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Journal of Cannabis Research volume 4 , Article number: 33 Cite this article. Metrics details. Cannabis sativa has accompanied humankind since ancient times, permeating the most diverse aspects of its existence, among which the search for health promotion and well-being stands out. Nevertheless, during the twentieth century, a series of restrictions and controls have been adopted internationally to prevent the abusive use of this species. Despite that, there has been an increased demand for the medical use of cannabis and its derivatives in the last few decades, especially among patients with debilitating conditions for which the existing therapeutic alternatives are limited. Accordingly, several countries have adopted regulatory strategies to allow access to cannabis-based products. This study aimed to overview the existing regulatory frameworks for medical cannabis around the world, focusing on the current Brazilian scenario. In addition to supply and access regulation aspects, some quality-related issues regarding cannabis-based pharmaceutical products were addressed, with emphasis on risks to patients. The literature research was performed between October and March According to the retrieved information, by the time the data collection was completed, thirty-six countries had already implemented regulatory frameworks regarding medical cannabis, and sixteen countries had models under development or in the process of implementation. The characteristics of the assessed regulatory strategies vary considerably from country to country, reflecting sociocultural, historical, and political aspects. Among the key aspects that differed between the assessed models, one can highlight the type of cannabis products that are made available and the technical requirements applied to them, as well as the possible access mechanisms. Different supply regulation strategies were also observed regarding cannabis cultivation, production licensing, and distribution mechanisms. The species Cannabis sativa L. Cannabaceae has been cultivated by humankind since the emergence of the first agricultural civilizations, being adapted to diverse uses, including as a source of food, oil, and fiber, as well as for medicinal, recreational, and religious purposes Robert Clarke ; Bonini et al. This human-driven selection process over several centuries is the origin of the phenotypic diversity of species that remains nowadays Bonini et al. Although there are records of the medicinal use of the species in various cultures since ancient times, it was not until the nineteenth century that the interest in exploring its therapeutic potential became outstanding in the Occident Robert Clarke ; Seddon and Floodgate This period was marked by the widespread use of commercial cannabis-based products, which were mainly used as anti-inflammatory, analgesic, anti-emetic, and anti-convulsant Bonini et al. This was reflected in the inclusion of monographs of the species in some official compendia, including the United States Pharmacopeia Madras ; Giancaspro et al. Nevertheless, the active constituents of the species were not known at that time and there was no adequate standardization of the commercial pharmaceutical products, which caused their therapeutic effects to be highly variable. In addition, therapeutic alternatives of synthetic origin emerged at the beginning of the twentieth century. Together, these factors lead to a dramatic decline in interest in the medical use of this species Pisanti and Bifulco ; Madras ; Kalant and Porath-waller Despite this, there were no reports of serious cases of intoxication by cannabis products Pisanti and Bifulco Also during that period, observation of potential risks associated with cannabis use, including the abuse and chemical dependency, has raised concerns from government authorities in several countries, leading to the formulation of restrictive laws regarding the growth, commercialization, and consumption of the species Pisanti and Bifulco ; Seddon and Floodgate ; Madras ; European Monitoring Centre for Drugs and Drug Addiction a. In Brazil, trade-in all substances considered to be narcotics was prohibited in and, in , Decree Among the guidelines defined in the UN Assembly, one can highlight the facilitation of access to controlled substances for medical and research purposes Mackay and Phillips In spite of the limitations imposed by the aforementioned prohibitionist policies, the research into the phytochemical composition and the pharmacological properties of C. A number of non-clinical and clinical studies have been carried out in the last decades, providing scientific evidence of the effectiveness of C. In this regard, one can highlight the use of cannabidiol CBD to reduce seizures in patients with refractory epilepsy when added to conventional anti-epileptic drugs, especially in children with Dravet and Lennox-Gastaut syndromes Stockings et al. Therefore, additional clinical trials of good methodological quality are still needed in order to support the aforementioned therapeutic claims European Monitoring Centre for Drugs and Drug Addiction b ; Health Products Regulatory Authority ; Dinis-Oliveira ; Russo Regarding the safety profile of cannabis-based