A measure at the House of Representatives, consolidated from 10 bills, was approved in principle by the committees on dangerous drugs and on health on Feb. 7. As of Feb. 28, 10 of the 16 members of the expanded Senate panel on health and demography have signed their committee report endorsing approval of its own version of the bill.

The bills will be submitted to their respective plenaries for second reading, the farthest that similar measures seeking to legalize medical cannabis have gone through the legislative mill alongside each other in the two chambers. 

The advocates say the PMA, the biggest organization of doctors in the country, is also “fear-mongering,” or trying to scare Filipinos into rejecting medical cannabis with allegedly baseless claims of a “clear trend” supposedly showing its harmful effects outweighing the benefits in countries that had legalized marijuana.

The PMA has acknowledged the medical value of cannabis but it suggests that it would be better for Filipinos, especially the youth, to steer clear of the drug and for authorities to keep it out of reach.

It believes that the legalization of medical cannabis will eventually lead to legalizing and decriminalizing the recreational use of marijuana. But both the House and the Senate bills restrict cannabis use to medical purposes only.

“Legalization of cannabis will send a wrong message, especially to our youth, that our government considers cannabis as a safe substance, and therefore expose our citizens to unnecessary harm,” the PMA said. It cited, among other effects, adverse brain development in fetuses and infants of mothers who use cannabis.

“To stand against the legalization of cannabis is to stand for a safer, brighter future for all Filipino children,” it said.

One prominent opponent of medical cannabis, public health expert Dr. Anthony Leachon, said in an interview on the “Dos por Dos” radio program: “Once it is approved, it will open the gateway to recreational marijuana, and God bless us on how we can control it once it comes out.”

Confusing the public

But according to Haraya Policy Center, a nonprofit that promotes access to plant-based medicine, the PMA does not make clear distinctions between the medical and the nonmedical use of cannabis, and this confuses the public.

“Its sweeping generalizations stand on inaccurate information and unscientific assumptions that both misinform and disinform the public,” Haraya said in a statement issued on Feb. 20.

“Using the prospect of decriminalization and recreational use as arguments against medical cannabis is irresponsible of a medical association that is supposed to promote medical science and scientific thinking and genuinely serve the interests of patients without catering to vested interests,” it said.

The PMA argues that it is not necessary to pass a new law specifically to legalize medical cannabis as the Dangerous Drugs Act already permits the importation of certain medicines like cannabis for “compassionate use.”

But Dr. Donnabel Trias-Cunanan, a dentist who heads Cannahopefuls Inc., another group that campaigns for legalized medical cannabis, said the application for compassionate use is so tedious that only one person has attempted it. She said that person eventually gave up due to the protracted process and the very high price of imported cannabis medicine, which is estimated at P1.5 million a year for just one patient.

This complicated process to obtain cannabis medicine makes it “practically impossible” to secure a compassionate special permit, according to Haraya.

For about a decade now, Trias-Cunanan and her group have been pushing for the legalization of medical cannabis to treat people suffering from epileptic seizures. Her 12-year-old daughter has been afflicted with epilepsy—which she calls “kisay” (convulsion)—since she was a baby.

P58K per 60-ml bottle

One popular cannabis oil used to treat epileptic seizures and approved by the US Food and Drug Administration (FDA) is sold for $1,042 (P58,000)per 60-ml bottle.

“We are passionately advocating for an open door to other brands. Eventually we will be able to produce them in the Philippines so that it would be available to many who are poor,” Trias-Cunanan told CoverStory.ph.

The pending bills permit importation and alternatives to imports, plus more options of cannabis medicines from those approved by the US FDA, the reference agency for the Philippine FDA.

“Millions of patients worldwide benefit from cannabis as a treatment for a variety of medical conditions and even for wellness purposes without reporting notable adverse consequences to their health,” Haraya said, adding that no one has died from cannabis overdose.

It acknowledged “isolated cases” of ill-effects, but said these typically resulted from mixing cannabis with alcohol or other toxic substances. “Those isolated cases must not be used to defeat the intent of the bills to provide patients access to safe medical cannabis,” it added.

