In-depth | Health

The Long Road Towards Legalization

By - 09.12.2019

How long until medical cannabis is legalized in the Balkans

Marko is 37 years old. He has multiple sclerosis (MS), an autoimmune disease that affects the central nervous system. Contemporary medicine remains in the dark when it comes to its exact cause and a complete cure is still unknown.

Diagnosed with MS seven years ago, he began using cannabis oil four years ago.

“I researched ways that I would be able to relieve my chronic condition all by myself when I realized that the medicines I had, were not in line with what I had been prescribed,” Marko tells K2.0, harking back to the difficulties he faced while getting treatment in one of Serbia’s state hospitals.

His prescription medicine could not be obtained in Serbia at the time. He was offered a replacement medication, but he was soon put off by the side effects of this drug — fever, fatigue and muscle pain — he decided to seek an alternative.

Marko was one of the few “lucky ones” who managed to get treatment anyway. MS Platform Serbia, an association bringing together people with MS, their families and medical professionals, points out that only 12 percent of  people with the condition in Serbia receive treatment. The rest are placed on a waiting list, where they may spend 10 to 15 years. Some of them are never provided with medication.

“When I made up my mind about changing treatments, I had to wrangle over it with my doctor,” he recalls. “It was coming off as if they wanted to give me a treatment that I kept refusing.”

He says that his doctor initially objected to Marko’s decision not to take interferon drugs (immunomodulatory drugs used to treat a wide spectrum of diseases — in Serbia, only first- and second-generation interferons are available).

“Seeing how my condition improved using CBD, my doctor supported me,” Marko says. “My disease could not be alleviated by THC, the psychoactive substance found in the cannabis plant,” Marko says.

“It helps me a lot with cramps, it reduces weariness, and it makes it easier for me in general,” he claims, noting that his friend from abroad used to buy him the oil at first. It costs him approximately 250 to 300 euros per month to buy CBD.

As is the case with a large number of people diagnosed with multiple sclerosis in the region, Marko is forced to make his own supply of oil that greatly helps him cope with this disease. Photo: K2.0.

“My only source of income is a disability pension, amounting to just over 100 euros a month,” he says. Marko lives with his parents and reveals that at first he was not in a position to afford the monthly amount of CBD oil he needed.

“Then I gradually did some more research, so I learned how to make it on my own. Now I spend about 100 euros every month, but coming up with this whole idea and reaching financial sustainability was no walk in the park,” Marko says.

Medical rather than recreational use

According to data obtained from different associations and hospital registers, there are roughly 9000 people with MS in Serbia, around 3000 in Bosnia and Herzegovina, while North Macedonia has 995 such cases as of May 2005. In Croatia, where no national MS records office has been set up, there are no precise figures of the number of people diagnosed with this autoimmune disease.

In each of the aforementioned countries, no cannabis-based medication is legally available. However, legalization activists from all around the region have been raising their voices.

The use of cannabis for medical purposes is currently legal in 21 countries, one of the recent additions being North Macedonia.

Marko is able to acquire the plant he uses to produce his own CBD oil more easily because CBD can be extracted from industrial hemp plants legally grown both across the region and in many other countries.

In January of this year, the World Health Organization (WHO) director wrote an open letter to the Secretary-General of the United Nations, where he advised that cannabis be taken off the narcotics list. In line with The Single Convention on Narcotic Drugs, cannabis and cannabis-related substances were classified as narcotics in 1961, when they were labelled as “harmful substances with limited medical benefits”. 

WHO representatives hold that such a classification “severely limits access to this plant and the scope of research pertaining to its potential therapeutic uses.”

The WHO director’s recommendation was reviewed at the UN Commission on Narcotic Drugs session held in March 2019, but the General Assembly vote on this proposal was postponed. Their conclusion was that it was too early to vote on this matter: Member states need more time to consider the recommendation before it is put to a vote.

The use of cannabis for medical purposes is currently legal in 21 countries, one of the most recent additions being North Macedonia, as well as in 33 U.S. states. In some countries of the EU — including France and Estonia, where medical use of cannabis is still prohibited — certain cannabis-based medications are available for purchase with a special medical prescription.

