São Paulo, Brazil – Due to an increase in medical cannabis prescriptions, Brazilian states have passed laws to regulate the distribution of cannabis by the public health system, a step the federal government has failed to take for eight years while national legislation is being debated in Congress.
Since 2015, Congress has been discussing a federal bill that allows the production and sale of cannabis-based medicines, but the proposal is stalled and still has no forecast of being voted on. Other similar proposals were presented in 2019 and 2023.
“Today, we don’t have a federal legislation on the subject that can unify judicial decisions in the national territory and this creates a lot of insecurity for those who need the medication,” lawyer Vanessa Louzada told Brazil Reports.
As a result, some states leapfrogged the federal government and created local laws to guarantee patients’ access to cannabis.
In São Paulo, for example, a law was passed in January of this year which creates a state policy to provide free medical cannabis.
The goal of the program is to diagnose and treat patients with cannabis-based medicines, in addition to promoting public policies to raise awareness about the use of cannabis, with lectures, training courses for managers and campaigns for the general knowledge of the population about medical cannabis.
Doctor and cannabis researcher Paula Dall’Stella said the law is a huge win for patients and “equalizes the rights of this population to receive the products without having to go through often obscure paths to get treatment.”
According to lawyer Thayan Fernando, it is important to see the largest state in terms of population, São Paulo, opening its doors to medical cannabis, which could be a decisive move in influencing the rest of Brazil.
“Often, the issue of cannabis comes up against public safety, due to the illegal use of marijuana. But the authorities need to understand that one issue has nothing to do with the other. We need to separate A from B. If cannabis is capable of improving people’s quality of life, we need to take advantage of it. The state of São Paulo understood that,” he said.
Other state laws
The southern state of Paraná approved a law in February that guarantees access to cannabis-based medicines in the public health network. In order to gain access, patients must fulfill some requirements, such as presenting a medical report, with the detailed diagnosis, the justification for using medical cannabis and the expected treatment timeframe.
According to the president of the Chamber of Paraná, state deputy Ademar Traiano, the easy access to medicines will benefit countless families, with patients who will be able to use cannabis “to have better living conditions.”
The state of Pernambuco, in Brazil’s northeast, passed a law in December 2022 that allows the cultivation and production of cannabis for medicinal purposes, which means that patients with a medical prescription will be able to ask for authorization to produce cannabis at home. The idea is to reduce spending on medical cannabis that currently needs to be imported.
This is because, in 2015, the National Health Surveillance Agency (Anvisa), a federal government agency, allowed for the import of medicines made from cannabis, but prices for these medications can range from R$ 500 (USD $100) to R$ 2,000 (USD $500) per month, which make them inaccessible to a large part of the Brazilian population, especially in cases of long-term treatments.
In 2016, Anvisa authorized the sale of imported products in Brazilian pharmacies. There are currently 25 medicines approved by the agency. Publicist Alex Miranda, 34, is one of the thousands of Brazilians who buy cannabis-based medicines at regular pharmacies.
Struggling to sleep since he was a teenager, Miranda sought an alternative treatment with cannabis oil after taking several traditional medicines over the years. With a doctor’s guidance, Miranda began using cannabis to fight insomnia in 2020, when his condition worsened due to the Covid-19 pandemic.
“I became more anxious because of the pandemic and this impacted the quality of sleep even more. That’s when my doctor suggested a cannabis-based medicine. At first, I had some doubts, but I ended up accepting it after reading a lot about the subject,” he told Brazil Reports.
Miranda’s health insurance denied him the treatment for free. He had to file a lawsuit, which has yet to be ruled on. For now, Miranda pays out of his own pocket, but says the investment is worth it, as he has been able to sleep better.
“I buy the medicine imported at a local pharmacy. It is expensive, around R$500 per month (USD $100), but my sleep has improved a lot. The result has been better than I expected at the beginning of the treatment,” he said.
Increase of medicinal cannabis in Brazil
Even with the high price, a survey by Portal Cannabis & Saúde showed a 342.3% growth in sales of cannabis-based products in pharmacies in Brazil since 2018. Medical prescriptions grew 487.8% last year. Among medical specialties, neurologists and psychiatrists are the ones who most recommend cannabis products.
But for those who don’t have the money to pay for the treatment, the way out is to go to court, where there are two possible solutions: either the patient asks the government or a health insurance provider to pay for the medicine or asks for an exceptional authorization to plant cannabis at home, without running the risk of being arrested on drug charges.
Currently, Brazil has at least 2,748 lawsuits in court in which patients seek authorization to grow cannabis at home, according to data from lawtech Deep Legal.
For Fernando, the lawyer, it is “unfortunate” to see that the health of Brazilians is limited to financial issues, forcing patients to go to court.
“As a lawyer, I see Brazilian patients in court queues fighting for the right to access medicines that could be freely offered by the public health system,” he said.