Asst. dr. Tanja Bagar: We need to talk about cannabis without the current stigma, only then can we expect a fruitful discussion that will be the basis for proper regulation.

Viva and I.canna.blog

In the summer issues we are in Vivi and on the portal viva.si opened up the issue of the use of cannabis for medical purposes. The editorial board received numerous questions from readers who wanted to know more. Therefore, we decided to dedicate an article to this truly broad area in each issue, in cooperation with the International Cannabinoid Institute ICANNA and together with various experts who will prepare contributions, each from their own field, to I.canna.blog on the ICANNA website. To begin, we are publishing an interview with the director of the institute, Assoc. Prof. Dr. Tanja Bagar.

You are a microbiologist and a doctor of biomedical sciences. You received your doctorate from the Faculty of Medicine in evidence-based science. What convinced you to start working professionally in this field, since the field of cannabinoids is still very much in its infancy?
I have always been fascinated by the functioning of our bodies, especially cells. The communication pathways between them are particularly remarkable, as they tirelessly transmit signals throughout the body. During my studies, we learned about intercellular communication in several subjects, so I was all the more surprised when, several years after my doctorate, I came across an article about the endocannabinoid system (ECS), which is common to all vertebrates, including humans, and about which I knew nothing. I was fascinated by the insights into its functioning and role in our bodies, as well as the research potential of this field.

We are talking about a field in which there is great confusion, not only scientifically, but also legally, materially, politically, and all of it driven by prejudice. Why?
I agree, it's a real mess. There is more and more information, as well as more misinformation and nonsense. Just look at our legislation on cannabis - the ministry's regulations allow something, the government decree prohibits it, and the Single Convention on Narcotic Drugs, adopted by the United Nations General Assembly, is ignored.

This situation benefits no one.
I want you to think about its multifaceted usefulness and potential when you hear the word hemp. We have even stigmatized industrial hemp, once a completely common crop that was in every house in Prekmurje. The severity of the stigmatization by the general public and experts is slowly decreasing, as awareness and education are accelerating this process. However, it seems that we are going from one extreme (prohibition) to another (appropriation by the authorities) in the legal system, with both sides referring to protecting the interests of the people.

Was this the reason why you founded the international ICANNA Institute this year with a group of different experts from different countries?
In addition to studying professional literature, I began attending numerous congresses on this topic, initially as a listener, then as a lecturer. I was also approached by parents of sick children who, due to the (impossibility) of treatment in Slovenia, were left to their own devices and, in extremely difficult situations, sought treatment abroad, investing a lot of energy, time, money and hope in it. These stories touched me very much. I helped them as best I could; among other things, the parents and I were interested in the possibilities of legally producing a CBD food supplement that would be controlled from seed to the final product. The stoic response was eloquent enough for us to abandon this intention, and confirmed the need for a more comprehensive approach to this issue. Such an approach is enabled by the form of a research and educational institute, in which foreign and domestic experts from various fields work and is a relevant player in this story.

One of the main goals of the ICANNA Institute is the regulation of this area, as you wrote, regulation tailored to the human being? What does that mean?
The current confusion and regulation are certainly not human-friendly. To illustrate: industrial hemp, which is exempt from the aforementioned Single Convention on Narcotic Drugs, is permitted for food purposes in accordance with the regulations. However, the natural non-psychoactive food supplement CBD, made from industrial hemp, is officially permitted only conditionally. To my knowledge, no one has yet managed to obtain a decision from the Public Agency of the Republic of Slovenia for Medicines and Medical Devices for this food supplement. On the other hand, with a few clicks on the internet, we can find a huge range of CBD supplements, but they are unverified. The story regarding THC is also clear. Due to its psychoactivity or "hatefulness", cannabis is placed in Group 1, i.e. in the company of the hardest drugs. Then, only isolated or synthetic THC was placed in Group 2, which allows its use in healthcare. Not only does synthetic THC have a lower therapeutic potential than the natural active ingredient, but serious questions about its (un)safety are also raised. In contrast, the CBD present in the plant acts as an antagonist to THC and reduces its psychoactivity, and in addition, they enhance each other's medicinal or beneficial effects. The latest change, which placed the extract in Group 2, is not enough. Decriminalization of cannabis and appropriate regulation are needed.

