KUALA LUMPUR: As a psychiatrist and drug addiction specialist, Associate Prof Dr Rusdi Abd Rashid has seen the adverse effects of marijuana on patients and how it can induce psychosis in those with schizophrenia and other mental disorders.
So he was surprised to see how it calmed down the severely autistic son of a patient who had been depressed because she was unable to cope with her son’s condition.
“She (had given) the CBD (cannabidiol) oil to her son – she just put a few drops under the tongue on a daily basis – and she found the child became less hyperactive and showed less disturbing behaviour,” said Dr Rusdi, who is the director of the Centre for Addiction Sciences at Universiti Malaya.
Dr Rusdi became curious about the possible medical benefits and applications of cannabis, especially CBD, the non-psychogenic part of the plant, wondering if the CBD oil would work on older individuals with severe autism.
His and other researchers’ desire to discover the medical benefits of cannabis and kratom, a lesser-known psychotropic drug closely related to opium, is helping to fuel the debate on legalising the two drugs in Malaysia, a country that sentences anyone convicted of drug trafficking to death.
Under the Dangerous Drugs Act 1952, having possession of over 200 grammes of cannabis or cannabis resin is presumed to be proof of intent to distribute and anyone caught with the amount will face the death penalty if convicted.
As for kratom, the drug is listed under the Poisons Act 1952. While not considered a narcotic and its cultivation and usage are allowed, the sale of the drug is prohibited unless by authorised agents.
This means if Dr Rusdi tries to study whether the CBD oil is effective in treating behavioural problems by conducting his own experiments with CBD oil, he runs the risk of the death penalty.
But things may be changing on this front.
On the heels of the World Health Organisation (WHO) dropping medical marijuana from its list of dangerous drugs, Malaysia is now considering legalising the use, sale and distribution of cannabis and kratom for medicinal use by forming a bipartisan caucus to study the regulatory issues involved.
On Nov 9, Health Minister Khairy Jamaluddin told the Dewan Rakyat that cannabis use was allowed for medical purposes under present laws, saying the products have to be registered with the Drug Control Authority under the Ministry of Health (MOH).
He said sellers must have licenses and permits under the Control of Drugs and Cosmetics Regulations 1984, the Poisons Act as well as the Dangerous Drugs Act, to import and sell cannabis products in Malaysia. Only medical personnel registered under the Medical Act 1971 can dispense the products.
“Cannabis (hemp) is also listed under the Single Convention on Narcotics Drugs 1961 Schedule 1. Schedule 1 limits the use of cannabis to medicinal and scientific purposes that involve production, manufacture, export, import, distribution, trade, usage and ownership,” he said.
Many experts are aware of this provision but say they are reluctant to apply for approval from MOH as the process is too difficult.
Dr Rusdi said even if researchers manage to convince the approval committee of the merits of their study on the medical use of cannabis, it is often too expensive to continue as they would have to purchase the cannabis, rather than grow it themselves as it involves another approval process. However, with the announcement from Khairy, many have decided to try their luck again.
The caucus, of which Member of Parliament (MP) for Kuching Dr Kelvin Yii Lee Wuen is a member, hopes to study this issue and come up with a sound strategy to legalise and regulate cannabis and kratom.
“When we talk about legalising (cannabis), it’s not about having it widely circulated in the open market… you know the perception that everyone is smoking and getting high and everything. But it’s for regulation so it is used strictly for its medicinal and economic properties,” he said.
He said legalising the use of these plants for medicinal purposes will provide health and economical benefits to the country, and reduce sales of the drug in the black market while ensuring the product is safe for consumption.
Some of the possible benefits of cannabis are in its use as pain relievers, muscle relaxants, antiemetic (anti-nausea) and anticonvulsants (anti-seizure). It may also help in treating substance abuse.
“(With legalisation) there is an element of control, we can monitor its implementation, we can tax it, we can control the production and sale and evaluate the constant impact,” added Dr Yii.
Director of Centre for Drug Research at Universiti Sains Malaysia Prof Dr B. Vicknasingam sees the economic benefits of cultivation and sale of cannabis and kratom to the international market, but thinks Malaysia should lead the way in kratom research due to its long history of use in traditional medicine.
Unlike cannabis, there are fewer hurdles in studying kratom and its properties in Malaysia.