medicinal products, the risks associated with the short-term use have been considered analogous to those of other medicines available on the market, with serious adverse effects rarely reported in clinical trials. On the other hand, long-term risks are less known; therefore, further studies are needed to generate sufficient evidence European Monitoring Centre for Drugs and Drug Addiction b ; Health Products Regulatory Authority Notwithstanding the recent cannabis rescheduling, the development of scientific-based regulations that address health risks related to the use of cannabis products, as well as adequate quality specifications, is still a challenge. Additional information was also retrieved from websites of regulatory agencies from assessed countries and gray literature relevant to the addressed topic. A set of relevant aspects for the evaluation and comparison of the addressed regulatory models was defined, including four main subjects: I supply regulation, II demand regulation, III type of available products, and IV technical criteria related to the available products. Each of those subjects was divided into two or more subtopics treated separately. A set of categories was defined for each subtopic in order to allow a standardized classification of the evaluated models see Supplementary Material. International drug control treaties in force do not prevent signatory nations from allowing the use of cannabis for medical and scientific purposes within their territories European Monitoring Centre for Drugs and Drug Addiction a ; World Health Organization ; European Monitoring Centre for Drugs and Drug Addiction b ; United Nations Office on Drugs and Crime For that, however, a set of stringent control measures are required, among which stands out the need to establish government agencies responsible for controlling the medical cannabis supply chain, which must report to the International Narcotics Control Board INCB World Health Organization ; European Monitoring Centre for Drugs and Drug Addiction b ; Health Products Regulatory Authority ; Aguilar et al. National cannabis agencies also have the exclusive right to maintain stocks of harvested plant material, being responsible for its distribution on a wholesale scale Health Products Regulatory Authority Furthermore, cannabis-based products should be dispensed upon prescription and used under medical supervision, based on evidence of their safety, effectiveness, and quality European Monitoring Centre for Drugs and Drug Addiction b. The INCB considers that the cultivation of cannabis for personal medical use does not meet the minimum criteria related to the control requirements of the Convention. Therefore, signatory countries whose regulatory framework allows cannabis self-cultivation would be in breach of this treaty Health Products Regulatory Authority Cannabis cultivation exclusively for industrial obtaining of seeds and fibers is exempted from the controls of the aforementioned treaty United Nations Office on Drugs and Crime It is worth mentioning that the UN Convention does not establish distinctive restrictive control regimes for different cannabis variants, regardless of their variety concerning cannabinoid profiles, which is known to be decisive for the psychopharmacological properties of the species World Health Organization The aforementioned requirements provide a background for signatory countries to outline their regulatory frameworks regarding medical cannabis. Nevertheless, development processes have been predominantly idiosyncratic, resulting in a variety of regulatory approaches which reflect cultural, historical, and political aspects European Monitoring Centre for Drugs and Drug Addiction b ; Belackova et al. Different outcomes can also be observed depending on the characteristics of these regulatory models, as well as on the local context Seddon and Floodgate ; European Monitoring Centre for Drugs and Drug Addiction b ; Belackova et al. It can be noticed that most countries that currently have regulatory policies for access to medical cannabis are concentrated in the Americas and Europe Fig. Some of the elements that characterize these different regulatory approaches will be discussed below. Additional information on implemented regulatory frameworks can be found in Table S1 Supplementary Material. Regulatory models regarding access to medical cannabis around the world and their classification according to the types of available cannabis-based pharmaceutical products. The classification is based on data obtained from October to March The sources of the original information regarding the assessed models are listed in the supplementary material. Legal status of medical cannabis and cannabis-based pharmaceutical products around the world. Among the key aspects that may differ between different regulatory models, one can highlight the type of cannabis products that are made available for patients, along with the access mechanisms to them European Monitoring Centre for Drugs and Drug Addiction a ; European Monitoring Centre for Drugs and Drug Addiction b ; Health Products Regulatory Authority ; Belackova et al. Cannabis-based medicinal products can be classified primarily between those that have undergone a regular marketing authorization