Policies Against Pain. Interview with Manuel Guzmán

Transcription of the video: Alchimia at "Policies Against Pain", interview with Manuel Guzmán 

CaixaForum (Madrid) - September 18, 2017

CAROLA PÉREZ

Hi. Good morning and once again, thank you very much to everyone who has come today to join us on a very important day for us, because not only are we going to talk about medical cannabis, but it’s also the day when politicians are going to sit down at the table, we are going to debate together, and also the patients are going to come out to talk and explain our needs to you…

MANUEL GUZMÁN 

Hello, good day. Well, in this talk I will try in way of an introduction to this day, to summarise what we know today from a biological perspective, pharmacological, clinical, about the topic that we’ll focus on, which will monopolise the day today, and also those that lie ahead, so motivating and so intense, which is, as you well know, medicinal cannabis. And it’s that cannabis really has some unique properties, really exclusive, that make it a potential source (in some cases a real source) of compounds to improve quality, to alleviate some symptoms of some diseases and to improve the quality of life as you know, of many patients.

Well, cannabis, as I think you all know, is unique within the plant kingdom, within the approximately 300,000 species of plants that exist today in nature, cannabis is unique because it produces a series of compounds that are exclusive to it, which we therefore call cannabinoids, and which are precisely those that give it those bioactive properties, those unique pharmacological properties over human beings…

MARÍA - Alchimia 

Hello Manuel, or Manolo… which do you prefer?

MANUEL GUZMÁN 

Well, it’s like Jekyll & Hyde, I’ve got both… two sides.

MARÍA - Alchimia 

Both sides. The truth is that you’re very well known, much loved. I believe you’re the most appreciated now here in this world…

MANUEL GUZMÁN 

Well, in any case it’s appreciated.

MARÍA - Alchimia

Yes, thank you very much for the talks because they are very, very clear and well, it shows that there’s a lot of passion.

Simply, well I’m curious: Since you are at the Observatory (OECM) and well, you deal with a lot of sick people… which illness do you think, when a patient comes to see you, begins treatment and starts taking it… in which illness do you see the most evolution?

MANUEL GUZMÁN

Yes, the most widespread case among medicinal cannabis patients is pain, it is the most transverse disease. What we are talking about is that cannabinoids have effects on neurological diseases, but one of them is the attenuation of pain, in oncology, one of them is the attenuation of pain, in musculoskeletal diseases where one of the effects is the attenuation of pain, etc… pain is a very transversal disease, very horizontal, very common to many diseases and in fact is where cannabinoids probably have a better therapeutic niche.

So, undoubtedly, in the fields of neuropathic pain, chronic pain, arthritic pain, articular, fibromyalgia, etc, etc… that's where one probably sees a greater improvement in not all, but in some patients who tolerate it and feel a beneficial effect in their evolution, and also it’s such a long term disease, so variable in terms of the causes in the management etc that each patient has and a disease where there are also more drugs and more general therapies to treat it where, well, the treatment is also more flexible and it is easier to approach the patient. The patient can also incorporate it into their pharmacopoeia, combining it with other analgesics, with their other types of habits and well, can get a better performance…

MARÍA - Alchimia 

A better result.

MANUEL GUZMÁN

And nowadays we know, you know, that our organism, like that of most animals, produces molecules similar to THC in the brain, and therefore they are called endogenous cannabinoids (of our organism) or endocannabinoids. Among them anandamide stands out, this would be the endogenous THC, speaking graphically, that our brain produces and therefore nowadays it is clear that the THC from the plant, as we have said, acts through some receptors, sensors on the surface of many of our body’s cells and it does so simply because it has the shape, the key of THC, which is practically identical to the key of anandamide.

So what THC does, imitating the action of this endogenous key that we have in our brain and in the tissues of the anandamide, is to attach to the same receptors, to join the same channels…

• Which is the disease that will benefit the most from cannabinoid treatment?

MANUEL GUZMÁN

Well, it's hard to know. On one hand we have the classic therapeutic applications of cannabinoids, for example the inhibition of nausea and vomiting, the inhibition of spasticity etc., the attenuation of pain, in which we still have much to learn. And I think that the effects can still be optimised much more than we are aware today. That is, the first thing I believe, we must improve on the indications that are already relatively well established, to reach more patients and to have better efficacy with fewer side effects.

