Publicado
Barreras de acceso al cannabis medicinal en Colombia. Una revisión narrativa
Barriers to access to medicinal cannabis in Colombia. A narrative review
Barreiras ao acesso à cannabis medicinal na Colômbia. Uma revisão narrativa
DOI:
https://doi.org/10.15446/rcciquifa.v54n1.119551Palabras clave:
Cannabis medicinal, barreras de acceso, economía farmacéutica, sistema de salud (es)Medical cannabis, access barriers, pharmaceutical economics, health system (en)
Cannabis medicinal, barreiras de acesso, economia farmacêutica, sistema de saúde (pt)
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Introducción: En Colombia, desde el 2017, el mercado del cannabis medicinal se encuentra regulado; sin embargo, existen brechas entre la norma, disponibilidad y acceso de los pacientes a productos farmacéuticos con derivados del cannabis, aprobados por el ente regulatorio y que cumplan con los estándares de calidad. Objetivo: realizar una síntesis narrativa para identificar elementos que pudieran estar incidiendo en el acceso de medicamentos con derivados de cannabis medicinal de los pacientes. Metodología: se realizó una revisión narrativa consistente en cinco fases: I) búsqueda bibliográfica, II) revisión por título y resumen, III) Revisión de texto completo y IV) selección de las referencias y V) Análisis descriptivo. Resultados: se identificaron barreras individuales para el acceso como el bajo poder adquisitivo en pacientes, mitos y connotaciones morales que se tiene la marihuana por parte de la población general y los médicos, la falta de entrenamiento de estos últimos. Por otro lado, a nivel institucional y de sistemas de salud se detectaron dificultades en los trámites para acceder a los tratamientos y poca disponibilidad de medicamentos. Conclusiones: los hallazgos ofrecen un acercamiento en proponer soluciones y alternativas para la estructuración de políticas en salud pública que garanticen el acceso a medicamentos derivados del cannabis a los pacientes que lo requieran
Introduction: In Colombia, since 2017, the medical cannabis market has been regulated; however, there are gaps between the standard, availability and access of patients to pharmaceutical products with cannabis derivatives, approved by the regulatory body and that meet quality standards. Objective: to carry out a narrative synthesis to identify elements that could be affecting patients' access to medicines with medicinal cannabis derivatives. Methodology: a nar-rative review was carried out consisting of five phases: I) bibliographic search, II) review by title and abstract, III) full text review and IV) selection of references and V) descriptive analysis. Results: individual barriers to access were identified such as low purchasing power in patients, myths and moral connotations that marijuana has on the part of the general population and doctors, and the lack of training of the latter. On the other hand, at the institutional and health systems level, difficulties were detected in the procedures to access treatments and poor availability of medicines. Conclusions: the findings offer an approach to proposing solutions and alternatives for structuring public health policies that guarantee access to cannabis-derived medicines for patients who require them.
Introdução: Na Colômbia, desde 2017, o mercado de cannabis medicinal é regulamentado; No entanto, há lacunas entre a norma, a disponibilidade e o acesso dos pacientes aos produtos farmacêuticos derivados da cannabis, aprovados pelo órgão regulador e que atendem aos padrões de qualidade. Objetivo: realizar uma síntese narrativa para identificar elementos que possam estar influenciando o acesso dos pacientes aos medicamentos contendo derivados medicinais da cannabis. Metodologia: Foi realizada uma revisão narrativa composta por cinco fases: I) busca bibliográfica, II) revisão por título e resumo, III) revisão do texto completo e IV) seleção de referências e V) análise descritiva. Resultados: Foram identificadas barreiras indi-viduais de acesso, como o baixo poder aquisitivo dos pacientes, os mitos e conotações morais que a maconha tem por parte da população em geral e dos médicos, e a falta de capacitação destes últimos. Por outro lado, a nível institucional e do sistema de saúde, foram detetadas dificuldades nos procedimentos de acesso aos tratamentos e baixa disponibilidade de medicamentos. Conclusões: Os achados oferecem uma abordagem para propor soluções e alternativas para a estruturação de políticas públicas de saúde que garantam o acesso aos medicamentos derivados da cannabis para os pacientes que deles necessitam.
