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Medical marijuana trend slow to take off in Finland

Patients seeking pain-relieving cannabis preparations have been frustrated by tight regulations, social stigma and widespread confusion.

Medical cannabis pills used in a pilot to treat cancer sufferers in Australia. Image: EPA/MICK TSIKAS

Cannabis - also known as marijuana - has long been tightly controlled and regulated by governments around the world, including in Finland. However, recent research in the pharmaceutical and medical sectors suggests that some strains are safe for medicinal purposes and for the treatment of a number of conditions.

In Finland the cannabinoid CBD, which is aidely thought to have therapeutic properties, is only currently available in one product - Sativex® oral spray - as a treatment for severe muscular spasms in multiple sclerosis patients. Further uses of CBD as a medicinal product are decided on a case-by-case basis by Finland's pharmaceutical regulator, the Finnish Medicines Agency (FIMEA), the body responsible for supervising and developing the pharmaceutical sector in Finland.

Even in cases where CBD may become available, the threshold for receiving a prescription is high. Prescriptions can only be provided by specialists in neurology or doctors working in a neurological clinic and only after patients have not responded adequately to other anti-spasticity medication and who demonstrate clinically significant improvement in spasticity related symptoms during an initial trial of therapy.

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Image of medicinal cannabis piloted in a clinical trial to treat cancer sufferers at Royal Prince Alfred Hospital in Sydney Image: Mick Tsikas / EPA

The main psychoactive ingredient in cannabis is tetrahydrocannabinol (also known as THC) but there are more than 100 other cannabinoids within the hemp plant, and there are many differences between them. Unlike THC, cannabidiol – also known as CBD or "cannabis light" – is constituent part of cannabis that has been approved by some medical regulators to treat conditions such as multiple sclerosis and epilepsy.

As CBD has become more widely accepted as a medical solution across the world attitudes towards cannabis have softened. Canada allowed medicinal marijuana before it took the step of also legalising recreational marijuana earlier this year. 

In Finland, however, cannabis still has a long way to go before its use becomes medically and socially acceptable.

Medical cannabis an 'immense taboo'

After living an active life involving sports and other outdoor pursuits, George Murray* suffers from a number of health issues including an arthritic knee and hip, and a ruptured disk that often causes back spasms. Now in his early 60s, inflammations, caused by anything from cold weather to the general effects of aging, can cause him a lot of pain.

Murray has been prescribed a number of different medicines in recent years, but has found them to be either ineffective in treating his pain or to have very disagreeable side-effects including extreme drowsiness or digestive irritation. When Murray learned that it might be possible to obtain a CBD-based product in Finland through a prescription, he was eager to try it in an attempt to alleviate his pain.

"I asked my doctor for medical marijuana and he nearly fell out of his chair. It was as if I had raised some kind of immense taboo. And he was a fairly young doctor, so my impression is that the topic is not well studied in medical school here."

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Cannabis has found its way into a range of products in countries that have decriminalised its use. Image: Eugene Garcia / EPA

On a recent trip home to the United States, where CBD products are more widely available, Murray tested a product recommended by a pharmacist and noticed an immediate effect.

"It really calmed down the overall inflammation and eased the pain. I would like to have access to low-THC, high-CBD products as they really seemed to help - at least in my case."

He argues that the current legislation in Finland which strictly limits access to CBD needs to be reviewed and that the benefits to consumers and to the government - in the form of increased tax revenue - are obvious.

"With legislation, consumers would have much better choices based on their own medical profile and needs. We would see better quality control and people could feel confident that the product is as it is described by the seller."

Action needed by Finnish regulator

Murray’s call for a review of the current legislation on hemp-based products in Finland is echoed by Tommi Saltiola, a representative of the Jyväskylä-based company Hamppumaa which develops and distributes products made from hemp.

Saltiola attributes the slow rate of progress in Finland to a lack of understanding and knowledge of the medicinal and health effects of CBD, even though there is an abundance of studies on the subject and hemp is “one of the most researched plants on the planet.” “The cannabinoid industry is in an exponential growth period”, explains Saltiola, “and loosening the regulations would allow for faster development without jeopardising the health of the people.”

Finland is one of very few countries within the EU where CBD is considered a tightly-regulated medicinal substance, and not a novel food substance as it is categorised elsewhere. This restricts the free movement of the product within the EU, and Saltiola argues that the responsibility of justifying this restriction should lie with FIMEA.

"According to EU agreements relating to the free movement of goods, the country that is prohibiting a product has to show that it is necessary and if needed also show that it results in serious risk to national health," explains Saltiola. "This would include pertinent evidence such as technical, scientific, statistical and nutritional information."

No such evidence has yet been released by FIMEA, says Saltiola, and instead the regulator has thus far "concluded that CBD is a medicinal substance because CBD is contained in some medical products."

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Flowers of a cannabis plant. Image: Jon Santa Cruz / AOP

Eeva Sofia Leinonen, a Senior Medical Officer with FIMEA, disputes this understanding of where the initiative lies. Instead she explains that every product containing CBD is analysed and then classified, and that current regulations in Finland are similar to those in many other countries in the EU.

"Medicinal products are only assessed for acceptability if a marketing authorisation has been applied for them. Meaning that the initiative for marketing a medicine in the EU or in Finland comes from the pharmaceutical company who has developed the medicine."

Leinonen further explains that products originating from the same substance may fall into different categories depending on the formulation as measured by such criteria as strength, administration, dosage, and intended use. Due to these many complex factors contributing to the classification of CBD products, Leinonen recognises that the subject is often still widely misunderstood.

"‘Medical cannabis’ is therefore a problematic term likely to cause confusion. FIMEA deals with medicinal products, one of which in Finland contains extracts from Cannabis sativa with THC and CBD as active pharmaceutical ingredients. You would not talk of ‘poppy medicine’ in the case of medications containing morphine, or of ‘willow medicine’ in the case of aspirin, I expect?"

Legislation 'slow to change'

Meanwhile, George Murray must wait and see if he will ever be able to obtain the medicine he believes he needs. Having lived in Finland for nearly 20 years, he has become frustrated by what he perceives as a very slow rate of change when it comes to issues pertaining to legislation.

"There seems to be a mindset of 'doing nothingness' here in Finland when it comes to progressive issues that might challenge what I view as a decidedly conservative society and political system," says Murray.

"When I first came to Finland I thought it was a very progressive place but it turns out that it is a highly calculated conservative place that avoids risks of any kind. Therein lies the strong emphasis on rules, whether they make sense or not."

*Alias used to protect the identity of the interviewee.