Miguel Guimarães: “Any pharmaceutical product related to cannabis must be sold in pharmacies”

The President of the Ordem dos Médicos (OM), Miguel Guimarães, said in an interview with Cannapress that all cannabis derivatives must be made available in community pharmacies, including oils and dehydrated flowers.

Graduated in Medicine from the University of Porto in 1987, Miguel Guimarães is 55 years old, was President of the Northern Regional Council of OM, Urologist at Hospital de São João and won the elections for President of the OM for the triennium from 2017 to 2019, with more than 70 percent of the votes.

Miguel Guimarães spoke to Cannapress at the end of the debate on Medicinal Cannabis that the OM itself organized, on the 18th of April, and accepted the invitation from Cannativa — Associação de Estudos sobre Cannabis, to attend the 1st Portuguese Conference on Medicinal Cannabis, which will take place on the 9th and 10th of November in Lisbon, and which provides for the training of doctors and health professionals.

OM discussed cannabis for medicinal purposes today. What is the main objective of this initiative?
First of all, I would like to thank you for your presence in this debate that took place here at the Ordem dos Médicos, because it was an important debate, in which several essential things were said. I think this debate has brought up virtually every issue that can be of importance in the cannabis issue, from its therapeutic use and benefits to potential side effects. Also the fact that Portugal – and this is a vision that I find interesting – has an ideal climate for growing cannabis. This is already happening with foreign companies, but if it happened with Portuguese companies, it would certainly be better for the country. But we can somehow take the initiative and lead research into the cannabinoid pathway, because the cannabinoid pathway has great potential. We all have the feeling that it exists, even because of the private experiences that each person has had in some types of diseases, and therefore there is an immensity of potentialities related to our country that we can take advantage of. This was well highlighted by some people who were in the audience and so I think the debate turned out to be very helpful.

Miguel Guimarães, Chairman of the Ordem dos Médicos, in an interview with Cannapress. PHOTO: Miguel Schmitt // Cannapress

Knowing that Dr. Miguel Guimarães doesn't want to dwell too much on issues that have to do with medical cannabis, since he refers the matter to the specialty colleges, what is the position of the Order of Doctors in this matter?
Regarding the OM's position, at the moment, the one taken by the National Council for Medicines Policy (CNPM) and by the competence in clinical pharmacology, which was obviously approved by the National Council of the Order of Doctors (CNOM), over which I preside. It is a position that is balanced at the moment, favoring the use of cannabis-derived medicines in situations where there is already scientific evidence, which there are many, not so few. And curiously, in that same document, we already called attention to the fact that it was important, even because we have the conditions to do so, to carry out research in this area. And we have good researchers in Portugal, we have good companies, in terms of pharmaceutical laboratories we have some, we have Bial, which is already a large laboratory and has already produced two drugs, but we have others. And the Portuguese State itself can use what are the researchers that exist in hospitals, in Health Centers, in Institutes, to start promoting research in this area, because I think this has a future and is also a way for the country in terms of new drug development. And by developing new medicines, even new therapeutic forms, even if they are not pills, it can have a positive impact on the economy itself, not immediately, but in the medium term, and this was, in fact, highlighted by some people present here.

OM has already said that it is against the smoked form, but having also seen here that there are other possibilities, such as the vaporized form, do you only agree with the use of cannabis as a medicine?
There are several drug forms that can be used, not just the pill. There are oils and alternatives that are equally effective. The issue of the smoked plant itself, of the original plant, is always a more complex issue in this case of therapeutic indication. For example, what Mr. PSD deputy spoke about is a completely different issue from what we were discussing here today, which does not mean that it should not be discussed as well, and it is an issue for deputies to take seriously, the issue of trafficking that is often done in this type of plants, which is known throughout the world, and what can be the advantages and disadvantages of legalization or decriminalization. In practical terms, at the moment we are not in a position to be able to have a favorable opinion on smoked cannabis, because smoked cannabis does not have a control over the compounds of the plant, what the plant itself has and produces during smoking. That is, it is not possible to control the active principles that can have a positive therapeutic effect and those that have side effects.

But do they admit the possibility of selling dehydrated flowers for vaporization in the pharmacy, as is already the case in other countries?
I think any cannabis-related pharmaceutical product should be sold in pharmacies.

