Should Cannabis as Medicine be Specifically Regulated ?

In 2017, a patient case in Sangau, West Kalimantan, involving a women with syringomyelia has drawn public attention. The case ended with the arrest of her husband who cultivated Cannabis to treat her disease. Currently, Indonesian regulation classifies Cannabis as the first group of narcotics which are prohibited to be used as medicine. This research aimed to ellaborate whether Cannabis as medicine should be specifically regulated. Data source was national and international regulation on narcotics and scientific evidence regarding medical benefit of Cannabis The data was obtained from literature search with following keywords; regulation of Cannabis, medical use of Cannabis, Cannabis medicine. Analysis was conducted using qualitative approach. The results of this study showed that Indonesian regulation regarding Cannabis is associated with International Convention on narcotics. Evidencebased data on Cannabis application in medical treatment have been extensively studied. Given beneficial effect of Cannabis to treat many diseases, several countries have already regulated the use of Cannabis for medical purpose. In conclusion, it is worth to consider a specific regulation for medical Cannabis in Indonesia, given its beneficial utilization to treat certain diseases.


Introduction
In 2017, a patient case in Sangau, West Kalimantan, involving a women with syringomyelia drew public attention.Husband of the patient was arrested, trialed and sentenced for cultivation of Cannabis at his home grounds.Based on data from the case file No.111/Pid.Sus/2017/PN.Sag at Sangau Court of First Instance, it was clear that the cultivation of Cannabis by this man was only for the medical purpose, specifically to treat his wife. 1 The wife had been in severe pain due to syringomelia for many years.Once every two weeks, she needed to be hospitalized.The patient was introduced with Cannabis treatment in 2016.After consuming cannabis, she felt better and could sleep without pain.She confessed that consumption of Cannabis never made her lost of consciousness.Eventually, she died not long after her husband was arrested and trialed. 1,2rrent Indonesian regulation on Cannabis can be found in the Law No. 35/2009.All genus of Cannabis and all part of the plant, including the resin, tetrahydrocannabinol (THC), all its isomer, all its chemical stereoforms, delta-9 THC, and cannabidiol (CBD) are classified as narcotic group I. 3 The aim of this study was to examine whether there was a need to formulate a specific regulation on the use of cannabis for medical purpose.

Methods
This is an explanatory research using qualitative approach.Data source was national and international regulation on narcotics and scientific evidence regarding medical benefit of cannabis.The data was obtained from literature search with following keywords; regulation of Cannabis, medical use of Cannabis, Cannabis medicine.

Legal aspect
Indonesian regulation on narcotics is associated with International Convention on Narcotics/1961.Indonesia was one of the 73 countries that become first member of the convention.Indonesian law regarding narcotics shall comply the international convention.Currently, legal statement regarding narcotics is provided in Law No. 35

Medical aspect
Cannabinoids isolated from Cannabis plant has been extensively studied in medical research.The most frequent used cannabinoids are THC and CBD.Previous clinical trials suggested potential benefits of cannabinoids for alzheimer, dementia, Huntington disease, and other nervous system disorders. 4,5Other studies revealed that cannabinoids could reduce tumor growth in animal model of cancer by modulating signalling pathway in cell proliferation. 6Cannabinoids can also be used for palliative care, particularly in chemotherapy-induced nausea and vomiting due to its anti-emetic effect. 7In addition, CBD also exhibited anti-convulsant activity that can be used for epilepsy treatment.][9][10][11] Previous study also showed that cannabinoids exhibited modest effect in multiple sclerosis patients, particularly to treat spasticity.Australia enacted the law in 2016, while Germany did in 2017.[15][16][17][18][19][20][21][22] Our finding showed that there were enough evidence-based data that proved Cannabis can be used for medical purpose.There were also several on-going clinical trials related to the use of cannabis in medical therapy.
For that reason, the regulations of medical cannabis should be considered.Document No. LB.02.01/III.03/885/2015permitted a research using Cannabis in Indonesia.However, this study has never been performed.Many scientific researches can be perfomed with respect to the medical use of Cannabis in Indonesia.Pharmacoeconomic evaluation of the use of medicinal cannabis can also be performed to support the evidence on the clinical and economic benefit on the use of this product.It is worthwile to have a specific regulation on medical Cannabis, that would allow at least the registration of CBD and THC, which are benfeficial to improve for patient care.

Conclusion
It is worth to consider a specific regulation for cannabis to be used for medical purpose, given its beneficial application.
/2009, which state that all genus of Cannabis and all part of the plants, including Cannabiss as potential drug candidate for type 2 diabetes mellitus.This document stated that this research should be performed by a team, involving researchers from that institute and Ministy of Health.Nevertheless, the research team from Ministry of Health still yet to be appointed, resulting in the delay of the research on medical application of Cannabis in Indonesia.