Referencias
1. P. Pacher, N.M. Kogan & R. Mechoulam. Beyond THC and endocannabinoids. Annu. Rev. Pharma-col. Toxicol., 60, 637–659 (2020). Doi: https://doi.org/10.1146/annurev-pharmtox-010818-021441
2. R.G. Pertwee. Emerging strategies for exploiting cannabinoid receptor agonists as medicines. Br. J. Pharmacol., 156(3), 397–411 (2009). Doi: https://doi.org/10.1111/j.1476-5381.2008.00048.x
3. A.R. de Mello-Schier, N.P. de Oliveira-Ribeiro, A.C. de Oliveira e Silva, J.E.C. Hallak, J.A.S. Crippa, A.E. Nardi & A.W. Zuardi. Cannabidiol, a Cannabis sativa constituent, as an anxiolytic drug. Rev. Bras. Psiquiatr., 34(Suppl 1), S104–S110 (2012). Doi: https://doi.org/10.1590/s1516-44462012000500008
4. K.K. O'Connell, D. Gloss & O. Devinsky. Cannabinoids in treatment-resistant epilepsy: A review. Epilepsy Behav., 70, 341–348 (2017). Doi: https://doi.org/10.1016/j.yebeh.2016.11.012
5. I. Dykukha, R. Malessa, U. Essner & M.A. Überall. Nabiximols in chronic neuropathic pain: A meta-analysis of randomized placebo-controlled trials. Pain Med., 22(4), 861–874 (2021). Doi: https://doi.org/10.1093/pm/pnab050
6. P.F. Whiting, R.F. Wolff, S. Deshpande, M. Di Nisio, S. Duffy, A.V. Hernandez, J.C. Keurentjes, S. Lang, K. Misso, S. Ryder, S. Schmidlkofer, M. Westwood & J. Kleijnen. Cannabinoids for medical use: A systematic review and meta-analysis. JAMA, 313(24), 2456–2473 (2015). Doi: https://doi.org/10.1001/jama.2015.6358. Erratum en: JAMA, 314(5), 520 (2015). Doi: https://doi.org/10.1001/jama.2015.8253. Erratum en: JAMA, 314(8), 837 (2015). Doi: https://doi.org/10.1001/jama.2015.9010. Erratum en: JAMA, 314(21), 2308 (2015). Doi: https://doi.org/10.1001/jama.2015.15929. Erratum en: JAMA, 315(14), 1522 (2016). Doi: https://doi.org/10.1001/jama.2016.3470
7. B.J. Piper, R.M. DeKeuster, M.L. Beals, C.M. Cobb, C.A. Burchman, L. Perkinson, S.T. Lynn, S.D. Nichols & A.T. Abess. Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep. J. Psychopharmacol., 31(5), 569–575 (2017). Doi: https://doi.org/10.1177/0269881117699616
8. J. Ryan & N. Sharts-Hopko. The experiences of medical marijuana patients: A scoping review of the qualitative literature. J. Neurosci. Nurs., 49(3), 185–190 (2017). Doi: https://doi.org/10.1097/jnn.0000000000000283
9. A. Hulaihel, O. Gliksberg, D. Feingold, S. Brill, B.H. Amit, S. Lev-Ran & S.R. Sznitman. Medical cannabis and stigma: A qualitative study with patients living with chronic pain. J. Clin. Nurs., 32(7-8), 1103–1114 (2023). Doi: https://doi.org/10.1111/jocn.16340
10. A.K. Schlag, R. Zafar & D. Nutt. Medical cannabis and epilepsy in the UK – A qualitative analysis of the carers’ perspective: “We’re asking for quality of life for our children”. Drug Sci. Policy Law, 7, 1–10 (2021). Doi: https://doi.org/10.1177/20503245211034930
11. K.M. Gardiner, J.A. Singleton, J. Sheridan, G.J. Kyle & L.M. Nissen. Beliefs, knowledge and con-cerns of health professionals regarding medicinal cannabis: a systematic review. PLoS One, 14(5), e0216556 (2019). Doi: https://doi.org/10.1371/journal.pone.0216556
12. República de Colombia, Ministerio de Salud y Protección Social. Decreto 811 de 2021 (“Por el cual se sustituye el Titulo 11 de la Parte 8 del Libro 2 del Decreto 780 de 2016, Único Reglamentario del Sector Salud y Protección Social, en relación con el acceso seguro e informado al uso del cannabis y de la planta de cannabis”). Bogotá D. C., Colombia, 2021; 59 p. URL: https://www.minsa-lud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/decreto-811-de-2021.pdf. Consultado el 4 de marzo de 2024.
13. República de Colombia, Ministerio de Salud y Protección Social. Resolución 315 de 2020 (“Por la cual se actualizan los listados de estupefacientes, psicotrópicos, precursores y demás sustancias sometidas a fiscalización, de aquellas clasificadas como monopolio del Estado y de los medicamen-tos de control especial de uso humano y veterinario, y se dictan otras disposiciones”). Bogotá D. C., Colombia, 2020; 37 p. URL: https://minsalud.gov.co/Normatividad_Nuevo/Reso-luci%C3%B3n%20No.%200315%20de%202020.pdf. Consultado el 4 de marzo de 2024.