Then there are some other diseases, for example, childhood epilepsies, where CBD has proven to be a very relevant antiepileptic, but we still have a lot to learn. Is it better or worse than the other antiepileptic drugs that exist on the market today? Alone or combined with them? Does CBD only attenuate seizures or does it actually improve the modulation of this nervous system and therefore all the functions associated with it? The integration of the child at the educational level, at the family level, his intellectual, social development, etc etc… that, well there are signs but we still have a lot to learn in this field also, which is really fascinating.

And then there could be new indications, where we’re fighting but of course, it’s more difficult to get to where I would say we would pass to another, qualitatively, to another stage. We would pass from the palliative effect of the cannabinoids to the, if you want, remedial or even curative effect, taking it to the extreme, right? And above all it would be two types of diseases: neurodegenerative diseases and cancer.

In neurodegenerative diseases many laboratories in the world are trying to see if THC and other cannabinoids are not only palliative for some symptoms, for example spasticity or seizures, but also can protect neurons and therefore can have a remedial effect if that’s wanted, right?

And then there’s the case of cancer, where cannabinoids can not only fight some of the symptoms derived from cancer, like pain, nausea, vomiting, loss of appetite, etc. but perhaps in some cancers and in some patients In particular, cannabinoids may be antitumoral.

So I think we essentially have these 3 levels nowadays:

• The safest level, but we still have to learn from therapies, from conventional indications.
• An intermediate level of new diseases that have emerged in recent years, with children's epilepsies being the most relevant.
• And at thespearhead, more laboratory work, but there’s still a long way to go to get to the clinical level, which is the attempt to move from the palliative to the remedial terrain.

MARÍA - Alchimia 

To the remedial terrain, of course. Because the trial with… are clinical trials on people far away? Is it a financing issue or a policy issue?

MANUEL GUZMÁN 

It's a bit of both. Some small trials have already begun to be done but we are still very much in our infancy ...

MARÍA - Alchimia 

Underhand I guess, right?

MANUEL GUZMÁN

Yes, it is complicated. Well, it influences everything, it influences, really the trials can be done but the industriousness is enormous. Sometimes it’s a monster that you see before you, because being included in the list 1 of the United Nations (UN) and the subject of international treaties, although really the states could pull out of these treaties but in practice they don’t. This has also created a very strong stigma against the substance, which is still seen in many cases as a drug of abuse, and it can become so under a different usage, because here we’re talking about controlled therapeutic use etc.

MARÍA - Alchimia 

A mis use, yes.

MANUEL GUZMÁN

…and then that detracts greatly from the interests of the administrative staff, the clinicians, the companies that could finance the studies, etc. So in the end we find ourselves in a situation where research in the laboratory with mice, with rats, with cells, etc. advances in a more or less rapid way, but research with humans is desperately slow.

MARÍA - Alchimia 

The most necessary…

MANUEL GUZMÁN

But of course, yes, the most necessary without a doubt if we want to get medicine to the patients. But hey, there are shortcuts, like the medical card, patients finding it for themselves, there are Associations, there are Clubs, but it’s not the ideal situation, and that’s why we advocate and bring the problem to the table, we discuss it and try to regulate in the best way possible using examples that we already have from many countries where there are things that work, sometimes not, and well, then taking the best of each one and adapting it as best as possible to Spanish socio-political reality, health, etc. and well, try to do something worthwhile so that many patients can benefit.

MARÍA - Alchimia 

What would you say, finally, what would you say to a patient who is considering it, but isn’t familiar, doesn’t know where to go, what can we say? What would you say? We take note so everyone who listens the interview can help any supporter.

MANUEL GUZMÁN

Well, the basis of everything is information. So the first thing that should be considered is whether that patient is a potential beneficiary of one of the better-established therapeutic effects of cannabis and for that it is best to be informed. There are many online resources but there are also Associations, there are Institutions, the Spanish Observatory of Medicinal Cannabis (OECM) where you can find this information.