process for medicines and those that have gone through more simplified authorization processes or were even exempted from specific regulatory authorizations. While for the former, it is necessary to prove their safety and efficacy through extensive non-clinical and clinical studies, in addition to demonstrating compliance with the elements of Good Manufacturing Practices GMP , including proper quality assurance; for the latter, there is generally no guarantee that these aspects are met Seddon and Floodgate ; European Monitoring Centre for Drugs and Drug Addiction b. Notwithstanding the clear advantages of the conventional regulatory pathway European Monitoring Centre for Drugs and Drug Addiction b ; Belackova et al. This can be attributed, at least in part, to the access difficulties arising from the strict controls imposed on cannabis, even when it comes exclusively to scientific research-related activities Small It is also worth mentioning that the inherent variability in the chemical composition and the lack of appropriate characterization of herbal extracts are complicating factors in the process of drawing conclusions from the results of a set of different clinical trials Food and Drug Administration This also applies to clinical trials conducted with cannabis-based medicines, which are sometimes not comparable with each other regarding the pharmaceutical formulation, dosage form, and chemical composition of the cannabis-based active pharmaceutical ingredients API European Monitoring Centre for Drugs and Drug Addiction b ; Health Products Regulatory Authority ; Dinis-Oliveira ; Russo Consequently, the set of cannabis-based medicines that meet the requirements for marketing authorization under the conventional pathway is still limited. As far as we know, all currently available medicines that fall within this category are characterized by containing isolated cannabinoids or synthetic analogous as API rather than crude C. Dronabinol or nabilone-based medicines are also regularly registered in various countries European Monitoring Centre for Drugs and Drug Addiction b ; Health Products Regulatory Authority , although their use is currently less frequent. Another drawback of the regularly registered cannabis medicines is their relatively high cost, which imposes additional access difficulties, especially on low-income patients Seddon and Floodgate ; European Monitoring Centre for Drugs and Drug Addiction b ; Belackova et al. Given the abovementioned limitations, some regulatory authorities have adopted alternative strategies to make cannabis medicinal products available European Monitoring Centre for Drugs and Drug Addiction b ; Health Products Regulatory Authority ; Aguilar et al. In most cases, these products are supposed to be dispensed on prescription and should be used under medical supervision. As the therapeutic indications for this type of cannabis products are not defined based on clinical studies presented during the marketing authorization process, some regulatory approaches include the pre-definition of a set of eligible diagnoses e. In addition to the aforementioned approaches, there are others that include access policies to cannabis products outside the medicines regulatory system Seddon and Floodgate ; European Monitoring Centre for Drugs and Drug Addiction b ; Health Products Regulatory Authority ; Aguilar et al. Most of those schemes include access to herbal cannabis, with varying levels of quality requirements, ranging from pharmaceutical-grade medicinal cannabis e. Classification of the assessed regulatory models with regard to the possibility of access to herbal cannabis. Classification of the assessed regulatory models with regard to the possibility of medical cannabis cultivation and the purposes of that activity. API, active pharmaceutical ingredient. One important drawback of those more permissive approaches is the lack of confidence among physicians to recommend the use of medical cannabis without the proper support of clinical evidence Seddon and Floodgate ; European Monitoring Centre for Drugs and Drug Addiction b ; Health Products Regulatory Authority ; Schlag Indeed, the widespread use of unregistered cannabis products that have not undergone clinical trials is far from ideal, especially since C. Moreover, unregistered medical cannabis preparations are often obtained in breach of Good Agricultural Practices GAP or Good Manufacturing Practices GMP , which raises serious concerns regarding quality issues, among which heterogeneity of cannabinoid concentration stands out World Health Organization ; Health Products Regulatory Authority ; Dinis-Oliveira As a result, batch-to-batch consistency of the safety-efficacy profile may not be guaranteed, which compromises the promotion of rational use of medical cannabis Health Products Regulatory Authority ; Dinis-Oliveira It is also worth mentioning that access schemes outside the medicines regulatory system may discourage the conduct of appropriate clinical trials, in addition to making it more difficult to systematically assess the benefits and risks associated with the use of medical cannabis European Monitoring Centre for Drugs and Drug Addiction b ; Health Products Regulatory Authority In order to mitigate the possible negative