14. INVIMA: Instituto Nacional de Vigilancia de Medicamentos y Alimentos. Guía para las visitas de buenas prácticas de elaboración de preparaciones magistrales a base de cannabis. Bogotá D. C., Colombia, 2020. URL: https://www.invima.gov.co/productos-vigilados/medicamentos-y-productos-biologi-cos/cannabis-medicinal. Consultado el 4 de marzo de 2024.
15. República de Colombia, Ministerio de Salud y Protección Social. Resolución 2808 de 2022 (“Por la cual se establecen los servicios y tecnologías de salud financiados con recursos de la Unidad de Pago por Capitación (UPC)”). Bogotá D. C., Colombia, 2022; 132 p. URL: https://www.minsa-lud.gov.co/Normatividad_Nuevo/Resoluci%C3%B3n%20No.%202808%20de%202022.pdf. Consul-tado el 4 de marzo de 2024.
16. Corte Constitucional. Sentencia T-451, Bogotá D. C., Colombia. URL: https://www.corteconstitucio-nal.gov.co/relatoria/2023/T-451-23.htm. Consultado el 4 de marzo de 2024.
17. A.B. Evanoff, T. Quan, C. Dufault, M. Awad & L.J. Bierut. Physicians-in-training are not prepared to prescribe medical marijuana. Drug Alcohol Depend., 180, 151–155 (2017). Doi: https://doi.org/10.1016/j.drugalcdep.2017.08.010
18. L. Belle-Isle, Z. Walsh, R. Callaway, P. Lucas, R. Capler, R. Kay & S. Holtzman. Barriers to access for Canadians who use cannabis for therapeutic purposes. Int. J. Drug Policy, 25, 691–699 (2014). Doi: https://doi.org/10.1016/j.drugpo.2014.02.009
19. J. Hwang, T. Arneson & W. St Peter. Minnesota pharmacists and medical Cannabis: A survey of knowledge, concerns, and interest prior to program launch. P T., 41(11), 716–722 (2016).
20. K.E. Moeller & B. Woods. Pharmacy students’ knowledge and attitudes regarding medical mariju-ana. Am. J. Pharm. Educ., 79(6), 85 (2015). Doi: https://doi.org/10.5688/ajpe79685
21. B. Carlini, G. Carter, R. Roffman & R.N. Takahashi. Medical cannabis and chronic pain. Science-based education in times of legalization. University of Washington Institute on Drug and Alcohol Abuse, 2017. URL: https://adai.uw.edu/cerp/mcacp/. Consultado el 8 de septiembre de 2024.
22. Federación Médica Colombiana. Formación médica para una óptima prescripción de cannabis medicinal. Bogotá D. C., Colombia, 2023. URL: https://www.federacionmedicacolom-biana.com/2023/04/12/formacion-medica-para-una-optima-prescripcion-de-cannabis-medicinal/. Consultado el 8 de septiembre de 2024.
23. C. Lopera-Londoño, D. Pino-Marín, M. Ceballos & P. Amariles. Percepción de los estudiantes de los programas de Química farmacéutica, tecnología en regencia de farmacia y medicina de la Uni-versidad de Antioquia frente al uso terapéutico de los cannabinoides. Salud UIS, 50(3), 215–223 (2018). Doi: http://dx.doi.org/10.18273/revsal.v50n3-2018006
24. ProColombia. Industria del Cannabis en Colombia, 2018. Bogotá D. C., Colombia, 2018. URL: https://procolombia.co/publicaciones/industria-del-cannabis-2018-en-colombia. Consultado el 8 de septiembre de 2024.
25. Redacción Semana. Cannabis: el año de la verdad. Revista Semana, Bogotá D. c., Colombia, 2020. URL: https://www.semana.com/economia/articulo/cannabis-el-ano-de-la-verdad/648385. Consultado el 8 de septiembre de 2024.
26. P. Zuleta, B. Tocua & T. Martínez-Ferro. Cannabis Legal: desafíos de la industria de cannabis para usos médicos y científicos en Colombia, CESED – Centro de Estudios sobre Seguridad y Drogas, Universi-dad de los Andes, Bogotá D. C., Colombia, 2023; 37 p. Disponible en https://cesed.unian-des.edu.co/wp-content/uploads/2023/12/Cannabisentrega3_DIAGRAMADO-1.pdf. Consultado el 8 de septiembre de 2024.
27. República de Colombia, Ministerio de Salud y Protección Social. ABECÉ sobre el uso médico y cientí-fico del cannabis en Colombia: Decreto 613 del 10 de abril de 2017. Bogotá D. C., Colombia, 2017; 5 p. URL: https://www.minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/COM/abece-cana-bis-colombia.pdf. Consultado el 8 de septiembre de 2024.