In the case a physician or specialist, or a doctor considering that the patient is really responsive to the use of cannabis or when the patient makes that personal decision for himself, because obviously this is the right of each patient, then we try to access the most relevant product in terms of chemical composition etc. to the illness, a product that is traceable and safe.

That is, the patient knows that he is taking cannabis with a certain amount of THC, a certain amount of CBD, with a specific terpene chemotype etc etc… and that he also knows that this preparation is safe, that it has no contaminants, no heavy metals or solvents, bacterial contamination, fungal, etc.

And then, well, ideally monitor the patient with a health professional. If that isn’t possible, then with somebody close who has experience and try to listen, understand, see how it’s going… I mean, ideally a follow-up like any other medicine. But if it can’t be done, then at least integrate it as much as possible within your usual medication to be able to see what the positive effects are, the effects sought, the side effects, how any side effects can be mitigated, how we can improve the effectiveness of only cannabis as therapy or cannabis combined with other drugs.

Normally these are chronic patients with very devastating diseases etc and are polymedicated patients, so that’s also very important to take into account, to ensure the cannabis does not interfere negatively with medications, but also because ideally, it can even promote the desired therapeutic effects, analgesic effects for example, with other medications.

MARÍA - Alchimia 

Information is power, right?

MANUEL GUZMÁN 

Totally. It’s fundamental.

MARÍA - Alchimia 

Well, many thanks, till next time!

MANUEL GUZMÁN 

Thank you all. Truly, it’s a pleasure.

JOSÉ CARLOS BOUSO

In this map you’ll see that some countries have a green circle. This map is online on our website, later I’ll tell you where you can find it, I will post it on Friday so that anyone can see it and it’s also an interactive map, as I will try to explain later. There are countries where there is a little green circle, which means that there is some type of regulation but it’s not fully complete and a little black circle in the medical cannabis program which allows access in all its complexity to all products including the plant (the herbal cannabis).

CARLOS GOICOECHEA

In contrast to all the signals from this morning that were quite pessimistic… I want to send a message of hope to you and say yes. That there are things and that with time there are going to be more and more things.

I always have to put this slide into any talk I’m able to, I liked it a lot. It’s Descartes, he is not Descartes, he is a child, but Descartes was the first to speak about pain as a transmission system, which sent information from the periphery, from the area where the pain existed to the brain. Before, the pain was in the heart, the pain was an emotion. Descartes was the first to say no. Nerves also count. Something must be in the brain.

ARACELI MANJÓN

The United Nations (UN) treaties that regulate drugs DO NOT prohibit the regulation of medical cannabis at all.

We don’t want Cannabis for a stye in the eye. We want it for terrible diseases!

Regulating medical cannabis, allowing patients access to it is an ethical imperative and we are wasting our time. Thank you.

BERNARDO SORIANO

Well, I think we have to be positive about the response of the patients, researchers, doctors and politicians. The truth is that the Observatory (OECM) becomes an interlocutor and for the first time has achieved rapport among all these agents, who in the end are those involved in cannabis, in what we want, right? In these policies on cannabis, it’s very significant.

Next, we must denote the humanity that this type of event stands for, it makes your hair stand on end… and then also, because a small negative point would be that some Parties, that in theory should have things a little clearer and see this terrible reality that medicinal cannabis users are living, that they don’t have a little more compassion on this issue, right?

In the end, the political opportunity, the times, have more influence than the needs and requests of patients, and this would be the small negative point. But the balance is good, it’s something that we are pushing forward and I think that they're going to take steps so that soon we’ll have some changes.

Then, recognise the work that they’re doing at the Observatory (OECM), an exquisite, magnificent work, which without a doubt has made a quantum leap in terms of revindication and proposals.

 

PATIENTS MANIFESTO:

We ask that you regulate the right to auto-cultivation and compassionate collective cultivation. Let us help each other!

The current situation only gives us legal and health insecurities, much stress and more pain.

Thank you for giving us the opportunity to explain our situation, our needs and some of our solutions.

Please, consider the current policy of irregularity to which the medicinal use of this substance is subject, and where it leaves us.     

Hopefully from your position you can help us. I hope you never have to go through this on a personal level!

… and please, remember: OUR PAIN CAN’T WAIT !!