impacts of using less regulated cannabis products, some access policies limit their indication to patients with debilitating or life-threatening conditions who are refractory to treatment with conventional medicines European Monitoring Centre for Drugs and Drug Addiction b ; Krcevski-Skvarc et al. For those patients, the possibility of improving life quality outweighs the possible risks. This understanding is also at the basis of compassionate use schemes, which allow access to medicines under clinical investigation or regulatory approval phase Seddon and Floodgate ; European Monitoring Centre for Drugs and Drug Addiction b ; Health Products Regulatory Authority ; Aguilar et al. Although restricted, these access policies usually serve as a starting point for more elaborate regulatory frameworks Health Products Regulatory Authority Patient authorization mechanisms may also vary from country to country. Most accessed schemes are based on conventional medical prescriptions Table S1, Supplementary Material. Administrative approvals such as individual patient registration are also required in some cases, especially for regulatory approaches based on access to unregistered cannabis-based preparations European Monitoring Centre for Drugs and Drug Addiction b ; Aguilar et al. The assessed regulatory models also differed concerning medical cannabis supply. Four distinguishing aspects can be highlighted on this topic: I cannabis cultivation whether it is allowed or not and for what purposes ; II the extent of domestic supply whether pharmaceutical preparations are imported or manufactured domestically and, in this case, whether the API is imported or not ; III the production licensing whether growing and manufacturing activities are centralized by government agencies or undertook by licensed private companies ; and IV distribution mechanisms whether this activity is centralized or not. In certain countries, cultivation is limited to API obtention to be supplied to the pharmaceutical industry, under controlled conditions e. Besides, there are those with more comprehensive models, which provide for the possibility of cultivation for different purposes e. Regardless of the aforementioned distinctions, countries that authorize Cannabis cultivation adopt a series of control measures, including the granting of specific licenses by the government, according to the scale and purpose of cultivation Health Products Regulatory Authority ; Belackova et al. Certification on GAP is also required in some countries e. Similarly, the manufacturing of cannabis-based pharmaceutical products on an industrial scale must also comply with GMP requirements and are generally conditional on the granting of specific licenses European Monitoring Centre for Drugs and Drug Addiction b ; Health Products Regulatory Authority ; Aguilar et al. Additional requirements concerning facility security, such as access controls, crop integrity assurance, and disposal or destruction of cannabis remains, may also apply in some cases e. The state can assume different roles regarding the cannabis supply chain regulation, ranging from the simple monitoring of the activities carried out by licensed companies e. The most centralized models of supply chain regulation are often associated with better control of possible risks to patients, including those related to quality issues and deviations from intended use, although they generally offer less flexibility in terms of access options Belackova et al. The costs involved and the structure available to government agencies are also factors to be considered when defining the best regulatory approach. Some regulatory models also provide for self-cultivation by patients or cultivation by caregivers or associations for direct supply to patients, either alone or in parallel with large-scale cultivation European Monitoring Centre for Drugs and Drug Addiction b ; Aguilar et al. Self-cultivation is often conditioned to the obtaining of previous individual authorization from regulatory authorities, which, in most cases, is dependent on medical recommendation. Several regulatory approaches establish clear limits on the number of cannabis plants or the amounts of herbal cannabis the patient may keep for personal consumption. Such limits, however, vary significantly from country to country Table S1, Supplementary Material. The technical requirements applied to cannabis-based products are another relevant distinguishing aspect of the regulatory models. For cannabis-based medicines submitted to a regular marketing authorization process, technical criteria are generally well defined within the scope of the medicine regulatory system. In turn, the technical criteria imposed on unregistered cannabis products may vary depending on the regulatory framework Seddon and Floodgate ; European Monitoring Centre for Drugs and Drug Addiction b ; Russo ; Aguilar et al. For instance, some regulatory schemes require that unregistered products are manufactured according to GMP requirements and that their relevant quality attributes are monitored so that batch-to-batch consistency can be ensured e. Others include non-industrialized products, such as officinal and magistral preparations, which may lack appropriate quality control and