28. Congreso de la República de Colombia. Ley 1819 de 2016 (“Por medio de la cual se adopta una reforma tributaria estructural, se fortalecen los mecanismos para la lucha contra la evasión y la elusión fiscal, y se dictan otras disposiciones.”). Bogotá D. C., Colombia, 2016. URL: https://www.funcionpublica.gov.co/eva/gestornormativo/norma.php?i=79140. Consultado el 8 de septiembre de 2024.
29. Congreso de la República de Colombia. Ley 1787 de 2016 (“Por medio de la cual se reglamenta el Acto Legislativo 02 de 2009.”. Bogotá D. C., Colombia, 2016. URL: https://www.funcionpu-blica.gov.co/eva/gestornormativo/norma.php?i=80394. Consultado el 8 de septiembre de 2024.
30. M.A. Ware, T. Wang, S. Shapiro & J.P. Collet, COMPASS study team. Cannabis for the Management of Pain: Assessment of Safety Study (COMPASS). J. Pain, 16(12), 1233–1242 (2015). Doi: https://doi.org/10.1016/j.jpain.2015.07.014
31. G.M. Allan, J. Ramji, D. Perry, J. Ton, N.P. Beahm, N. Crisp, B. Dockrill, R.E. Dubin, T. Findlay, J. Kirkwood, et al. Simplified guideline for prescribing medical cannabinoids in primary care. Can. Fam. Physician, 64(2), 111–120 (2022). URL: https://www.cfp.ca/content/cfp/64/2/111.full.pdf
32. College of Physicians and Surgeons of Alberta. Cannabis for Medical Purposes: Standard of Practice. URL: https://cpsa.ca/physicians/standards-of-practice/cannabis-for-medical-purposes/. Consul-tado el 27 de mayo de 2022.
33. National Academies of Sciences, Engineering, and Medicine. The Health Effects of Cannabis and Can-nabinoids: The Current State of Evidence and Recommendations for Research. National Academies Press (US), Washington DC, 2017. Doi: https://doi.org/10.17226/24625 . Consultado el 8 de septiembre de 2024.
34. Queensland Health, Clinical Guidance: for the use of medicinal cannabis products in Queensland, Queens-land Government, 2017; 32 p. URL: https://www.parliament.qld.gov.au/Work-of-the-Assembly/Ta-bled-Papers/docs/5517t966/5517t966.pdf. Consultado el 8 de septiembre de 2024.
35. Ministry of Health, Welfare and Sports. Office of Medicinal Cannabis. Information for pharmacists and healthcare professionals (Version November 2021), The Hague, The Netherlands, 2021; 6 p. URL: https://english.cannabisbureau.nl/documents/circulars/2018/07/03/information-for-pharma-cists-and-healthcare-professionals. Consultado el 8 de septiembre de 2024.
36. A.D. Bell, C. MacCallum, S. Margolese, Z. Walsh, P. Wright, P.J. Daeninck, E. Mandarino, G. Lacasse, J.K. Deol, L. Freitas, et al. Clinical practice guidelines for cannabis and cannabinoid based medicines in the management of chronic pain and cooccurring conditions. Cannabis and Cannabinoid Research, 9(2), 669–687 (2024). Doi: https://doi.org/10.1089/can.2021.0156
37. Minnesota Department of Health. Health Care Practitioner Guidance for Minnesota’s Medical Cannabis Program, 2023; 6 p. URL: https://mn.gov/ocm/assets/Health%20Care%20Practitioner%20Guid-ance%20for%20MN%27s%20Medical%20Cannabis%20Program_tcm1202-628222.pdf. Consultado el 8 de septiembre de 2024.
38. Medical Cannabis Clinicians Society. Recommendations and Guidance on Medical Cannabis under Pre-scription, 2nd. ed. London, UK, 2020; 11 p. URL: https://www.ukmccs.org/wp-content/up-loads/2020/03/Recommendations-and-Guidance-on-Medical-Cannabis-under-Prescription-2nd-Edition-2020.pdf. Consultado el 8 de septiembre de 2024.
39. National Institute for Health and Care Excellence (NICE Guideline). Cannabis-based medicinal prod-ucts. London, UK, 2021, 30 p. URL: https://www.nice.org.uk/guidance/ng144/resources/canna-bisbased-medicinal-products-pdf-66141779817157. Consultado el 8 de septiembre de 2024.
40. Israel Ministry of Health, The Medical Cannabis Unit. IMC-GCP Cannabis for medical use: Information booklet and medical guide. Circular number 154/2016. Jerusalem, Israel, 2019. URL: https://www.gov.il/en/pages/about-yakar. Consultado el 8 de septiembre de 2024.
