Preventing Oversight on Medical Cannabis Legislation in Malaysia: Analysis of Risks, Benefits and Regulation Requirements
Keywords:Benefits, Legislation, Medical Cannabis, Regulations, Risks
The United Nations Office on Drug and Crime (UNODC) ranked cannabis as the most widely used substance worldwide in 2021. It has been predicted that the use will dramatically increase in the next five years due to an increasing number of countries starting to legalise it for medical purposes. In 1983, Malaysia declared the substance use problem as a national emergency. Since then, the government has taken many steps to establish a ‘country without illicit drugs’. To analyse risks, benefits and regulations of medical cannabis, a narrative review synthesising the findings of literature retrieved from computerised database search was conducted. Increasing evidence shows that legalising cannabis leads to an increased number of people starting to abuse this substance and become dependent on it, including the country that became the first to legalise cannabis. Although there are claims and studies reported that medical cannabis is needed to treat certain diseases, the decision to legalise cannabis in Malaysia needs to carefully weigh the risks and benefits. After all, there are other FDA-approved medicines clinically proven to be safe and effective alternatives that are currently available to treat such diseases. The control of cannabis licensing and selling needs to be taken into serious consideration before deciding on the regulatory status of cannabis. Therefore, the best way to prevent the spike of cannabis abuse in Malaysia is by prohibiting possession, planting, harvesting and processing cannabis, even for personal use. The lack of high-quality clinical trials regarding the benefits and harms of cannabis for medical purposes should also be a major consideration before the decision to legalise cannabis is made.
‘Dangerous Drugs Act 1952 and Regulations’ Official Portal of Pharmaceutical Services Programme (25 May 2022) <https://www.pharmacy.gov.my/v2/en/documents/dangerous-drugs-act-1952-andregulations.html> accessed 12 April 2022.
‘Is marijuana safe and effective as medicine?’ National Institute on Drug Abuse (July 2020) <https://nida.nih.gov/publications/research-reports/marijuana/marijuana-safe-effective-medicine> accessed 14 April 2022.
‘Malaysia in talks to become first in Asia to allow medical marijuana’ The Straits Times (26 September 2018) <https://www.straitstimes.com/asia/se-asia/malaysia-in-talks-to-become-first-in-asia-to-allowmedical-pot> accessed 12 April 2022.
‘Medical marijuana patient numbers’ Marijuana Policy Project (27 May 2021) <https://www.mpp.org/issues/medical-marijuana/state-bystate-medical-marijuana-laws/medical-marijuana-patient-numbers/> accessed 12 April 2022.
‘Singer-composer suspected of cultivating ganja plants remanded for seven days’ New Straits Times (25 March 2022) <https://www.nst.com.my/news/crime-courts/2022/03/783271/singer-composer-suspectedcultivating-ganja-plants-remanded-seven> accessed 12 April 2022.
‘State medical cannabis laws’ National Conference of State Legislatures (14 Jun 2022) <https://www.ncsl.org/research/health/state-medicalmarijuana-laws.aspx> accessed 15 April 2022.
‘Synthetic Cannabinoids (K2/Spice)’ National Institute on Drug Abuse (NIDA) (2012) <http://www.drugabuse.gov/publications/drugfacts/spice-synthetic-marijuana>.
‘Thailand Drops Cannabis From Its List of Controlled Narcotics’ The Diplomat (9 Februari 2022) <https://thediplomat.com/2022/02/thailanddrops-cannabis-from-its-list-of-controlled-narcotics/>.
Agensi Anti-Dadah Kebangsaaan (AADK), ‘Statistic Trend of Number of Drug Addicts Detected According to Type of Drugs, 2016 – 2020' (2021) <https://www.adk.gov.my/en/statistic-trend-of-numberof-drug-addicts-detected-according-to-type-of-drugs-2016-2020/> accessed 14 April 2022.
Agensi Antidadah Kebangsaan, Kementerian Dalam Negeri, Buku Maklumat Dadah (Putrajaya, 2020).
Agrawal A. and others, ‘Cannabis and other illicit drugs: comorbid use and abuse/dependence in males and females’ (2003) 34(3) Behavior Genetics 217-228.
Ahmed S. and others, ‘The Impact of THC and CBD in Schizophrenia: A Systematic Review’ (2021) 23(12) Front Psychiatry 1225.
Aluko R.E., ‘Hemp seed (Cannabis sativa L.) proteins: composition, structure, enzymatic modification, and functional or bioactive properties’ in Nadathur S.,Wanasundra J.P.D. and Scanlin L. (eds), Sustainable protein sources (Academic Press, 2017).
Amin M.R. and Ali D.W., ‘Pharmacology of Medical Cannabis’ (2019) Adv Exp Med Biol 1162, 151-165.