standardization MacCallum and Russo Table S1, Supplementary Material. For regulatory models that provide access to unregistered products, the need to prevent risks associated with exposing patients to low-quality, adulterated, or contaminated products is a major concern. In this regard, the search for the definition of appropriate parameters of identity, purity, and cannabinoid content applied to cannabis-based API and pharmaceutical products is worth noting World Health Organization ; Sarma et al. Among the critical quality issues to be considered regarding herbal cannabis, one can highlight the need to characterize and standardize the cannabinoid profile and to guarantee that the plant material is free from microbiological e. On this topic, the known susceptibility of herbal cannabis to contamination by fungi of the species Aspergillus fumigatus L. Monitoring the stability of cannabis-based API and pharmaceutical products through the assessment of relevant quality attributes is also a challenge European Monitoring Centre for Drugs and Drug Addiction b. In this context, stand out the development of some quality monographs on cannabis inflorescences, including the German Pharmacopoeia monograph Deutsches Arzneibuch n. It is also worth mentioning that initiatives from organizations such as the Association of Official Analytical Chemists AOAC International and the American Society for Testing and Materials ASTM have engaged different stakeholders in the development of independent quality standards and guidelines, which may help to construct a set of appropriate analytical methods and quality specifications for medical cannabis Sarma et al. In Brazil, the species C. Nonetheless, the regulation of this activity remained pending, hindering its execution from a practical standpoint. Since , there have been some notable advances toward allowing the medicinal use of the species in the country. Parallel to this, discussions about the viability of the medicinal use of the species gained ground in the national congress. However, authorization applicants were exempted from the presentation of safety and efficacy proofs. This regulatory approach was mainly driven by the increased demand for the availability of these products in the domestic market. However, many of the imported products have not been subject to regulatory approval as medicines in countries of origin; therefore, relevant parameters regarding their quality, safety, and efficacy may have been neglected. Furthermore, the costs of acquiring these products via importation are generally very high when considering the socioeconomic reality of most Brazilians de Oliveira et al. Consequently, it is common for interested patients to apply to the courts for these products to be paid for by the public health system, which is often granted de Oliveira et al. However, in view of the overall low quality of most of those products, there is no evidence of a favorable cost-benefit ratio in this situation. Faced with the limited availability of affordable cannabis medicinal products, many patients end up resorting to lower-cost access alternatives such as self-cultivation, which is not regulated, or clandestine distribution networks. There are also non-profit associations of patients that have obtained exemptional legal authorizations for cannabis cultivation and preparation of cannabis extracts for medicinal purposes de Oliveira et al. Indeed, it is not uncommon for patients who have experimented with using imported non-pharmaceutical grade products to hypothesize that self-cultivation would be a lower-cost strategy that would provide equivalent results de Oliveira et al. This reasoning, however, establishes a false dichotomy between the two options i. In addition, there is a lack of understanding among the lay population that cannabis-based products with therapeutic claims are complex in terms of composition, preparation process, and pharmacological effects and, therefore, should be treated and controlled as medicines. In view of the above, it is noticeable that, despite the approaches adopted in recent years to expand the availability of cannabis-based products in Brazil, a large portion of the interested patients still have limited access to quality pharmaceutical products. The current text of this legislative proposal provides for C. If approved, this may favor the access to cannabis-based API by pharmaceutical industries and research institutes. However, the effectiveness of these measures will depend on how they are implemented and the enforcement mechanisms established. One of the challenges of medical cannabis regulation is to achieve a balance between guaranteeing patients access to the products they need and controlling the risks inherent to their use Belackova et al. In an ideal scenario, the development of regularly registered cannabis-based medicines should be prioritized, for which the relevant aspects of safety, efficacy, and quality are properly investigated Health Products Regulatory Authority This favors the construction of a solid basis for the rational use of these products. On the other hand, higher regulatory standards generally imply higher costs, which can hinder patient access, unless appropriate strategies are adopted by the government Belackova et