41. Utah Department of Health and Human Services. Guidance on the suggested use of medical cannabis. 2022; 56 p. URL: https://medicalcannabis.utah.gov/wp-content/uploads/Guidance-on-the-Sug-gested-Use-of-Medical-Cannabis_v1_Final-1.pdf. Consultado el 8 de septiembre de 2024.
42. República de Colombia, Instituto de Evaluación Tecnológica en Salud. Documento técnico para el desarrollo de una Revisión Sistemática de Literatura de Efectividad y Seguridad de grupo para aplicaciones médicas de cannabis y productos terminados derivados del cannabis. Ministerio de Salud y Protección Social, Bogotá D. C., Colombia, 2022; 168 p. URL: https://www.minsalud.gov.co/sites/rid/Lists/Bi-bliotecaDigital/RIDE/VP/RBC/rsl-efectividad-seguridad-aplicaciones-medicas-cannabis-produc-tos-terminados-cannabis.pdf. Consultado el 8 de septiembre de 2024.
43. D.I. Abrams, J.F. Hilton, R.J. Leiser, S.B. Shade, T.A. Elbeik, F.T. Aweeka, N.L. Benowitz, B.M. Bredt, B. Kosel, J.A. Aberg, et al. Short-term effects of cannabinoids in patients with HIV-1 infection: a randomized, placebo-controlled clinical trial. Ann. Intern. Med., 139(4), 258–266 (2003). Doi: https://doi.org/10.7326/0003-4819-139-4-200308190-00008
44. A. Andries, J. Frystyk, A. Flyvbjerg & R.K. Støving. Dronabinol in severe, enduring anorexia ner-vosa: a randomized controlled trial. Int. J. Eat. Disord., 47(1), 18–23 (2014). Doi: https://doi.org/10.1002/eat.22173
45. M. Haney, J. Rabkin, E. Gunderson & R.W. Foltin. Dronabinol and marijuana in HIV+ marijuana smokers: Acute effects on caloric intake and mood. Psychopharmacology, 181(1), 170–178 (2005). Doi: https://doi.org/10.1007/s00213-005-2242-2
46. M. Haney, E.W. Gunderson, J. Rabkin, C.L. Hart, S.K. Vosburg, S.D. Comer & R.W. Foltin. Dronabinol and marijuana in HIV-positive marijuana smokers. Caloric intake, mood, and sleep. J. Acquir. Immune Defic. Syndr., 45(5), 545–554 (2007). Doi: https://doi.org/10.1097/qai.0b013e31811ed205
47. J.G. Timpone, D.J. Wright, N. Li, M.J. Egorin, M.E. Enama, J. Mayers & G. Galetto. The safety and pharmacokinetics of single-agent and combination therapy with megestrol acetate and dronabinol for the treatment of HIV wasting syndrome. AIDS Res. Hum. Retroviruses. 13(4), 305–315 (1997). Doi: https://doi.org/10.1089/aid.1997.13.305
48. E. Meiri, H. Jhangiani, J.J. Vredenburgh, L.M. Barbato, F.J. Carter, H.M. Yang & V. Baranowski. Efficacy of dronabinol alone and in combination with ondansetron versus ondansetron alone for delayed chemotherapy-induced nausea and vomiting. Curr. Med. Res. Opin., 23(3), 533–543 (2007). Doi: https://doi.org/10.1185/030079907x167525
49. A.H. Söderpalm, A. Schuster & H. de Wit. Antiemetic efficacy of smoked marijuana: Subjective and behavioral effects on nausea induced by syrup of ipecac. Pharmacol. Biochem. Behav., 69(3-4), 343–350 (2001). Doi: https://doi.org/10.1016/s0091-3057(01)00533-0
50. D.R. Blake, P. Robson, M. Ho, R.W. Jubb & C.S. McCabe. Preliminary assessment of the efficacy, tolerability and safety of a cannabis-based medicine (Sativex) in the treatment of pain caused by rheumatoid arthritis. Rheumatology (Oxford), 45(1), 50–52 (2006). Doi: https://doi.org/10.1093/rheu-matology/kei183
51. J.R. Johnson, M. Burnell-Nugent, D. Lossignol, E.D. Ganae-Motan, R. Potts & M.T. Fallon. Multi-center, double-blind, randomized, placebo-controlled, parallel-group study of the efficacy, safety, and tolerability of THC:CBD extract and THC extract in patients with intractable cancer-related pain. J. Pain Symptom. Manage., 39(2), 167–179 (2010). Doi: https://doi.org/10.1016/j.jpainsym-man.2009.06.008
52. R.Q. Skrabek, L. Galimova, K. Ethans & D. Perry. Nabilone for the treatment of pain in fibromyal-gia. J. Pain, 9(2), 164–173 (2008). Doi: https://doi.org/10.1016/j.jpain.2007.09.002
53. R.M. Langford, J. Mares, A. Novotna, M. Vachova, I. Novakova, W. Notcutt & S. Ratcliffe. A dou-ble-blind, randomized, placebo-controlled, parallel-group study of THC/CBD oromucosal spray in combination with the existing treatment regimen, in the relief of central neuropathic pain in pa-tients with multiple sclerosis. J. Neurol., 260(4), 984–997 (2013). Doi: https://doi.org/10.1007/s00415-012-6739-4
