Between laughter and jokes, María Angela Villamil affirms with admirable calm: "It hurts me to be alive."
She jokes about her condition, while she says that she has lived with constant pain for four years, when an infection left her with a chronic, incurable and difficult to manage condition, according to what doctors have told her.
She has searched for all possible alternatives to cope with the pain and two years ago she found medicinal cannabis.
She came to this one through referrals from a friend who knew of successful cases and suggested someone who could sell her some drops.
The person who initially sold her the product was not a doctor, but she told him that she sought advice from one.
Villamil agreed and took cannabis drops for a few months.
She is a psychologist, she did not feel completely safe because of the risk of using a handmade product.
She kept looking and managed to contact a pain specialist doctor who designed a masterful cannabis formula for her, a kind of pharmaceutical preparation made from a personalized medical prescription, and she recommended a new provider that she had her support.
The treatment was not cheap.
After a year of regularly taking the new drops, one day she felt different effects.
She says that she lasted more than four hours outside of herself, with altered senses and consciousness.
It was a traumatic situation that, when repeated, led her to consult her doctor.
Villamil felt that neither she nor her supplier gave her satisfactory answers.
Although she decided to break up with that professional, she felt that cannabis was key in her treatment, so she continued to search for her.
Searching here and there, she came across Lenis Rivera, one of the most prominent doctors in pain treatment in the country and with extensive training in the use of medical cannabis.
Rivera explained that she had a “cognitive imbalance”, perhaps because the components of the cannabis she was using were unbalanced.
He prescribed a new formula, in another laboratory, and since then Villamil has had no problems with his treatment, which, he stresses, is key in a condition as complex as his.
Before having his private practice, Rivera worked at the Roosevelt Institute and later with KHIRON, a company dedicated to medical cannabis research and one of the leaders in this field in Colombia.
With KHIRON he was trained in Canada in relation to medical cannabis and returned to the country to train other doctors and promote the use of cannabis in the treatment of chronic pain and other associated symptoms.
Although Rivera highlights the results of the medicinal use of cannabis on the health of his patients, he repeatedly warns that it should be used under professional supervision: “Although cannabis is not harmful, it is not harmless either.
It can generate secondary effects in people who already have some pathology”.
Since the legalization of medical cannabis, the number of patients who turn to it looking for this medical alternative has grown.
This has implied more production, not always regulated or with conditions necessary for medical use.
That is why the treatments can cost more than 100 dollars per month, an inaccessible value for many.
This has meant that many patients use home-made medicines, less expensive but also more risky.
According to Rivera, the legalization must have gone hand in hand with a campaign from the Government to combat the stigma that cannabis maintains: “I would totally agree with it being something standardized.
Just as there are guidelines for the use of analgesics or for certain pathologies, there are also guidelines for the use of medicinal cannabis and health personnel should be aware of them.
There is still a lot of ignorance and fear, not only on the part of the patients, but also on the medical side, ”he assures in a conversation with EL PAÍS.
Dr. Lenis Rivera, pain specialist, in her office in Bogotá. JUAN PÁEZ
Medical access for a few
Since Resolution 2292 of 2021 of the Ministry of Health, medicines and master formulas containing CBD and THC, two substances found in cannabis, are covered in the Health Benefits Plan (PBS), formerly known as the Compulsory Health Plan. Health (POS), the list of products and services covered by public health insurance in Colombia.
This means that Health Provider Companies (EPS) must ensure their delivery to patients who need them, avoiding them having to pay for treatment out of pocket.
For Efraín López, legal adviser on cannabis matters and director of Árpez Company, one of the key points after legalization has been to achieve real access for all patients, beyond bureaucratic obstacles or large private costs.
For him, "it is urgent to include more cannabinoid drugs in the PBS, since it is the only way to democratize the use of medical cannabis," he says.
In addition to these barriers, the EPS recently gave a new interpretation to a document from the Ministry of Health and began to deny the delivery of master formulas through the PBS.
This is serious because it hinders patients' full access to their medicines and treatments.
Likewise, as the market is relatively new, there are also very few medicines with cannabinoids that are registered by Invima—the entity in charge of guaranteeing the sale of medicines in Colombia so that they are part of the PBS.
This results in the need to expand the offer, but this takes time, because the scientific literature on medical cannabis is barely under construction, which is an impediment for pharmaceutical companies to develop new cannabis medicines and achieve their registration.
For López, Colombia could follow the experience of Brazil, where pharmaceutical companies had a five-year grace period in which they used a temporary health registry that allowed them to be prescribed and, from there, generate evidence for the scientific literature.
The expert affirms that the arrival of the Government of Gustavo Petro can be an opportunity to get out of the limbo that remained.
Especially if he materializes the proposals that he has put forward for a transformation of drug policy.
“Important scenarios open up as long as the Petro administration comprehensively lands these ideas in the medical cannabis sector.
And finally, it is possible to reflect the essence of Law 1787 of 2016, which was, among others, comprehensive access to medical cannabis for the population.”
This is also what the anesthesiologist Jaime Jaramillo refers to, who after decriminalization created, together with other colleagues, PENSAKANA, a research center on medical cannabis.
For him, the Government did not apply the Law rigorously, and left legal and medical loopholes that mainly affect patients.
"It is essential that the Government apply the law as it should have been from the beginning, which implies an economic analysis, setting maximum sales prices taking into account all the actors involved in the chain of commerce, among others," he reflects.
López and Jaramillo agree that, given the substantial growth of people seeking alternative therapies and the rapid development of this industry, the Government is indebted to land medical cannabis not as a way to decriminalize, but as a health issue. that can have a real impact on the lives of patients like María Angela Villamil.
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