Former NFL player Rob Gronkowski announced on August 27 that he will focus on his campaign to allow professional sports leagues, like the National Football League (NFL), to relax their restrictions on the use of cannabidiol (CBD) for pain relief. This continues the momentum started in 2018 when the World Anti-Doping Agency (WADA) removed CBD from its list of prohibited substances.

The legalization of marijuana and its derivatives, like CBD, is a complex issue as several countries around the world have, to differing degrees, legalized it, including Brazil, The Netherlands, Uruguay, in addition to various states throughout the United States. Medicinal CBD is a particularly interesting and growing industry.

The objective of this commentary is not to advocate the legalization of marijuana, nor support its banning. Rather, the goal is to understand the current situation of CBD for medicinal uses in the Western Hemisphere and what is the future of this potential market.

CBDs for health uses

Apart from marijuana’s obvious recreational uses, strings like CBD can be of use for patients who are suffering from painful diseases and to combat depression. Moreover, CBD can be utilized for neurological conditions, psychiatric problems, and as non-inflammatory medication. In an article published by the Harvard Medical School, Peter Grinspoon, MD, adds that “part of its allure is that [CBD] is clearly safer than opiates (it is impossible to overdose on and far less addictive) and it can take the place of [nonsteroidal anti-inflammatory drugs] such as Advil or Aleve, if people can’t take them due to problems with their kidneys or ulcers or [gastroesophageal reflux disease].” Hence, it comes as no surprise that Gronkowski has started his own company to sell CBD to professional athletes that suffer from pain related to extreme sports.

In an interview with the author, Gustavo de Lima Palhares, CEO of Ease Labs, a multinational CBD company primarily focused in the Brazilian market, explained that “there is also very promising research being conducted in the oncology area, where there is already scientific evidence of the positive effects of cannabinoids regarding the control of very common symptoms in oncology patients such as pain, nausea and appetite enhancement. In addition, in-vitro studies suggest that CBD has an anti-tumor effect as it inhibits the growth of cancerous cells.”

Finally, it is worth noting that, in his article for the Harvard Health Blog, Dr. Grinspoon explains that in contrast to THC (tetrahydrocannabinol) “that causes the ‘high’ that goes along with marijuana consumption, CBD-dominant strains have little or no THC, so patients report very little if any alteration in consciousness.” Furthermore, “the extract from the hemp plant known as CBD has little, if any, intoxicating properties.” The fact that studies show that CBD is not addictive is an argument in favor of its usage for health purposes. In an off-the-record interview with the author, a U.S.-based physician explained that the U.S. is facing a crisis of opioid addiction, hence CBD is an attractive alternative. The physician would not recommend CBD to patients as the first line of treatment, “but we [healthcare professionals] should regard it as a valid option.”

Recent Developments regarding legalization

As has been widely discussed elsewhere, several countries have legalized or are in the process of legalizing marijuana and its derivatives, such as Georgia, Luxembourg, The Netherlands, South Africa and South Korea – the degrees to which they are legal, like consumption for medical or recreational use, and how much a person can possess or grow, greatly vary.

Generally speaking, Europe is leading the charge towards a new attitude towards marijuana in general and CBD in particular – case in point, members of the European Parliament have “call[ed] on member states to allow doctors to use their professional judgment in prescribing cannabis-based medicines. When effective, these medicines are to be covered by health insurance schemes in the same way as other types of medicine, they say.” A more specific recent example is Luxembourg, a tiny European nation, which has proposed legislation that will allow citizens over the age of 18 “to be able to buy the drug for recreational use legally within two years. The state will regulate production and distribution through a cannabis agency.” Of course, plenty of countries continue to outlaw marijuana usage like Saudi Arabia.

Regarding the U.S., states like California, Colorado, New York, among several others have decriminalized possession of marijuana, and it is common to find CBD dispensaries throughout the city – the same can be said for the U.S. capital, as dispensaries have opened in posh areas of Washington DC. An April 2019 article in Vice notes that “in the U.S., spirits among reformers are high, despite the recent high-profile failure to legalize in New Jersey. ‘There is broad political support to get it passed in New York, New Jersey, and New Mexico over the next one or two years,’” said Jag Davies, Director of Communications Strategy at the Drug Policy Alliance.

Regarding the Western Hemisphere, Uruguay became the regional pioneer when it comes to marijuana legalization, as it is one of the few countries in the world where it has fully legalized medical and recreational use. As for recent developments, in early 2019, Peru legalized cannabis for medical uses, while the government of Ecuador is debating a similar proposal.