54. D. Turcotte, M. Doupe, M. Torabi, A. Gomori, K. Ethans, F. Esfahani, K. Galloway & M. Namaka. Nabilone as an adjunctive to gabapentin for multiple sclerosis-induced neuropathic pain: a ran-domized controlled trial. Pain Med., 16(1), 149–159 (2015). Doi: https://doi.org/10.1111/pme.12569
55. M.S. Wallace, T.D. Marcotte, A. Umlauf, B. Gouaux & J.H. Atkinson. Efficacy of inhaled Cannabis on painful diabetic neuropathy. J. Pain, 16(7), 616–627 (2015). Doi: https://doi.org/10.1016/j.jpain.2015.03.008
56. S. Pooyania, K. Ethans, T. Szturm, A. Casey & D. Perry. A randomized, double-blinded, crossover pilot study assessing the effect of nabilone on spasticity in persons with spinal cord injury. Arch. Phys. Med. Rehabilit., 91(5), 703–707 (2010). https://doi.org/10.1016/j.apmr.2009.12.025
57. O. Devinsky, J.H. Cross, L. Laux, E. Marsh, I. Miller, R. Nabbout, I.E. Scheffer, E.A. Thiele & S. Wright; Cannabidiol in Dravet Syndrome Study Group. Trial of Cannabidiol for drug-resistant sei-zures in the Dravet syndrome. N. Engl. J. Med., 376(21), 2011–2020 (2017). Doi: https://doi.org/10.1056/nejmoa1611618
58. E.A. Thiele, E.D. Marsh, J.A. French, M. Mazurkiewicz-Beldzinska, S.R. Benbadis, C. Joshi, P.D. Lyons, A. Taylor, C. Roberts & K. Sommerville; GWPCARE4 Study Group. Cannabidiol in patients with seizures associated with Lennox-Gastaut syndrome (GWPCARE4): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet, 391(10125), 1085–1096 (2018). Doi: https://doi.org/10.1016/S0140-6736(18)30136-3
59. K. Vyas. The power of real-world evidence in rare and difficult-to-treat epilepsies. Jazz Pharma-ceuticals, Inc., 2018. URL: https://www.jazzpharma.com/perspectives/power-real-world-evidence-rare-and-difficult-treat-epilepsies. Consultado el 8 de septiembre de 2024.
60. R. Jetly, A. Heber, G. Fraser & D. Boisvert. The efficacy of nabilone, a synthetic cannabinoid, in the treatment of PTSD-associated nightmares: A preliminary randomized, double-blind, placebo-con-trolled cross-over design study. Psychoneuroendocrinology, 51, 585–588 (2015). Doi: https://doi.org/10.1016/j.psyneuen.2014.11.002
61. K.R. Müller-Vahl, U. Schneider, A. Koblenz, M. Jöbges, H. Kolbe, T. Daldrup & H.M. Emrich. Treat-ment of Tourette's syndrome with Delta 9-tetrahydrocannabinol (THC): a randomized crossover trial. Pharmacopsychiatry, 35(2), 57–61 (2002). Doi: https://doi.org/10.1055/s-2002-25028
62. P. Fox, P.G. Bain, S. Glickman, C. Carroll & J. Zajicek. The effect of cannabis on tremor in patients with multiple sclerosis. Neurology, 62(7), 1105–1109 (2004). Doi: https://doi.org/10.1212/01.wnl.0000118203.67138.3e
63. H.S. Greenberg, S.A. Werness, J.E. Pugh, R.O. Andrus, D.J. Anderson & E.F. Domino. Short-term effects of smoking marijuana on balance in patients with multiple sclerosis and normal volunteers. Clin. Pharmacol. Ther., 55(3), 324–328 (1994). Doi: https://doi.org/10.1038/clpt.1994.33
64. Z.D.S. Vicente-Célis, J.C. Salazar, R. Pineda-Tamayo & J.M. Anaya. Sobre la necesidad de la farma-coeconomía. Comenzar por los principios. Rev. Colomb. Reumatol., 18(3), 187–202 (2011). Doi: https://doi.org/10.1016/S0121-8123(11)70053-6
65. J.M. Corroon, Jr., L.K. Mischley & M. Sexton. Cannabis as a substitute for prescription drugs - a cross-sectional study. J. Pain Res., 10, 989–998 (2017). Doi: https://doi.org/10.2147/jpr.s134330
66. D.J. Kruger & J.S. Kruger. Medical cannabis users' comparisons between medical cannabis and mainstream medicine. J. Psychoactive Drugs, 51(1), 31–36 (2019). Doi: https://doi.org/10.1080/02791072.2018.1563314
67. A.C. Bradford & W.D. Bradford. Medical marijuana laws reduce prescription medication use in Medicare Part D. Health Affairs (Millwood), 35(7), 1230–1236 (2016). doi: https://doi.org/10.1377/hlthaff.2015.1661
68. Parts of Medicare. U.S. Centers for Medicare and Medicaid Services. Baltimore, MD. URL: https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/whats-medi-care. Consultado el 8 de septiembre de 2024.