Antičević V. and others, ‘The personality traits and social characteristics of Croatian heroin addicts and cannabis users’ (2011) 35(3) Collegium antropologicum 701-707.
Barrett F.S. and others, ‘Hallucinations following acute cannabis dosing; a case report and comparison to other hallucinogenic drugs’ (2018) 3(1) Cannabis and Cannabinoid Research 85-93.
Benmaamar R., ‘Colorado: a first in the USA for legal sale of marijuana’ (2014) 15(2) The Lancet oncology E55.
Boggs D.L. and others, ‘Clinical and Preclinical Evidence for Functional Interactions of Cannabidiol and Δ9-Tetrahydrocannabinol’ (2018) 43(1) Neuropsychopharmacology 142-154.
Bottorf J.L. and others, ‘Relief-oriented use of marijuana by teens’ (2009) 4(1) Substances Abuse Treatment, Prevention, and Policy.
Brigo F. and others, ‘Anti‐seizure medications for Lennox‐Gastaut syndrome’ (2021) 4 Cochrane Database of Systematic Reviews
Cabral G.A. and others, ‘CB2 receptors in the brain: role in central immune function’ (2008) 153(2) British Journal of Pharmacology 240–251.
Centre for Disease Control and Prevention (CDC), ‘Addressing Prescription Drug Abuse in the United States Current Activities and Future Opportunities’ (Washington, US Department of Health & Human Rights, 2013).
Centre for Disease Control and Prevention (CDC), ‘Wide-ranging online data for epidemiologic research (WONDER)’ <http://wonder.cdc.gov> (2020).
Clements K.W. and others, ‘The demand for marijuana, tobacco and alcohol: inter-commodity interactions with uncertainty’ (2009) 39(1) Empirical Economics 203-239.
D’Souza D.C. and others, ‘The psychotomimetic effects of intravenous delta-9-tetrahydrocannabinol in healthy individuals: implications for psychosis’ (2004) 29(8) Neuropsychopharmacology 1558–1572
Dangerous Drug Act 1952 [Act 234] <https://www.pharmacy.gov.my/v2/en/documents/dangerous-drugs-act-1952-and-regulations.html>.
Domino E.F., ‘Neuropsychopharmacologic studies of marijuana: Some synthetic and natural THC derivatives in animals and man’ (1971) 191(1) Marijuana: Chemistry, Pharmacology, and Patterns of Social Use 166-191.
Fragoso Y.D. and others, ‘Cannabis and multiple sclerosis’ (2020) 20(8) Expert Review of Neurotherapeutics 849-854
Freeman T.P. and others, ‘Changes in delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD) concentrations in cannabis over time: systematic review and meta-analysis’ (2021) 116(5) Addiction 1000.
Gage S. H. and others, ‘Association between cannabis and psychosis: epidemiologic evidence’ (2016) 79(7) Biological psychiatry 549-556.
Gobbi G. and others, ‘Association of Cannabis Use in Adolescence and Risk of Depression, Anxiety, and Suicidality in Young Adulthood: A Systematic Review and Meta-analysis’ (2019) 76(4) JAMA Psychiatry 426-434
Gomes F.V. and others, ‘Cannabidiol injected into the bed nucleus of the stria terminalis reduces the expression of contextual fear conditioning via 5-HT1A receptors’ (2012) 26(1) Journal of Psychopharmacology 104–113.
Greydanus D.E. and others, ‘Marijuana: current concept’ (2013) (42) Frontiers in Public Health 1, 1-17.
Hall W. and Degenhardt L., ‘Cannabis use and the risk of developing psychotic disorder (2008) 7(2) World Psychiatry 68-71.
Hall W. and Degenhardt L., ‘Medical marijuana initiatives: are they justified? How successful are they likely be?’ (2003) 17(10) CNS Drugs 689-697.
Haney M., ‘The marijuana withdrawal syndrome: diagnosis and treatment’ (2005) 7(5) Current Psychiatry Reports 360-365.
Harper S. and others, ‘Do medical marijuana laws increase marijuana use? Replication study and extension’ (2012) 22(3) Medical Marijuana Laws and Marijuana Use 207-212.
Hathaway A.D. and Sharpley J., ‘The cannabis experience: An analysis of flow’ in Jacquette D. (ed), Cannabis: What were we just talking about? (Wiley-Blackwell, 2010) <https://doi.org/10.1002/9781444324440.ch3>.
Hernandez S. H. and Nelson L.S., ‘Prescription drug abuse: insight into the epidemic’ (2010) 88(3) Clinical pharmacology and therapeutics 307–317 <https://doi.org/10.1038/clpt.2010.154>.
Howden M.L. and Naughton M.T., ‘Pulmonary effects of marijuana inhalation’ (2011) 5(1) Expert Review of Respiratory Medicine 87-92.