Meanwhile, some North Macedonian shops now offer the “Relax+Cannabis” water produced by the Gorska Voda non-alcoholic beverage company. The drink costs just under 1 euro. As reported by TV Nova. 

The packaging says that the product contains a “multifruit cannabis seed extract.” There is no explanation as to whether it contains CBD and THC, and if so, in what amount nor whether there are any trace amounts of these substances. 

Gorska Voda has not responded to K2.0’s questions regarding the composition of this “multifruit cannabis extract,” having also failed to provide information on whether the beverage is registered as a dietary supplement or as plain bottled water.

The “Koding — Gorska Voda DOOEL” company director is Goran Todorov, who also serves as the president of the local Social Democratic Union (SDSM) board in the town of Kavadarci (the party leader is Zoran Zaev). 

Last year, the company was granted 296,000 euros by the Innovation Fund for the purposes of “creating a new packaging, design, and label for the aloe vera and acerola cherry water,” hence the pro-opposition media outlets’ multiple 2018 stories on SDSM officials receiving money from the Innovation Fund.

Cannabis superpower in the Balkans

Back in 2016, North Macedonia became the region’s first country to legalize the use of cannabis for medical purposes. According to the current amendments to the Law on the Control of Narcotics and Psychotropic Substances, producers are required to have permits from the Ministry of Health.

 A visit from Mike Straumietis this past summer brought this issue to public attention. A multimillionaire who has made a fortune in the cannabis trade. More specifically, he is the owner of Advanced Nutrients — one of the world’s largest companies manufacturing cannabis supplements — which is how he got his nickname “American Don”.

Straumietis posted a photograph on his Instagram profile showing him with North Macedonian prime minister Zoran Zaev. In the caption he wrote that “this country [North Macedonia] has huge potential [to become one of the] Cannabis Superpowers.” 

The Government of North Macedonia had not announced the visit beforehand, subsequently explaining that they are not obliged to inform the public about all meetings every day.

Progress has been made in Croatia as well, where even industrial hemp cultivation is forbidden by law (unlike in Serbia, whose authorities are set to de-liberalize cannabis growth for industrial purposes). However, amendments to the Law on Combating Drug Abuse came into force in May, enabling Croatian pharmaceutical manufacturers to grow this plant with permission from the Croatian Agency for Drugs and Medical Products (HALMED).

According to their officials, HALMED should be issuing manufacturing authorizations pursuant to Health Ministry’s rules of procedure. But those have yet to be passed.

HALMED has also confirmed that no permit for medical cannabis production has been issued in Croatia to date.

Meanwhile in Serbia — where industrial cannabis farming has been legal for years — the attitude towards this plant is shifting in the opposite direction. This July, the one-year-old Commission for Psychoactive Controlled Substances reached a conclusion based on an analysis by the Chemistry Faculty professor Milovan Ivanović — who claims that CBD is a psychoactive substance. It is a move that may jeopardize the production of hemp for industrial purposes.

The Commission concluded that “ the chemical substance CBD cannot be manufactured, purchased, sold, or imported/exported on the territory of Serbia,” adding that “hemp (Cannabis sativa) cultivation, import or export aimed at either domestic or international production of CBD should be banned”.

Vigorous campaign for legalization in Bosnia and Herzegovina

In contrast, WHO insists that CBD and products containing less than 0.2 percent THC content (the psychoactive constituent of cannabis) do not fall under the psychoactive substances category.

“We support legalization because CBD oil should not be cooked in pots,” members of the Konoplja charity (HUK) point out. The association gathers together cannabis producers who advocate legalization.

"We back legalisation for medical purposes only; in other words, we rally for making cannabis available for purchase with medical prescriptions."

Omer Isović, president of the "Zmajevo srce" association

HUK says that they press for the legalization of medical cannabis rather than for full legalization, as is the case in countries such as the Netherlands, the Czech Republic and Uruguay.

“The Commission’s conclusion will hamper even industrial production,” HUK representatives explain, the official position of their organization being that the hemp plant is “a building material, textile and a cure”.