Dr. Gem Marq Mutia, president of the Philippine Society of Cannabinoid Medicine, said the PMA is “exaggerating the harms—more of fear-mongering—but downplaying the benefits” of medical marijuana.

There is no evidence to back claims that legalization of recreational use has led to the youth’s increased access to marijuana, he said. “How much more when it is for medical legalization?”

Claims by opponents of the proposed law that legalizing marijuana will lead to a rise in the number of motor vehicle accidents and in the incidence of psychosis and schizophrenia are unsubstantiated, he added.

‘First, do no harm’

Mutia said the PMA is playing the “old tune” of “First, do no harm” to justify its opposition to the alleged dangers of medical cannabis.

“These cannot speak to the harm caused by tobacco and alcohol,” he said, citing in particular the growth restriction and deformities in fetuses caused by alcohol consumption. “They even have a name for it—fetal alcohol syndrome. That is how well-known and debilitating alcohol is, and it is perfectly legal and even advertised on TV,” he said. “They do not see the harm in the prohibition [of cannabis].”

Haraya president Chuck Manansala said that while the PMA invokes the physician’s motto, it prohibits access to an important medicine.

“What ‘First, do no harm’ are they talking about? If you deprive your patient of a potential life-saver, are you not doing harm, only because you cannot get over your prohibitionist mentality?” Manansala said.

The PMA and proponents of medical cannabis share some points of agreement—recognition of the medicinal value of cannabis, strict regulations required for its use, no diversion for nonmedical use, and the need for local research into the drug.

Despite these, Manansala is not optimistic about winning over the PMA to support the bills that would legalize and ensure safe access to medical cannabis. “I don’t know how we can do that because we tried,” he said. 

Manansala recalled that when he and other proponents invited the PMA to discuss a bill filed by Rep. Rodito Albano in 2014, they received a dressing down and a “sermon,” and their credentials were questioned by the doctors.

“They blasted every single clause of the bill,” he said. “Immediately after, they held a press conference where they ripped the bill like the Katipunan [ripped the cedulas]. They already condemned medical cannabis.”

Manansala said they received a better response from the Catholic Church, which they initially expected would be harsher toward them. “The Church leaders did not condemn us, and explained that the doctrine of the Catholic Church is that dangerous drugs like marijuana are acceptable at the end stage [of an illness] for the alleviation of suffering,” he said. “At least it was not outright condemnation. There is room for agreement, unlike the PMA.”

Hopeful 

Mutia, an internist, said that despite resistance from the PMA, there is “more openness” among ordinary physicians toward medical cannabis. He is hopeful of the bills’ passage in Congress because, he said, many lawmakers are convinced that it is legal and safe to use.

“Fortunately, it is not up to [the PMA]. We are more concerned with the [Department of Health],” he said. 

Mutia said it is also fortunate that for the first time, the health secretary has officially recognized cannabis as medicine. “And most importantly, [he is] the first secretary to see the weakness of the importation route,” Mutia added.

Health Secretary Ted Herbosa said last year at his confirmation hearing at the Commission on Appointments that he supported and would push for legalizing medical cannabis.

Read more: Proponents urge ‘a little compassion’ in legalizing medical cannabis

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After years of trying up to 11 different medicines to quell Joy’s seizures, Gay was led to cannabis oil. She now swears by the efficacy of the oil that is derived from hemp or marijuana plant.

Gay keeps videos of her daughter’s epileptic seizures in her phone.

In one particularly harsh attack, the 9-year-old moans in pain and lets out a shriek while her skinny arms shiver as if a sudden cold wind has blown past. Her toes curl up and her hands turn into awkward fists, knuckles white, as she strains. When her thumb happens to get caught between her middle and ring fingers, it is squeezed until it turns bright red from the blood that is trapped there.

In other videos, no cries escape Joy’s gaping mouth, only gasps, snorts, or gargling sounds. Her eyes are wide open; her eyelids and sometimes her cheeks quiver.