al. The establishment of price control policies for cannabis-based medicines is necessary to prevent abusive practices from being adopted and patients from being driven to resort to the illegal cannabis market or self-cultivation instead Seddon and Floodgate ; Aguilar et al. However, it is worth mentioning that any costs imposed on the public health system should be outweighed by the proven benefits of the interventions Bacchi In this context, it would be important that the cannabis-based products subsidized by the Brazilian public health system should have their efficacy and safety duly based on clinical evidence. Notwithstanding, this condition is neglected in the abovementioned bill. The definition of relevant quality standards for cannabis-based API and products is also of ultimate importance. In this context, the development of pharmacopeial monographs for C. The promotion of an environment that encourages research and innovation is also an important factor so that well-designed products with favorable safety-efficacy profiles are made available to the population Health Products Regulatory Authority ; Dinis-Oliveira The definition of clear guidelines for the construction of the set of safety and efficacy proofs required for registration or marketing authorization of cannabis-based medicines is also an important aspect to be considered. Furthermore, monitoring the adverse effects of cannabis-based products available on the market, through an adequate pharmacovigilance system, is of great importance so as to ensure the risk-benefit ratio remains favorable over time for patients who use them Health Products Regulatory Authority ; Schlag The collection of safety data also allows the development of an evidence base that may further favor the regulatory framework improvement Schlag In this process, maintaining an open dialog between different stakeholders, including members of the scientific community, regulators, prescribing professionals, and patients can favor meeting the demands of society while maintaining the scientific rigor necessary to the subject Health Products Regulatory Authority ; Aguilar et al. It is also worth mentioning the need to provide an appropriate education for patients, in such a way that their concerns are addressed, so that they can understand the risks and benefits of therapy with cannabis-based products and dispel false and skewed views about them Health Products Regulatory Authority ; Schlag The debate over the medical use of C. On the one hand, the stigma created over many decades on the plant species has favored that several stakeholders advocate strictly prohibitionist policies, overestimating risks and failing to recognize the already proven benefits arising from its therapeutic use in certain conditions Seddon and Floodgate ; Aguilar et al. On the other hand, there are those who support indulgent access policies, based mainly on the popularly widespread misperception that C. As well as other medicines, medical cannabis and its derivatives should have their use based on evidence of quality, safety, and efficacy Health Products Regulatory Authority ; Government of Australia Nevertheless, the tendency to avoid investigating sensitive or controversial subjects, along with the difficulties imposed by international prohibitionist policies, has hampered scientific research on the therapeutic and pharmacological properties of the species, resulting in a knowledge gap that remains nowadays Small As a consequence, the scientific data that would be required for the regularization of cannabis-based medicines through conventional regulatory pathways are sometimes insufficient Health Products Regulatory Authority In addition, it is important to keep in mind the purposes of the medical cannabis regulation, with an emphasis on reducing risks to patients, as well as to develop mechanisms for clear communication with interested parties so they can understand both strengths and limitations of the regulatory choices. At the same time, regulators and policymakers should be able to recognize and be sensitive to the demands of the population, seeking to include them in the decision-making process Health Products Regulatory Authority Finally, the construction of regulatory models should be understood as a continuous process, and there must be spaces for constant improvement according to the observed outcomes and the evolution of scientific knowledge. The dataset generated and analyzed during the current study is available in the supplementary material. Medical use of cannabis and cannabinoids containing products — regulations in Europe and North America. Eur J Internal Medi. Article Google Scholar. RDC n. Google Scholar. RDC n o 03 de 26 de janeiro de RDC n o 17 de 6 de maio de RDC n o de 2 de dezembro de Medicinal cannabis policies and practices around the world. Int Drug Policy Consortium. Alves M. The Natural Fallacy in a Post-Truth era. EMBO Rep. Pharmacol Res. Bacchi A. 