There is a song by Brazilian band O Rappa that describes the illegal cannabis market, how profitable it is, and the diverse clientele that the business attracts, including actors, socialites and playboys. Some of the verses go like this: “I am selling herbs that heal and soothe (…) The clientele is vast, I know, because normal remedies do not always relieve the tension”. This anecdotal song translates a widespread acknowledgement of cannabis as a popular medicine in Brazil. Expressions like “fumar um de remedio” (“smoke a spliff for medicine”) and “nao tenho maconha nem pra remedio” (“I have no weed, not even for medicine”) also speak about the long popular tradition of using cannabis as a medicine in Brazil despite its prohibition.
Since 2015, Brazilians can legally access medical cannabis products. It has become a big business, with large fairs and startups set up, and serious financial investments becoming increasingly normalised in an industry with a burgeoning entrepreneurial sector. Prohibition Partners, an international cannabis market research firm, have tracked how Brazilian cannabis imports have boomed in the past few years, with an increase in 40% of imported products from 2020 to 2021. 7
However, as Brazil’s medical cannabis industry thrives, its success comes at the expense of patients who remain burdened by exorbitant costs and overwhelming bureaucratic hurdles should they want or need to cultivate their own medicine. While the industry is projected to generate massive profits of nearly £1.2 billion per year after regulation, medical cannabis patients are left grappling with a broken system that only legally offers expensive medicine, subjecting patients to exhausting judicial processes. Currently, a patient must petition for and receive a habeas corpus from a judge to provide them with legal protection to avoid arrest for home cultivation.
The industry patient divide
This stark contrast between industry growth and patient hardship demands immediate political attention. The skyrocketing profits and rosy outlook for industry insiders stand in stark contrast to the harsh reality faced by medical cannabis patients. These patients endure an arduous journey through the legal system and face an uphill battle to access the medicines they desperately need. Two significant barriers confronting patients are the need for judicial authorisation for its cultivation, and high costs for pharmaceutical-grade medical cannabis products. Regulated CBD products, which are already limited in number, come with an astronomical price tag. A single 30ml bottle of one of these products can set patients back around £390. This exorbitant pricing model places medical cannabis far beyond the reach of those who need it most. It is an outrage that patients, who are already dealing with health challenges, must bear the additional burden of unaffordable medications.
In order to remedy the current situation, Brazil must learn from the experiences of other nations. One striking example is the United Kingdom, where the pursuit of profit at the expense of patients has resulted in their marginalisation. Since its medical legalisation in 2018, only a handful of British patients have received publicly-funded prescriptions from the National Health System. Those who want to access their medicine in a legal way are forced to resort to expensive private clinics. One patient-activist I know complained several times about the unreliability of legal cannabis. Sometimes no dry flowers are available at all from legal suppliers. Sometimes some strains are, but not those that have the desired effect on her condition.
Legal flowers are also very expensive, costing at least £5 per gram. An illegal seller, however, delivers one ounce (28 grams) of Lemon Haze, Stardawg or Skywalker strains to their door for £160. If they buy two ounces or more, the price drops to £150 per ounce. And the illegal suppliers do not ask questions, nor require a prescription. They do not require a patient to be fully and exhaustively investigated, nor force them to access cannabis as a last-line prescribed therapy. Most important, though, illegal suppliers always have high-quality products available. This has created a system where one in four UK adults continue to access the illegal market for their medicine despite its legal availability.
The profit-driven approach to cannabis regulation, one that favours strict controls and high prices set by the pharmaceutical industry, harms patients who require medicine. Limited access and exorbitant costs end up driving them towards the illegal market where prices are lower and availability less restricted. The disparity between the exponential growth of the medical cannabis industry and the overwhelming challenges faced by patients highlights a disturbing prioritisation of profits over the well-being of those in need. The industry’s potential for financial success should not come at the expense of patient accessibility and affordable care. It is crucial to shift the focus back to the core purpose of medical cannabis—to improve the lives and well-being of patients.
Reform for access
Brazilian policymakers must implement urgent reforms, starting with passing the medical cannabis bill, which has been stalled for over two years in Parliament. This would be a major step towards lowering the cost of medicine, once it would allow the cultivation of cannabis in the national territory, which is currently prohibited. To lower the costs of medicine, we need to stop importing raw materials. Producing affordable medical cannabis products, in turn, will enable patients to obtain their medicine through legal channels, reducing reliance on the illicit market and improving safety standards. A bigger and more humane step would be, however, to end the prohibition of cultivation, and to allow patients to legally grow and process their medicine. By embracing a more compassionate and equitable approach to cannabis regulation, Brazil can pave the way for a society that truly values the well-being of its citizens.
The success of the medical cannabis industry should not be measured solely in financial terms but also in the positive impact it has on patients’ lives. By prioritising accessibility and affordability, Brazil can create an equitable and compassionate medical cannabis system that truly meets the needs of those who depend on it. The current state of Brazil’s medical cannabis industry, which reaps substantial profits, is in sharp contrast to the immense challenges faced by patients and their families. It is imperative that Brazil’s medical cannabis industry recognises its social responsibility and shifts its focus from profit-driven motives to patient-centric care.