Kafil T.S. and others, ‘Cannabis for the treatment of Crohn’s disease’ (2018) 11 Cochrane Database of Systematic Reviews
___ ‘Cannabis for the treatment of ulcerative colitis’ (2018) 11 Cochrane Database of Systematic Reviews
Krishnan S. and others, ‘Cannabinoids for the treatment of dementia’ (2009) 2 Cochrane Database of Systematic Reviews. Art. No.: CD007204. .
Latif Z. and Garg N., ‘The impact of marijuana on the cardiovascular system: a review of the most common cardiovascular events associated with the marijuana use’ (2020) 9(6) Journal of Clinical Medicine 1925.
Leatherdale S.T. and others, ‘Marijuana and tobacco use among young adults in Canada: are they smoking what we think they are smoking?’ (2007) 18(4) Cancer Causes Control 391-397.
Liguori A. and others, ‘Separate and combined side effects of marijuana and alcohol on mood, equilibrium and simulated driving’ (2002) 163(3) Psychopharmacology 399-405.
Lintzeris N. and others, ‘Medical cannabis use in the Australian community following introduction of legal access: the 2018–2019 Online Cross-Sectional Cannabis as Medicine Survey (CAMS-18)’ (2020) 17(1) Harm Reduction Journal 37 <https://doi.org/10.1186/s12954-020-00377-0>.
Lutge E.E. and others, ‘The medical use of cannabis for reducing morbidity and mortality in patients with HIV/AIDS’ (2013) 4 Cochrane Database of Systematic Reviews .
Madadi P. and others, ‘Characteristics of Opioid-Users Whose Death Was Related to Opioid-Toxicity: A Population-Based Study in Ontario, Canada’ (2013) 8(4) PLoS ONE e60600 <https://doi.org/10.1371/journal.pone.0060600>.
Magen I.E.M. and others, ‘Cannabidiol ameliorates cognitive and motor impairments in bile-duct ligated micevia 5-HT1A receptor activation’ (2010) 159(4) British Journal of Pharmacology 950–957.
Manchikanti L. and others, ‘Therapeutic use, abuse, and nonmedical use of opioids: a ten-year perspective’ (2010) 13(5) Pain physician 401–435.
McLaren J. and Mattick R. ‘Towards a national cannabis strategy’ (2003) 6(1) Of Substance: The National Magazine on Alcohol, Tobacco, and Other Drugs 15.
___ ‘Towards a national cannabis strategy’ (2013) 4(1) Of Substance: The National Magazine on Alcohol, Tobacco and Other Drugs 15.
McLoughlin B.C. and others, ‘Cannabis and schizophrenia’ (2014) 10 Cochrane Database of Systematic Reviews
Medina S. and Khawand-Azoulai M., ‘Palliative Care and Symptom Management in Breast and Gynecological Cancers’ in Cristian A. (ed),
Breast Cancer and Gynecologic Cancer Rehabilitation (Elsevier, 2021).
Melberg H.O. and others, ‘Is cannabis a gateway to hard drugs?’ (2009) 38(3) Empirical Economics 583-603.
Millar S.A. and others, ‘A systematic review of cannabidiol dosing in clinical populations’ (2019) 85(9) British Journal of Clinical Pharmacology 1888–900.
Ministry of Health Malaysia (MOH), ‘Soalan lazim: Kanabis (Cannabis)’ Program Perkhidmatan Farmasi (6 March 2020) <https://www.pharmacy.gov.my/v2/ms/entri/soalan-lazim-kanabis-cannabis.html> accessed 14 April 2022.
Morgan C. and Curran H., ‘Effects of cannabidiol on schizophrenia-like symptoms in people who use cannabis.’ (2008) 192(4) British Journal of Psychiatry 306-307.
Morris R.G. and others, ‘The effect of medical marijuana laws on crime: evidence from state panel data, 1990-2006’ (2014) 9(3) PloS One e92816.
Mücke M. and others, ‘Cannabis‐based medicines for chronic neuropathic pain in adults’ (2018) 3 Cochrane database of systematic reviews
National Institute of Drug Abuse (NIDA), ‘Overview’ (2022) <https://nida.nih.gov/publications/research-reports/misuse-prescriptiondrugs/overview> accessed on 14 April 2022.
Nutt D.J. and others, ‘Drug harms in the UK: a multicriteria decision analysis’ (2010) 376(9752) Lancet 1558-1565.
Pacula R.L., ‘Examining the impact of marijuana legalization on marijuana consumption: insights from the economic literatures’ (2010) RAND Drug Policy Research Center 1-24.
Peprah K. and McCormack S., Medical Cannabis for the Treatment of Dementia: A Review of Clinical Effectiveness and Guidelines (Ottawa, Canadian Agency for Drugs and Technologies in Health, 2019).