There is also interesting news from the Caribbean: in a 2018 report the CARICOM Commission (which represents 15 member countries in the region) said the following of cannabis, “the commission believes that the end goal for CARICOM [the Caribbean Community] should be the dismantling of prohibition in its totality, to be replaced by a strictly regulated framework akin to that for alcohol and tobacco, which are harmful substances that are not criminalized.” The report notes that “it is noteworthy that in the body of research conducted over the past four decades there has been no report of severe or fatal adverse events due to marijuana-based medications, a point made often in the Commission’s Consultations by members of the public.”

As for specific Caribbean nations, the parliament of Barbados is debating a law that will legalize medical cannabis. Even more, the government of Dominica is considering the decriminalization of possession of marijuana, while Saint Kitts and Nevis plan to similarly decriminalize marijuana and legalize cannabis use for medical purposes. In other words, many Western Hemisphere nations are adopting a more liberal and tolerant approach to marijuana in general, and cannabis for medical use in particular.

One country that has a mixed attitude towards marijuana is Brazil. Case in point, President Jair Bolsonaro declared in an August 2019 interview that he recognizes the demand and necessity to give access to cannabis-derived medicine to patients, but also raised his concern about the recreational use of cannabis. Brazil permits the import of CBD for health reasons and Brazil’s Health Regulatory Agency (Agência Nacional de Vigilância Sanitária: ANVISA) is currently, as an independent body of the government, analyzing the possibility of allowing internal production, despite the federal government’s mixed feelings about it.

The Future of the CBD medicinal Industry

An article by RTT News about the future of the legal marijuana industry optimistically argues that “the marijuana industry is rapidly transiting out of the black market and turning into a mainstream economic juggernaut.” Indeed, it seems that the ongoing global trend, meaning the legalization, to one degree or another, of marijuana consumption, is almost irreversible. The future of the legal marijuana industry will vastly depend on, unsurprisingly, the attitude of current and future governments.

Moreover, it is worth noting that even countries that continue to criminalize it, make an exception for CBD for medicinal uses. Countries like Singapore, with a zero-tolerance policy for drugs, allows for pharmaceutical cannabinoids. Even Turkey, a country in the global spotlight these days due to its foreign policy, is generally supporting the cannabis industry, including for medical uses. In other words, there is potential for this market to grow.

As for Brazil, the market remains restricted, even though CBD can be legally prescribed for medical reasons, as there are only a few companies that sell CBD in the Portuguese-speaking nation. Mr. Palhares of Ease Labs explains that currently “a patient has to have a prescription and request an import authorization to ANVISA (that takes around 55 days to be issued) which can reduce the speed of sales. This restricted scenario averts competition and consequently, prices end up being higher, if authorities open up more the market the biggest winners would-be consumers.”

Finally, we should see CBD from a financial standpoint as well. In an interview with HealthEurope, Dr. Delon Human, Head of Innovation and Medical Affairs of PharmaCielo Ltd., mentioned that since drugs that treat diseases such as diabetes, arthritis or cancer are constantly innovating, they result in high costs for new treatments and pills; obviously, individuals with limited financial resources will have more problems accessing them than wealthier patients. In contrast, cannabis offers the possibility of both high innovation and high access and is inexpensive to produce.

Final Thoughts

While the production, trafficking, and consumption of heavy drugs, like cocaine, continues to be a major problem in the Western Hemisphere, generally speaking, there is a clear trend towards a more tolerant attitude regarding marijuana, particularly if governments can profit from it via taxes. This serves as an incentive for policymakers and entrepreneurs to attempt to legalize it. (For example, foreign companies that want to set up operations in Barbados “will be required to ensure locals own at least 30% of the business, the Ministry of Agriculture has revealed.”)

The exception that many countries make regarding cannabis for medicinal use is particularly noteworthy, and we are already witnessing the growth of companies like Ease Labs in Brazil, which imports its products for Brazilian patients. According to Mr. Palhares, his company is actually “in favour of regulating production, storage and domestic sales of cannabis-derived products in Brazil, in order to guarantee the quality of the products produced and safety of the patients.”

Without a doubt, there is still a cultural taboo regarding cannabis, which will continue to influence how patients and doctors alike regard CBD for medicinal usage. However, there is an ongoing tendency towards accepting CBD as a valid alternative for pain relief and even, potentially, to help treat certain diseases. The fact that several Latin American and Caribbean governments are introducing, and even passing, the legalization of cannabidiol for medicinal purposes is a strong sign that this trend is here to stay.

The views expressed in this article are those of the author alone and do not necessarily reflect those of any institutions with which the author is associated.