“We have an advantage here. We always tell people interested in doing marijuana and cannabis research (that) the Western world has got a head start and they’ve already got products out there,” he said.
One of the aspects he would like to study is kratom’s potential as a pain reliever and to treat substance abuse.
Should legalisation happen, Malaysia would be following the example of many countries that have legalised cannabis and be the second country in Southeast Asia, after Thailand, to legalise cannabis and kratom for medical purposes.
There will have to be changes in many sectors with legalisation of medical cannabis and kratom.
All the experts Bernama talked to, from lawyers to medical officers to anti-drug activists, were supportive of medical marijuana. However, their support came with a caveat: Regulation must be strict to prevent any abuse once cultivation and sales of the drugs are legally allowed for medicinal purposes.
It is no secret that the cannabis market is worth billions of dollars and the kratom possibly worth as much. Such a hefty payday tends to attract bad actors.
Human rights lawyer Samantha Chong said Malaysia could use the example of Colorado in the United States on how to cultivate, process and dispense cannabis, while acknowledging the government should tailor the Colorado model to Malaysian society and culture.
Describing her trip to study the cannabis industry in the US mountain state as “an eye-opener”, she said the industry involved all sectors, from licensing, environmental impact, law enforcement, worker safety, security to transportation and sales.
“All the cannabis plants are strictly monitored by CCTV and each plant is tagged with its own RFID barcode … each cannabis plant can be tracked from cultivation to the dispensary,” she said.
She added the revenue Colorado receives from the sales of marijuana went to funding social services and training personnel for the industry.
From the legal perspective, law experts say the law must change to reflect the new status quo, such as dropping cannabis from the list of Schedule I drugs and, perhaps, shifting it to the Poisons Act, under which kratom is listed.
Chong said there is also a need for laws to prevent the abuse of power, as well as update other laws including the Drug Dependants (Treatment and Rehabilitation) Act 1983, the Sale of Goods Act 1957 and the Prison Act 1995.
The government will also have to prepare to commute the sentences of prisoners who have been given the death penalty for using cannabis for medicinal purposes.
“In the event any amendment is made, they ought to apply it retrospectively and then it could apply to cases such as that involving Amiruddin,” said Ramkarpal Singh, MP for Bukit Gelugor and also defence lawyer for Amiruddin Nadarajan Abdullah, or better known as Dr Ganja, the 63-year old cancer patient who is facing the death penalty if convicted of trafficking cannabis.
From the medical perspective, experts see a need for changes in the way the government approaches addiction and rehabilitation, which currently employs a more punitive method.
Medical experts do not think that it would be too difficult to allow the use of medical cannabis and kratom, saying the government could use the existing prescription framework of medications containing controlled substances, such as opioids and methadone.
Dr Rusdi said the current method involves a diagnosis and prescription from a trained and certified medical practitioner. The patient then gets the prescription filled out at registered pharmacies.
Patients are also required to carry a medical card saying they have been prescribed the controlled substance and by whom, in case they are stopped by law enforcement officers at any point.
Dr Rusdi does not see preventing abuse of medical cannabis and kratom as too difficult.
“If there is no proper diagnosis and we suspect they are just recreational users, then we won’t give a prescription,” he said.
Hemp and marijuana are both cannabis, except that hemp refers to any cannabis plant that contains 0.3 percent of tetrahydrocannabinol (THC) – the chemical that makes one high. All cannabis plants – C. sativa, C. indica and C. ruderalis – contain varying degrees of THC and cannabidiol (CBD).
Medical researchers and scientists are most interested in CBD, which is the compound mostly found in hemp, a specific type of C. sativa plant. Limited studies indicate medical benefits. The leaves and flowers of the hemp plant are used to make CBD oil, a common ingredient in many wellness products, such as skincare.
Hemp is also used to make paper, clothes, rope and sails.
Kratom is a common plant in Southeast Asia and has been used in traditional medicine in this part of the world for hundreds of years. Closely related to opium, it is gaining popularity in the United States, especially to reduce opioid withdrawal symptoms, a potential game changer in the country’s efforts to control its opioid crisis.
To date, no one has reportedly overdosed on kratom in Malaysia. In the United States, deaths reported from kratom use occurred when mixed with other drugs and medicines such as antihistamines.-Bernama