[perfectpullquote align=”right” bordertop=”false” cite=”” link=”” color=”” class=”” size=””]”There is a drug [Sativex] that is not even available in pharmacies and all this limits the use of this alternative.”[/perfectpullquote]

Any product, even the flowers themselves?
Yes. Any product that is indicated for effective treatment must be available in pharmacies, as with all herbal products, the medicines we know, syrups, in short, all these therapeutic forms. And therefore, it is regulating the sale. Another issue, which was also discussed here today, is that, although we have a drug derived from cannabinoids [Sativex], the truth is that it is not immediately available, that is, doctors prescribe it little and as they prescribe little laboratories don't have it available and then it's the fish with the tail in the mouth: if people use a certain type of medicine little, the laboratories have no interest in having them here permanently, because they are going to spoil. And then there are these special requests through Infarmed and that delays these situations a lot.

Cannapress has been monitoring very critical situations of patients with difficulties in accessing CBD (cannabidiol), which can only be purchased in Spain or which is held up at Customs when it is ordered, for example, from the United States…
This is a good question to ask Infarmed. See why: we already know that there are several drugs with cannabis-based derivatives that are marketed in Europe, have been authorized by the European Medicines Agency, and that are important in certain types of pathologies. I think that the way these medicines can be acquired should be more effective, faster. It is true that if a person asks for the medication, and if it is available in Europe, Infarmed can have the medication. Now, I don't know how long it takes and the time can be excessive. Perhaps a faster mechanism has to be found for certain types of medicines that are not, in fact, available in Portugal. This is because pharmaceutical laboratories are not interested in having these medicines available in Portugal, due to the volume of business involved in our country, because it is always a smaller country. This happens in a number of areas, it's not just with cannabinoids.

Miguel Guimarães, Chairman of the Ordem dos Médicos, in an interview with Cannapress. PHOTO: Miguel Schmitt // Cannapress

But that's not the only problem. Another pressing issue is, for example, the lack of medical follow-up for patients who use or want to use cannabis for medicinal purposes…
That is why these debates are important. And I think that the information and the fact that at this moment the public discussion started - which was not today, this was a drop of water in the middle of the ocean - the fact that people think about the matter and have documents, take positions, so we start by having a position, we may or may not change it later and so does the Ordem dos Farmacêuticos. This evolution and this debate, going further into what is research in this area, I think is very important. That's why I think the contributions that were made today were all positive, whether by people who focus more on the issue of clinical reasoning, research, etc., or by people who are more based on their personal experience. Because it is always the scientific evidence, from the masses, the evidence that can be taken from the world databases of what are the works that are or are not published, and what is the individual evidence. Even because many doctors have their individual experience. Doctors in Portugal rarely use cannabinoid derivatives and probably also out of ignorance, because they think they don't have them or because they don't usually hear about them, and so they're not particularly suited to this area. In fact, medicines are not promoted much either. There is a drug [Sativex] that is not even available in pharmacies, so all this also limits the use of this alternative.

And how is this impasse resolved?
So, as we are doing. Debating, talking, which is for things to start to take on a different dimension. And I think it's an important area that should be talked about more, and we're going to come back to that.

Cannativa is, in fact, working in this direction, in the organization of a Conference with Workshops for doctors and health professionals. We invited Ethan Russo, a neurologist and pharmacologist who developed, for example, Sativex for GW Pharmaceuticals, and he already confirmed his presence on the 9th and 10th of November.
Very well. People will be there.

Miguel Guimarães in conversation with colleagues in the garden of the Ordem dos Médicos, in Lisbon. Photo: Miguel Schmitt // Cannapress

We would very much like to invite you, from now on, to be present at this Conference.
I will be delighted to be present.

Do you think that the OM could also help in the dissemination of this Conference by doctors?
Yes, we can help, of course we can. Look, today we made a point of having several people present here, namely people with personal experience. That colleague of mine from Espinho, Ana Rita, who is a General and Family Medicine Intern, came today to give her testimony as a doctor and patient, she had to travel 600 km, but we tried to have as many different views as possible, of the Orders, of the Institutions, doctors, pharmacists, Infarmed, which has a great responsibility here in terms of what the medicines circuit is and which plays an important role in what is research done in Portugal. And then have people's experience. From doctors, on a personal level, and from patients. There were some patients there and at least two were doctors, but there were people who were just watching and I think the debate turned out to be positive. But cannabis is an issue that needs to be discussed and I think this is a good start.
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Featured photo: Miguel Schmitt // Cannapress