medical cannabis right now.
I think there are different types of opinions. There are those who give their opinion without having thought about it and there are those who give their opinion because they think it is a political issue and this bipolarization is never a good adviser for anything. I also don't doubt that there are people who speak up because they might eventually have an interest in the business that exists if cannabis is liberalized. I quote again Dr. Almeida Santos, who said, when he was president of the Assembly of the Republic, that if drugs were liberalized, some bodies in the banking system, in the financial system, could go bankrupt. There is a set of interests here and when I say interests I am talking about economic interests. I have an interest in this for public health.

Some say that cannabis is the business of the XNUMXst century.
Well, we know that there are many businesses from the XNUMXst century, which come from the XNUMXth century, drugs, human trafficking, etc. I've seen so much that it doesn't surprise me that this is going to be a business that enriches some existing companies or others that are going to be constituted.

But cannabis is a market where there is a lot of investment worldwide. In Portugal we currently have a Canadian company that invested 20 million euros in a medicinal cannabis plantation in Cantanhede, but it's all for export. However, a Portuguese patient is not authorized and that patient is criminalized, leading him to answer in court for having two or three plants on the balcony.
There is one thing that has calmed my spirit, which is that since this debate began, we have been talking about drugs again, which I think is important for all that they represent as a social problem, in terms of treatment and prevention, so I think it is positive. I can tell you that in recent years there have rarely been students who wanted to investigate the drug problem and this year, in a group of five students, I have three doing theses on drugs.

[perfectpullquote align=”right” cite=”” link=”” color=”” class=”” size=””]”We are talking about a public health issue, we are not talking about a whim”[/perfectpullquote ]

Anything about cannabis?
Yes, which gives me, I would say, some comfort. But there is an issue here that seems more important to me, which is that of people's well-being, but I have already heard the Minister of Health take a favorable attitude, health officials linked to political power and Members of Parliament who are committed to ensuring that this is passed, so I believe there will be consensus to allow the law to be passed quickly. Once again, we are talking about a public health issue, we are not talking about a whim. Taking drugs is easy, anywhere and anytime in all corners of the country, but here we are talking about a non-recreational use, which can improve the well-being of people who have a health problem. And this is just as important as using traditional medicines, and cannabis is already a traditional medicine with a long history.

With the decriminalization of drugs, Portugal ended up entering a somewhat strange dichotomy in which the heroin user was seen as a patient and the cannabis user was seen as a drug addict…
There was a time when using drugs was delinquency and those who used drugs were delinquents. Then we had a time when it was a delinquent who was sick, then we had a time when he was just sick, but he was criminalized. Taking drugs is part of a lifestyle that people choose, for whatever reason, and everyone has their own, such as taking pills, smoking cigarettes, drinking coffee, drinking tea or lemonade… I mean, we choose our lifestyle. , but we know that there are more and more people who consume a series of things, namely cannabis, and keep their social, professional, affective life perfectly organized and without distortions. That idea that we are talking about delinquents is an idea that makes no sense today, especially in the field of cannabis. If you ask me if there are people who use substances, including cannabis, who are excluded or marginalized as a result, obviously there are, as there are also if you look at the homeless population. The consumption of a drug or a prohibited or legal substance is not a criterion, in my opinion, that is minimally differentiating.

Isn't alcohol much worse, for example?
But alcohol, I said just now about the kids, was what we left out, because there was an idea of ​​drug prevention and we forgot about tobacco and alcohol. We are now remembering all this and in recent years a lot of work has been done on alcohol and tobacco. At this point, people are also starting to talk about addictions that were not yet classified in the medical dosage, such as video games or lorazepam, for example.

According to SICAD data, overdoses from alcoholic coma exceeded heroin overdoses.
Yes, I saw this data. It's true that we don't have a youth party that doesn't get drunk and burn the tapes without alcoholic comas. People drink until they practically fall to the side, so there is a relationship with alcohol that I think is very bad.

Today, who should guarantee the rights of sick people?
This is the big problem that the State has to solve and that is where there can't really be a let-go. There must be an active intervention through health control devices, namely INFARMED. There must also be an effective control so that, first, there is no shortage of those who need it, because we are talking about a medical need, second that it reaches people at an affordable price, and third with guarantees of quality. So this here is a fundamental matter and I don't think it can be abdicated. In the same way as to take an antibiotic, be entitled to hospitalization or a consultation with the National Health Service (SNS), it is part of our fundamental rights to use cannabis or any other substance under medical prescription to treat a health condition. . It is a matter of fundamental rights.

This is also enshrined in the Constitution of the Portuguese Republic, art 64, the right to health and the duty to defend and promote it.
And if there is evidence that cannabis is important in the treatment of some diseases, if it is proven that it acts on some physical and mental pathologies, then to refuse this, to delay this is to jeopardize something that is part of people's rights.

The problem is that laws can take years and patients, most of the time, don't have that time.
I think that these projects have already reached Parliament with some delay, which is why I said earlier that the problem needs to be resolved quickly. It doesn't mean that it will be solved in the knee, but that it will be solved quickly. And if this is fundamental to health, then let's do this without stalling here.

[perfectpullquote align=”left” cite=”” link=”” color=”” class=”” size=””]”If it is proven that it acts on some physical and mental pathologies, then to refuse this, to delay it is to put in causes something that is part of people's rights”[/perfectpullquote]

Finally, how is the stigma towards the cannabis plant broken and how can this situation be reversed? How, in essence, is this society re-educated in the new paradigm in relation to cannabis?
Sometimes the best way is to talk as little as possible. That's not what I did today (laughs), but deep down it's looking at things with a sense of naturalness. There was a time when people treated each other with the plants in the village's backyard. In my country, I'm from Góis, people still make olive leaf tea for high blood pressure, instead of taking drugs from the pharmacy. Maybe doctors don't think this very well, because there are specialized drugs to control high blood pressure, but it works for some people. Cannabis may not work for many people, but it will work for others, just as there are drugs that are very good for some people and very bad for others. What we do know is that cannabis helps with some pathologies and, having no lethal dose, which is a comfort and safety, it works very well. There will be people it won't work with, ok, but I can even tell you about a case that happened in France and that I usually tell my students. A young man planted some cannabis plants on the roof of his grandmother's house and one day the grandmother decided to make tea with it and felt much better from the pain, so she invited her old friends to have tea with her. All improved from the pain, but ended up in prison. We often have a conservative, retrograde look, so there needs to be an open-mind here, a capacity not to be scared of the unknown and to seek help and information from those who know. What exists is, above all, fear, and there is people who are permanently scared. But relief from fear is achieved when there is credible medical information and at the moment the information that exists is credible. We have to be open to what is explained to us by science and accept what is said, that is the evolution of science, and I think it should always be done with a very strong ethical component, whatever the scientific domain, and with transparency. And commercial interests can never override science and what people's well-being is all about.
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Photos: Laura Ramos