69. N. Ecker. The right prescription: High cost savings and other benefits from Medicare and Medicaid coverage of medical marijuana (April 14, 2022). Ohio State Legal Studies Research Paper No. 699, Drug Enforcement and Policy Center, No. 49, April 2022. Doi: http://doi.org/10.2139/ssrn.4084028
70. J.M. Corroon, Jr., L.K. Mischley & M. Sexton. Cannabis as a substitute for prescription drugs - a cross-sectional study. J. Pain Res., 10, 989–998 (2017). Doi: https://doi.org/10.2147/jpr.s134330
71. S.S. Stith, J.M. Vigil, I.M. Adams & A.P. Reeve. Effects of legal access to cannabis on Scheduled II-V drug prescriptions. J. Am. Med. Dir. Assoc., 19(1), 59–64.e1 (2018). Doi: https://doi.org/10.1016/j.jamda.2017.07.017
72. Minnesota Department of Health. Intractable pain patients in the Minnesota Medical Cannabis Pro-gram: Experience of enrolees during the first five months, 2018. URL: https://mn.gov/ocm/dmc/data-reports/special-reports/intractable-pain.jsp. Consultado el 8 de sep-tiembre de 2024.
73. B.J. Piper, R.M. DeKeuster, M.L. Beals, C.M. Cobb, C.A. Burchman, L. Perkinson, S.T. Lynn, S.D. Nichols & A.T. Abess. Substitution of medical cannabis for pharmaceutical agents for pain, anxiety, and sleep. J. Psychopharmacol., 31(5), 569–575 (2017). Doi: https://doi.org/10.1177/0269881117699616
74. NHS Digital, Antidepressants were the area with largest increase in prescription items in 2016. London, UK, June 2017. URL: https://www.wired-gov.net/wg/news.nsf/articles/Antidepres-sants%20were%20the%20area%20with%20largest%20increase%20in%20prescrip-tion%20items%20in%202016%2030062017111500. Consultado el 8 de septiembre de 2024.
75. D. Feingold, S. Brill, I. Goor-Aryeh, Y. Delayahu & S. Lev-Ran. Depression and anxiety among chronic pain patients receiving prescription opioids and medical marijuana. J. Affect. Disord., 218, 1–7 (2017). Doi: https://doi.org/10.1016/j.jad.2017.04.026
76. NHS Innovation Accelerator. NHS in Thames Valley to tackle sleeping pills epidemic with digital medi-cine. London, UK, March 2018. URL: https://nhsaccelerator.com/news-item/nhs-thames-valley-tackle-sleeping-pills-epidemic-digital-medicine/. Consultado el 8 de septiembre de 2024.
77. P. McCrone, S. Dhanasiri, A. Patel, M. Knapp & S. Lawton-Smith. Paying the price: The cost of mental health care in England to 2026. King’s Fund, London, UK, 2008. URL: https://www.kings-fund.org.uk/insight-and-analysis/reports/paying-price-mental-health-cost. Consultado el 8 de sep-tiembre de 2024.
