Ana Rita Andrade: “I am pleased that there is one more product for medical prescription”

Ana Rita Andrade is 34 years old, is a General and Family Medicine Physician and is responsible for the Kanab Clinic, a clinic specializing in cannabinoid treatments. Ana Rita is also a Multiple Sclerosis (MS) patient and has been using cannabinoids to minimize the symptoms of her pathology. After approval by Infarmed of the first cannabis-based substance or preparation, dried flowers with 18% THC, Cannareporter spoke to Ana Rita to find out how this new product can help you.

Can this new product solve your problems as a doctor and as a patient?
As a patient, I am very happy that there is yet another safe and quality product, with a pharmacovigilance program, available for the treatment of one of the most limiting symptoms of MS, which is the spasticity and muscle stiffness associated with MS. As a Doctor, I am pleased that there is yet another product available for prescription. This will inevitably lead to greater knowledge in the management and follow-up of patients undergoing cannabinoid treatment. Taken together, it all adds up to improvements for the patient.

Given that the price has not yet been announced, what would be the acceptable amount to be paid by patients for this product?
I am not able to put forward a price for the product. I can only say that the value of the product will probably follow the same rules that other preparations and medicines follow. That is, the price calculation must be based on the 4 reference countries, and follows specific rules for calculating drug prices.

What other cannabis derivatives do you expect to see approved this year in Portugal?
In my opinion, the products that may be available will be the products whose AIM are submitted to Infarmed, by the pharmaceutical companies. Most likely, in the case of Tilray Portugal, for example, which so far is the only pharmaceutical company with marketing authorization, the products they will present/submit will be the products they already produce and export. In this sense, it is likely that complete cannabis extracts may appear in pharmacies, in addition to THC 18% flower or even other more balanced concentrations and ratios.

How many patients do you think could benefit from this product?
I have no idea of ​​the epidemiological figures for the 7 Infarmed indications for the use of these substances. For use in chronic pain, chemotherapy-induced nausea and vomiting and spasticity/muscle stiffness associated with Central Nervous System (CNS) injuries, the population is much higher compared to, for example, use in refractory epilepsies, which are very fewer incidents, so the population will be smaller. However, currently the prescription of cannabis should be carried out, at least initially, in conjunction with other treatments and, if patients prove to be refractory to the treatments previously instituted, 2 questions arise here: 1 - The limitations of the SNS to apply the most differentiated, leaving some patients with less access, or greater difficulty in having this care; 2 – They may only have access to medical cannabis and preparations and substances if they have shown themselves to be at least partially refractory to all therapeutic options. But if there are still many patients who do not have access to certain therapies, then when will they be able to try cannabinoid treatment? I think that these patients, who do not have access to other therapies, can have faster access to preparations and substances based on the cannabis plant.

How many patients do you think you can prescribe it to once it becomes available?
Again, I can't point out numbers. We know that chronic pain is a major scourge in Portugal, being very prevalent. If we are talking about chronic pain, then patients with irruptive pain characteristics, mainly, and that fit within the medical indications, may be a high number. Patients with chemotherapy-induced nausea and vomiting may also increase the number of patients requiring the use of cannabinoids, preferably by inhalation. Patients with other CNS diseases that report spasticity and/or refractory muscle stiffness, such as stroke, which is the main cause of mortality and morbidity in Portugal, may also benefit from this therapy. As a General and Family Medicine doctor, I end up being the “case manager” doctor for many of these complex patients, since FGM interfaces with the different specialties and therapies instituted, and can be one of the most important factors for the management of these cases and the respective prescriptions.