While working as a product presenter for an alcohol brand at a pub in Sukhothai two years ago, Thitiporn Waritthanan was given a box of brownies by a male tourist. Five pieces she swallowed out of hunger. Yet little did she realise they were not ordinary brownies sold at any given market.
According to news reports, not long after the 26-year-old model ate the fudgy chocolate cake, she became severely hallucinatory, so much so she was rushed to a hospital in the province before being transferred to Buddhachinaraj Hospital in Phitsanulok. Later, it was found that the brownies were infused with marijuana.
Two days later, she still reportedly suffered anxiety and stress. According to her doctor, such an amount of weed she consumed would take effect for at least three days and in a worst-case scenario, the overconsumption of marijuana could put consumers at risk of heart failure.
"Marijuana-infused snacks and food can be highly intoxicated especially if dosage per unit is inappropriate. For example, only one bite of such snacks could be considered an overdose," said Asst Prof Dr Sahaphume Srisuma of Mahidol University's Ramathibodi Poison Centre.
Dr Sahaphume addressed the risk aspects of cannabis use at the ninth National Conference in Toxicology, recently organised by the Thai Society of Toxicology, the Thailand Risk Asessment Centre, the Institute of Nutrition, and the Thai Environmental Mutagen Society.
Although Thailand has legalised the use of cannabis for medical purposes following the revision of the Narcotics Act by the National Legislative Assembly late last year, medical marijuana is still considered a subject of controversy even among medical practitioners themselves. While Thailand is still debating how medical cannabis should be managed and controlled, other countries have taken steps forward. The United States, for example, welcomed Lowell Farms: A Cannabis Cafe as the country's first cannabis cafe earlier this month. Located in West Hollywood, California, the much-hyped 240-seat establishment is open for people aged 21 and above to consume marijuana freely.
America's first cafe to allow the consumption of cannabis opened earlier this month in California. (Photo: Kyle Grillot/Bloomberg)
According to a Reuters report, the food served at Lowell Cafe will not be infused with cannabis, but diners will be offered the services of a "flower host", who will advise how to pair different strains of marijuana with menu items and roll a joint at the table. In the meantime, Australia was reported earlier this month to have allocated a budget of AU$3 million (61.9 million baht) on cannabis product research to help patients falling victim to cancer.
Anunchai Assawamakin of the Department of Pharmacology, Mahidol University's Faculty of Pharmacy, said that what prevents Thailand from fully benefiting from medical cannabis is "madness". While in fact consumers as well as medical practitioners have a lot of cannabis-related knowledge input, they fail to connect the dots.
"The battle between Eastern and Western [medicine] is a consequence of a belief that they have different sources of knowledge. Western medicine believes well-designed methodology and research are most reliable. Eastern and Western medicine merely look at marijuana from different perspectives," said Anunchai.
After the legalisation of medical marijuana in Thailand, the country has three cannabis oil brands that have been legally approved -- the cannabis oil from the Government Pharmaceutical Organisation (GPO), the oil from the Chaophraya Abhaibhubejhr Hospital, and one from Daycha Siripatra, founder and president of the Khao Kwan Foundation.
"All the cases that have been reported to the Ramathibodi Poison Centre involved underground cannabis oil. So without cannabis oil brands that are allowed to be operated legally, people will definitely turn to underground products," said the pharmacology lecturer.
"As with anything, cannabis can be poisonous," he added. "What's important is how to properly control and manage it so that consumers can get the best benefit from it."
Thailand Public Health Minister Anutin Chanvirakul shows off extracted cannabis oil. (Photo: Sakchai Lalit/AP)
Dr Sahaphume echoed Anunchai's sentiment, quoting an adage that is a basic principle of toxicology: Only the dose makes the poison.
Cannabis in fact has more than 400 chemical compounds. The two active components for medicinal use are tetrahydrocannabinol (THC) and cannabidiol (CBD). THC -- the main chemical compound in cannabis -- is responsible for the high but is also used in various countries to relieve pain and nausea among patients suffering the side effects of chemotherapy. CBD, on the other hand, can counteract the high caused by THC. It has been proven to help reduce pain and act as an anti-inflammatory agent. Setting aside the medicinal benefits of weed's chemical compounds, Dr Sahaphume admitted that people who usually develop adverse side effects following cannabis use are rookies not familiar with the products.
"It's important for people new to cannabis medical products such as cannabis oil to start at the lowest dose," explained Dr Sahaphume. "Another problematic group of consumers is those who decide to repeat the dose because of delayed effects. Then there are those who use a high dose of cannabis oil. With all these misuses, consumers will end up in hospital. Therefore accurate advice needs to be given."
Despite cases of psychological effects caused by inappropriate use of medical cannabis, as well as the proven association between legalised marijuana and a sharp rise in car crashes in the United States, Dr Sahaphume believes that one major reason some groups of patients in Thailand decide to opt for medical cannabis is that they fail to be well responded to by the country's hospital system. "Time is the solution, not weed," commented Dr Sahaphume. "Patients want to get cured; they don't want to just use marijuana. These patients must be properly treated and cared for."
Amid the cannabis controversy, Anunchai believes that all aspects need to be controlled and managed wisely. Medical cannabis, said the pharmacist, is a truly individualised medicine. Fifty percent of Parkinson's patients, for example, will benefit from cannabis oil while the rest might fail. So right now, the problem is not about the country and its people not realising that cannabis is good. Thailand, he said, only falls short of a system to closely monitor and control the production and distribution of weed products.
"Marijuana from different locations has different levels of chemicals. So if we are to control it, we must start at the environment in which it is grown. Equally important is the extraction process, what type of solvent is used.
Cannabis oil products manufactured by the Government Pharmaceutical Organisation. (Photo: Pattarapong Chatpattarasill)
"The direction of control should gear toward accessibility, public-harm reduction and supply-chain management. If all this can be taken care of, there will be no more underground [medical cannabis products], which is the right approach toward consumer protection. This is one way to promote health for patients while reducing harm for people."
What's good about medicinal cannabis?
Medicinal marijuana has been proven effective in treating a variety of medical conditions, including:
- chronic pain
- neuropathic or nerve pain
- cancer pain
- nausea and vomiting associated with chemotherapy
- improving appetite in people with cancer and HIV/Aids
- multiple sclerosis
- certain types of epilepsy
However, risks involve:In case of acute intoxication
- feeling relaxed and drowsy
- impairment of memory, concentration and problem solving
- loss of co-ordination
- dry mouth and red eyes
- increased heart rates
High dosage of cannabis can also potentially result in:
- altered perceptions (such as time and space)
- panic and anxiety
- confusion
- paranoia and hallucination
Information from the ninth National Conference in Toxicology.