Similar views have been expressed by activists engaged within Zmajevo Srce, an association based in Tuzla.

“We back legalization for medical purposes only; in other words, we rally for making it [cannabis] available for purchase with medical prescriptions. In no way do we want it to be legal to smoke pot in cafes,” says Omer Isović, the president of this association.

In July, Zmajevo Srce initiated for a group of associations that represent people with different diseases, from all over the country, to send an open letter to the government of the Federation [of Bosnia and Herzegovina] and the Council of Ministers of Bosnia and Herzegovina. In this letter, they call for a discussion on the legalization of medical cannabis.

“We seem to have hit rock bottom in football and basketball, but does it need to be the same when it comes to medical treatment?” these people ask the authorities.

In early September, Saša Magazinović — a Social Democratic Party MP in the House of Representatives of the Parliamentary Assembly of Bosnia and Herzegovina — announced the launch of the initiative for medical cannabis legalization. On October 24, a rally titled “Better illegally alive, than legally dead” was held in Sarajevo, while Magazinović met Republika Srpska health and social welfare minister Alen Šeranić a few days later.

“We have agreed to work on finding the most efficient and legally unquestionable model, bearing in mind that citizens diagnosed with severe illnesses do not care how we bring about the legalization of these medications,” writes Magazinović in a Facebook post he made after the meeting, noting that “too much time has elapsed as these peoples’ conditions have been irreversibly deteriorating, some of them being forced to become criminals in order to improve it.”

“Magazinović reached out to us after the open letter. He advocates our cause as an individual who is in a position to speak up on a federal level,” Isović explains, adding that his association has talked to members of several political parties — he does not disclose any names — all of them having promised to offer their support for the initiative, at least for now.

“Our plan is to work our way up from lower government levels, eventually reaching national legislation,” Isović says about their approach. “I am sure that we could accomplish this goal very soon — in the next six months — because there is already a draft amendment to the Law on the Prevention and Suppression of Narcotic Drug Abuse.” Magazinović said.

Nedim — a person with psoriatic arthritis from Bosnia and Herzegovina — reveals that he needs 400 to 600 euros for his monthly supply of cannabidiol oil that he gets on the black market.

The amendment was drafted by the Interdepartmental Committee on Combating Narcotic Drugs earlier this year. K2.0 wanted to find out why this draft has not been sent for discussion to the Council of Ministers (after which the Parliamentary Assembly should vote on the document) and whether there would be any further amendments, but the Committee has failed to provide answers to these inquiries.

“I am outraged by the fact that a large number of people in our country cannot get medical treatment, and we do not even have the exact figures on how many such people there are,” Isović says. “We know about these cases, we know about those who used cannabis and it helped them. Why not give the medicine to the people?” he asks himself.

Though Marko’s vial of CBD oil he uses to relieve the symptoms of MS costs him approximately 250 euros a month in Serbia, Nedim — a person with psoriatic arthritis from Bosnia and Herzegovina — reveals that he needs 400 to 600 euros for his monthly supply [of CBD oil] that he gets on the black market.

Apart from that, he explains that product quality is vastly different on the black market, adding that he does not have a reliable supplier.

“I do not want to be in this position where I have to break the law while getting bilked,” Nedim points out in the hope that cannabis will be legalized for medical purposes in due time. “I am a person who got wounded for this country three times, and now some minister does not let me receive treatment,” he says, referring to the fact that he was a soldier during the war in Bosnia and Herzegovina.

In their studies, WHO does not deny the negative effects of cannabis consumption, including the impairment of cognitive and motor functions in healthy people.

However, in terms of diseases such as asthma, glaucoma, multiple sclerosis, and other chronic diseases, WHO points to a finding that cannabis treatment yields positive results. It should be noted that global-scale research still needs to be carried out in this respect.

UN member states are not pressured by the only umbrella organization that is able to issue such a recommendation on an international level. As a result, medical cannabis remains outlawed in most countries. In the Balkan region, the penalty for possession of cannabis-based products available on the black market ranges from three to five years in prison. K

Feature image: K2.0.