Pereira J. and Wiegand T., ‘Marijuana’ (2014) 3 Encyclopedia of Toxicology 157-159. Elsevier Inc.
___ ‘Marijuana’ (2014) Encyclopedia of Toxicology, 2nd Ed. Elsevier Inc.
Pertwee R.G., ‘The diverse CB1 and CB2 receptor pharmacology of three plant cannabinoids: delta9-tetrahydrocannabinol, cannabidiol and delta9-tetrahydrocannabivarin’ (2008) 153(2) British Journal of Pharmacology 199–215.
Porath-Waller A.J. and others, ‘A meta-analytic review of school based prevention for cannabis use’ (2010) 37(5) Health Education & Behavior 709-723.
Ramo D.E. and Prochaska J.J., ‘Prevalence and co-use of marijuana among youth adult cigarette smokers: an anonymous online national survey’ (2012) 7(5) Addiction Science & Clinical Practice.
Ream G.L. and others, ‘Smoking tobacco along with marijuana increases symptoms of cannabis dependence’ (2008) 95(3) Drug and Alcohol Dependence 199-208.
Redonnet B. and others, ‘Tobacco, alcohol, cannabis and other illegal drug use among young adults: the socioeconomic context’ (2011) 121(3) Drug and Alcohol Dependence 231-239.
Richards B.L. and others, ‘Neuromodulators for pain management in rheumatoid arthritis’ (2012) 1 Cochrane Database of Systematic Reviews .
Rubinstein M.L. and others ‘Frequent marijuana use is associated with greater nicotine addiction in adolescent smokers’ (2014) 141 Drug and Alcohol Dependence 159-162.
Russo E. and Guy G.W., ‘A tale of two cannabinoids: the therapeutic rationale for combining tetrahydrocannabinol and cannabidiol’ (2006) 66(2) Medical Hypotheses 234–246.
Sarris J. and others, ‘Medicinal cannabis for psychiatric disorders: a clinically-focused systematic review’ (2020) 20(1) BMC Psychiatry 24 .
Scheir A.R.M. and others, ‘Cannabidiol: a Cannabis sativa constituent, as an anxiolytic drug’ (2012) 34(1) Official Journal of the Brazillian Psychiatric Association S104-S117.
Scheurmeyer J. and others, ‘Temporal trends in marijuana attitudes, availability and use in Colorado compared to non-medical marijuana states: 2003-2011’ (2014) 140 Drug and Alcohol Dependence 145-155.
Smith G.W. and others, ‘Patterns of polydrug use in Great Britain: findings from a national household population survey’ (2010) 113(2-3) Drug and Alcohol Dependence 222-228.
Smith L.A. and others, ‘Cannabinoids for nausea and vomiting in adults with cancer receiving chemotherapy’ (2015) 11 Cochrane Database of Systematic Reviews .
Stern C.A. and others, ‘On disruption of fear memory by reconsolidation blockade: evidence from cannabidiol treatment’ (2012) 37(9) Neuropsychopharmacology 2132–2142.
Substance Abuse and Mental Health Data Archive, National survey on drug use and health (Rockville, Maryland, 2014).
Substance Abuse and Mental Health Services Administration, ‘Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health’ (2020) <https://www.samhsa.gov/data/>.
United Nations Office on Drugs and Crime, World Drug Report 2021 (United Nations publication, Sales No. E.21.XI.8).
Van der Steur S. J. and others, ‘Factors moderating the association between cannabis use and psychosis risk: a systematic review’ (2020) 10(2) Brain sciences 97.
Walitt B. and others, ‘Cannabinoids for fibromyalgia’ (2016) 7 Cochrane Database of Systematic Reviews
Webster P.C., ‘Oxycodone class action lawsuit filed’ (2012) 184(7) Canadian Medical Association Journal E345–E346 <https://doi.org/10.1503/cmaj.109-4158>.
World Drug Report, Booklet 2: Global overview of drug demand and drug supply (Vienna, Austria, UNODC Research, 2021).
Zeiger J.S. and others, ‘Subjective effects for alcohol, tobacco, and marijuana association with cross-drug outcomes’ (2012) 123 Drug and Alcohol Dependence S53-S58.
Zin C.S. and others, ‘Trends and patterns of analgesic prescribing in Malaysian public hospitals from 2010 to 2016: tramadol predominately used’ (2018) 11 Journal of Pain Research 1959-1966 <https://doi.org/10.2147/JPR.S164774>.
Zinboonyahgoon N. and others, ‘Medicinal cannabis in Thailand: 1-year experience after legalization’ (2021) 162 Pain S105-S109.
Zulfiqar F. and others, ‘Cannabisol, a novel D9-THC dimer possessing a unique methylene bridge, isolated from Cannabis sativa’ (2012) 53 Tetrahedron Letters 3560-3562.
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