How will you achieve this?
We must first start talking about cannabis without the current stigma, only then can we expect a fruitful discussion that will be the basis for appropriate regulation. At this moment, it is necessary to point out the incomprehensibility in a well-founded and repeated manner. By highlighting the essential emphases and results of various projects that are still ongoing, we want to overcome prejudices and encourage the competent state institutions to take action sooner rather than later. For political parties, which are increasingly aware of the need for a systemic approach and modernizing legislation, this area still remains a field for scoring political points. So some are preparing one solution, others another, but basically nothing is moving.

However, attitudes towards cannabis are changing. Doctors are the most reluctant. Why do you think this is the case?
Doctors have their own doctrine and act in accordance with it. Since cannabinoids are not included in it, their reluctance is understandable. However, they are increasingly familiar with the possibilities of treatment with them and I hope that they will not just wait passively, but will also highlight the necessity of changes in this area. Not least because of their mission. For now, there are only a few who can openly and at least fundamentally knowledgeable about cannabis and the meaning of its use in individual cases with their patients. More and more doctors are also turning to us and we are happy to cooperate with them. Patients benefit the most from this. However, we are saddened by the stories of patients about how they encountered great misunderstanding or rejection from doctors. Many patients do not even dare to tell their doctors that they use cannabis. A systemic approach is necessary for a more noticeable shift, so we are back to state jurisdiction, and for future generations of doctors, also considering including such content in study programs.

Hello conducted one of the few surveys among Slovenian doctors on their attitudes towards cannabis. The vast majority, almost 85 percent, of those surveyed admitted that they knew too little and that they wanted more information to be able to talk to their patients about this topic. Your Institute and you personally already lecture doctors in this field. What interests them most?
The recognition by the vast majority that they know too little is not surprising, but it is positive that they want more information and education. It is high time for this to happen. Patients are interested in concrete matters and therefore doctors are most interested in preparations, dosage, (contra)indications, practices from abroad and the like. We cooperate with colleagues from the institute in various forms of knowledge transfer, but formality is not essential, i.e. that the education is simply carried out, but the key is content and, of course, practice.

I.canna.blog is one of the first activities that the ICANNA Institute is undertaking together with Vivo, because we are united by a common goal, overcoming prejudices towards a prudent and constructive discussion for the benefit of people...
Where there are good intentions and will, there is also a way, which is why we quickly found common ground with Vivo. I.canna.blog will be co-created by insightful domestic and foreign experts and will shed light on cannabis issues from various fields. That is why Vivo and I are even more committed to adding a qualitative contribution together with this project. The blog will be published on the same day as Viva is published every month. Together, we will break down taboos step by step in the direction of destigmatization and breaking down prejudices about cannabis. Therefore, I kindly invite readers to read the Institute's website every first Friday of the month. ICANN and magazines Hello.

TOTALLY SIMPLE!

What are cannabinoids? These are compounds that bind to cannabinoid receptors. They are basically divided into three groups based on their origin:

• endocannabinoids: they are produced by every human being and are part of our endocannabinoid system,
• phytocannabinoids: found in some plants, especially cannabis,
• Synthetic cannabinoids: created in laboratories through chemical reactions.

What is CBD? This is one of more than 140 cannabinoids in cannabis that is not psychoactive or intoxicating. It acts on CB2 receptors, especially on the peripheral nervous system and immune system cells. In recent years, it has been the most intensively studied cannabinoid, as it shows extraordinary potential in various diseases, such as epilepsy, cancer, diabetes, Alzheimer's disease, ...

What is THC? This is the psychoactive cannabinoid in cannabis. It binds to CB1 receptors, which are present mainly in the central nervous system. Many CB1 receptors are found in certain brain centers (memory, coordination, pain, etc.). Activation of these receptors causes intoxication (high), which is the main reason for the ban on cannabis. There has long been interest in its use for medical purposes, with the natural form being preferred over the synthetic form due to its greater effectiveness (synergy) and safety.

Text: Assoc. dr. Tanja Bagar