78. K.F. Boehnke, J.R. Scott, E. Litinas, S. Sisley, D.A. Williams & D.J. Clauw. Pills to pot: Observational analyses of cannabis substitution among medical cannabis users with chronic pain. J. Pain, 20(7), 830–841 (2019). doi: https://doi.org/10.1016/j.jpain.2019.01.010
79. H. Wen & J.M. Hockenberry. Association of medical and adult-use marijuana laws with opioid prescribing for Medicaid enrollees. JAMA Intern. Med., 178(5), 673–679 (2018). Doi: https://doi.org/10.1001/jamainternmed.2018.1007
80. B. Okusanya, I.O. Asaolu, J.E. Ehiri, L.J. Kimaru, A. Okechukwu & C. Rosales. Medical cannabis for the reduction of opioid dosage in the treatment of non-cancer chronic pain: a systematic review. Syst. Rev., 9(1), 167 (2020). Doi: https://doi.org/10.1186/s13643-020-01425-3
81. C. Lee, M. Lin, K.J.B. Martins, J.R.B. Dyck, S. Klarenbach, L. Richer, E. Jess, J.G. Hanlon, E. Hyshka & D.T. Eurich. Opioid use in medical cannabis authorization adult patients from 2013 to 2018: Al-berta, Canada. BMC Public Health, 21(1), 843 (2021). Doi: https://doi.org/10.1186/s12889-021-10867-w
82. L.F. Valladales-Restrepo, S. Rubio-Londoño, L.F. Poveda-Martinez & J.E. Machado-Alba. Prescrib-ing pattern of analgesics in Colombia. Are there differences between capital cities and municipali-ties? A cross-sectional study. Drugs – Real World Outcomes, 9(3), 487–501 (2022). Doi: https://doi.org/10.1007/s40801-022-00318-2
83. W. Toro, A. Wagib, C. Arango, E. Valenzuela, M. Quijano, H. Cacerez & S. Gómez. Análisis de costo-efectividad de pregabalina versus gabapentin y carbamazepina en el tratamiento de dolor neuropático en pacientes con polineuropatia diabética en Colombia. Revista Oficial de la Asociación Colombiana para el Estudio del Dolor, 3(1), 58–67 (2008). URL: https://dolor.org.co/biblioteca/revis-tas/REVISTA%203-1.pdf
84. M. Duerden, T. Avery & R. Payne. Polypharmacy and medicines optimization: Making it safe and sound. The King’s Fund, London, 2013. URL: https://www.kingsfund.org.uk/insight-and-analysis/re-ports/polypharmacy-and-medicines-optimisation. Consultado el 8 de septiembre de 2024.
85. R.L. Maher, J. Hanlon & E.R. Hajjar. Clinical consequences of polypharmacy in elderly. Expert Opin-ion on Drug Safety, 13(1), 57–65 (2014). Doi: https://doi.org/10.1517/14740338.2013.827660
86. R. Abuhasira, L.B. Schleider, R. Mechoulam & V. Novack. Epidemiological characteristics, safety and efficacy of medical cannabis in the elderly. Eur. J. Intern. Med., 49, 44–50 (2018). Doi: https://doi.org/10.1016/j.ejim.2018.01.019
87. M.-A. Fitzcharles, C. Baerwald, J. Ablin & W. Häuser. Efficacy, tolerability and safety of canna-binoids in chronic pain associated with rheumatic diseases (fibromyalgia syndrome, back pain, os-teoarthritis, rheumatoid arthritis): A systematic review of randomized controlled trials. Schmerz, 30(1), 47–61 (2016). Doi: https://doi.org/10.1007/s00482-015-0084-3
88. W. Häuser, F. Petzke & M.A. Fitzcharles. Efficacy, tolerability and safety of cannabis-based medi-cines for chronic pain management - An overview of systematic reviews. Eur. J. Pain, 22(3), 455–470 (2018). Doi: https://doi.org/10.1002/ejp.1118
89. Australian Government, Department of Health and Aged Care. Guidance for the use of medicinal can-nabis for the prevention or management of nausea and vomiting in Australia. Canberra, 2017. URL: https://www.tga.gov.au/resources/resource/reference-material/guidance-use-medicinal-cannabis-prevention-or-management-nausea-and-vomiting-australia. Consultado el 4 de marzo de 2024.
90. P. Makary, J.R. Parmar, N. Mims, N.M. Khanfar & R.A. Freeman. Patient Counseling Guidelines for the use of cannabis for the treatment of chemotherapy-induced nausea/vomiting and chronic pain. J. Pain Palliat. Care Pharmacother., 32(4), 216–225 (2018). Doi: https://doi.org/10.1080/15360288.2019.1598531
91. Ministério da Saúde/Agência Nacional de Vigilância Sanitária/Diretoria Colegiada. Resolução da diretoria colegiada - RDC No 327, de 9 de dezembro de 2019. Dispõe sobre os procedimentos para a concessão da Autorização Sanitária para a fabricação e a importação, bem como estabelece requi-sitos para a comercialização, prescrição, a dispensação, o monitoramento e a fiscalização de produ-tos de Cannabis para fins medicinais, e dá outras providências. Brasília, 2019. URL: https://bvsms.saude.gov.br/bvs/saudelegis/anvisa/2019/rdc0327_09_12_2019.pdf. Consultado el 8 de septiembre de 2024.
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