On occasion, the child grits her teeth so hard that her mother wraps her hands with a piece of cloth so she won’t hurt herself when she accidentally bites into them. The uncontrollable convulsion takes over her body for several seconds. In that period, only the cushion of a couch or bed or her mother’s embrace protects her from things around that could hurt her.

Sometimes, after the seizure ceases, Joy’s head drops and slams hard into anything nearby. Gay says that when she is cradling her and this happens, the head drop feels like a sudden hard punch to her chest.

‘Scary’

“It’s scary,” Gay says.

But the “scariest of all” is when Joy holds her breath and Gay doesn’t know if she will ever exhale and inhale again. As a precaution, she keeps an oxygen bottle ready and connects a tube to Joy’s nose when an epileptic attack occurs.

After one attack subsides, Gay, like a soldier, prepares for the next which will come like an ambush. The seizures are unpredictable: “They will just suddenly attack her,” the mother says. “There is really no trigger.” 

But Joy doesn’t go “back to normal” after each seizure. She cannot, according to Gay, because of her illness—first declared as an infantile spasm that occurred every 30 seconds starting when she was just two weeks old.  

After more tests, the doctors found that Joy has mild spastic quadriparesis and Lennox-Gastaut syndrome (LGS), which was caused by focal cortical dysplasia resulting from the improper formation of the top layer of the brain. 

Gay says more tests are being conducted to finally determine if her child is indeed suffering from LGS or from Dravet syndrome, a genetic disorder.

With 20-50 epileptic attacks every hour before she turned 2 years old, Joy could only breastfeed for a month.

She would have been in the third or fourth grade by now, but she is nonfunctional because the attacks debilitated her early in life and compromised her nutrition. She is moved around on a wheelchair by her mother, who is by her side 24/7. She doesn’t speak but recognizes people around her and has a happy disposition when not battling a seizure.

She cannot eat on her own and has to be fed with semi-solid food and milk. “Most of the day she just rests and sleeps,” Gay tells CoverStory.ph.

“Gay” and “Joy” are not the true names of the mother and child and are being used in this report for their privacy and security.

‘Trial and error’ meds

Gay says that before she discovered cannabis oil, Joy used to take a cocktail of four to five different medicines daily to manage the illness. 

Not one had any long-lasting effects. “They were trial and error,” she says.

One of them, Valium, just puts the child into a stupor and turns her seizures into “slow motion” shaking. “She is just stoned whenever we visit her doctor,” Gay says.

A single mom who relies on part-time jobs and the generosity of friends, Gay saw the expenses for Joy’s medication growing over time. Monthly she is spending more than P10,000 for the prescription medicines in addition to over P16,000 for milk.

She learned about cannabis oil from a friend of her elder sister before Joy turned two.

She started giving Joy cannabis oil when the seizures were intensifying. She saw the number of attacks steadily decreasing to just three to five a day with two oral drops of cannabis oil twice daily. 

Joy can now sit up on her own but still cannot stand up, she says.

Gay declines to say how much she pays for a bottle of cannabis oil or how she gets it.

In a way she is still finding the right dosage, hoping to get the correct one “so that [Joy] will become functional” and walk on her own.

At the height of the Duterte administration’s war on drugs, Gay was frightened of being caught with the cannabis oil, which is still considered an illegal drug in the Philippines. 

“If I get caught, who will take care of my daughter? Life is unfair,” she says. “You know, as a parent, you will do everything so that your child will live a normal life. Just staring and doing nothing would be like killing your own child.” 

Decade-long push

Dr. Donnabel Trias-Cunanan, a longtime advocate of cannabis use as medicine, is hopeful that such worries will soon be over with the approval last week by the House of Representatives’ committees on health and on dangerous drugs of a consolidated bill to legalize medical cannabis.

“We are very happy. We were pushing this for a decade,” says Cunanan, a dentist who heads Cannahopefuls Inc., which launched its campaign to legalize medical cannabis in 2013.

Her personal advocacy was for her 12-year-old daughter, Julia, who has been suffering from epileptic seizures since she was a baby. Julia experienced 60-80 epileptic attacks daily until she was 5 years old.

“There was a point in time when we were already living in the hospital as she was bed-ridden,” Cunanan says.

It was the reason she became a passionate advocate for medical marijuana. “I wanted to really come to a point where she no longer has any seizures and then eventually has an improved quality of life.”

She says that if the seizures continue, mental retardation and global developmental delay will afflict Julia.

Dr. Gem Mutia, president of the Philippine Society of Cannabinoid Medicine, a group of more than 500 doctors with various specializations, is likewise hopeful that Congress will eventually pass the bill.

A similar bill in the Senate is pending in committee.

Mutia says the House bill, the consolidated version of 10 proposals, will ease the entry into the country of pharmaceutical cannabis approved by the Food and Drug Administration and allow the production of generic cannabis medicines in the Philippines.

Point of contention

The point of contention between opponents and supporters of medical cannabis is the use of the two potent elements from the cannabis plant—cannabidiol (CBD) and tetrahydrocannabinol (THC).

It is THC that gives a person a high when smoking marijuana; it has addictive properties. But CBD has no such effects on the body and is the main compound in the cannabis oil used for symptomatic treatment of epilepsy and other diseases.

“It is no longer a debate that cannabis can be a treatment,” says Mutia, an internist.

He laments the position of the Philippine Medical Association of continuing to support the criminalization of cannabis even as it recognizes its medicinal uses.

In 2016, the United Nations affirmed that drug use is an illness. But Mutia believes that such cases should be handled by healthcare professionals, “not the criminal justice system, not the judicial system, or the extrajudicial system.”

“There is no clinical practice guideline whatsoever in the treatment of drug addiction that includes criminalization, and more so the guideline does not include tokhang,” says Mutia, using the term used for the extrajudicial killing of drug pushers and users at the height of the war on drugs.

“There were so many things that were done in the name of [Republic Act No.] 9165 (or the Comprehensive Dangerous Drugs Act), and we don’t want any part of that so we don’t support criminalization,” he says.

Mutia says he became an advocate of medical cannabis after his late sister was afflicted with stomach cancer and drastically lost weight due to loss of appetite, which was reversed by CBD oil.

He says the House bill provides “arguably” the “most comprehensive cannabis program in the world.”

“Even if we were not the first to do it in Southeast Asia, we might be the first to do it correctly,” he says, citing the good and bad lessons from other countries who have legalized cannabis use.

He urges opponents of medical cannabis to “just sprinkle a little compassion” and not support its criminalization and prohibition.

“Although marijuana cannot solve all the problems in the Philippines, definitely this [bill] is a step in the right direction. This is a big deal to many patients. This can be everything for thousands of patients, and the right step towards justice and health care,” he says.

‘It works’

Camarines Sur Rep. Luis Raymond Villafuerte, the House majority leader and author of one of the 10 medical cannabis bills, says he has personally used CBD oil in the United States to treat his “terrible migraine.”

“It works,” he says. “I have talked to a lot of people, relatives, friends that at first were wary, cautious, and against, but after they tried it, eventually they supported it.”

He says people especially with epilepsy will benefit from medical cannabis as it will become more accessible.

Per Villafuerte, the consolidated bill calls for the creation of a Medical Cannabis Office (MCO) under the Department of Health to regulate the medical use of cannabis.

MCO will, among other functions, accredit government and private entities planning to establish laboratories and cultivate cannabis or hemp, importers or manufacturers of cannabis medicines, and physicians who can prescribe them to qualified patients with debilitating or non-debilitating diseases.

Villafuerte sees the Philippines as a major producer of cannabis medicines which can be a government revenue generator.

“The Philippines can be a major source to cultivate and manufacture it in the near future, in three to five years. Why? We have a very good climate,” he says.

Gay is thankful that the bill is making progress.

“I pray that the legal use of medical cannabis will eventually be passed for the sake of patients like my daughter,” she says. “Even if you prepare yourself for anything that might happen … it still hurts inside that I cannot give the right legal medicine to my child.”

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