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Deutsches Arzneibuch. Trial of cannabidiol for drug-resistant seizures in the dravet syndrome. Dinis-Oliveira RJ. The clinical toxicology perspective on the therapeutic use of cannabis and cannabinoids. Acta Med Portuguesa. European Medicines Agency. Epidiolex Assessment Report, vol. Cannabis legislation in Europe. Medical use of cannabis and cannabinoids: questions and answers for policymaking. Luxembourg: Publications Office of the European Union; b. Expert Committee on Drug Dependence. Annex 1-extract from the report of the 41 st expert committee on drug dependence: cannabis and cannabis-related substances; Food and Drug Administration. Botanical drug development - guidance for industry: U. Department of Health and Human Services. Silver Spring; Approval Letter. Application number Orig1s Stimuli to the revision process: the advisability and feasibility of developing USP standards for medical cannabis. Pharmacopeial Forum. Government of Australia. Health Products Regulatory Authority. Cannabis for medical use - a scientific review; Hillig KW. A chemotaxonomic analysis of terpenoid variation in cannabis. Biochem Syst Ecol. Kalant H, Porath-waller AJ. Mapping medical marijuana: state laws regulating patients, product safety, supply chains and dispensaries, Koltai H, Namdar D. Trends Plant Sci. Promoting cannabis products to pharmaceutical drugs. Eur J Pharm Sci. Review on clinical studies with cannabis and cannabinoids — Mult Scler. Eur J Pain. Therapeutic potential of cannabis, cannabidiol, and cannabinoid-based pharmaceuticals. Practical considerations in medical cannabis administration and dosing. Eur J Internal Med. Mackay R, Phillips K. Madras BK. Update of cannabis and its medical use. Alcohol Drug Abuse Res. Medicinal Cannabis Agency. Guideline on the regulation of medicinal cannabis in New Zealand. New Zealand. Misuse of drugs medicinal cannabis regulations Oliveira MB. Liinc em Revista. Pisanti S, Bifulco M. Modern history of medical cannabis: from widespread use to prohibitionism and back. Trends Pharmacol Sci. Robert Clarke MM. Cannabis: evolution and ethnobotany. Press U of C, editor; Pharmacognosy qualitative terpene profiling of cannabis varieties cultivated for medical purposes. Russo EB. Current therapeutic cannabis controversies and clinical trial design issues. Medicinal Cannabis Scheme in New Zealand: lessons from international experience and our own recent drug policy reform setbacks. PubMed Google Scholar. Ottawa: Gouvernement du Canada; Cannabis inflorescence for medical purposes: USP considerations for quality attributes. J Nat Prod. Schlag AKK. An evaluation of regulatory regimes of medical cannabis: what lessons can be learned for the UK? Med Cannabis Cannabinoids. Seddon T, Floodgate W. Regulating cannabis. Cham: Springer International Publishing; Book Google Scholar. Small E. 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The health and social effects of nonmedical cannabis use. Chapter 1. Download references. You can also search for this author in PubMed Google Scholar. All authors participated in the conception of the work. MRS was responsible for the data acquisition, analysis, and interpretation, as well as for the writing of the manuscript and the elaboration of the figures and supplementary material. The authors have given approval to the final version of the manuscript. That said, there are no competing interests. Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. Reprints and permissions. Medical cannabis regulation: an overview of models around the world with emphasis on the Brazilian scenario. J Cannabis Res 4 , 33 Download citation. Received : 31 May Accepted : 07 June Published : 16 June Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Abstract Cannabis sativa has accompanied humankind since ancient times, permeating the most diverse aspects of its existence, among which the search for health promotion and well-being stands out. Background The species Cannabis sativa L. Medical cannabis regulation around the world International drug control treaties in force do not prevent signatory nations from allowing the use of cannabis for medical and scientific purposes within their territories European Monitoring Centre for Drugs and Drug Addiction a ; World Health Organization ; European Monitoring Centre for Drugs and Drug Addiction b ; United Nations Office on Drugs and Crime Full size image. Medical cannabis in Brazil: status and perspectives In Brazil, the species C. Conclusion The debate over the medical use of C. Availability of data and materials The dataset generated and analyzed during the current study is available in the supplementary material. Google Scholar Brasil. Google Scholar Food and Drug Administration. Google Scholar Government of Australia. Google Scholar Madras BK. Google Scholar Medicinal Cannabis Agency. Google Scholar New Zealand. Google Scholar Oliveira MB. Google Scholar World Health Organization. Google Scholar Download references. View author publications. Supplementary Information. Additional file 1: Table S1. Regulatory models. About this article. Cite this article de Souza, M. Copy to clipboard. Contact us Submission enquiries: nikki.

Integrative Review on Cannabis sativa L. Origin Traceability

Buy Cannabis Porto Alegre

Marijuana, dried and ground Cannabis , is the most consumed illicit drug in the world. Many undesirable and risky effects to human health are caused by its use. As Cannabis derived drugs and products gain popularity across the world, there has been more and more reports on mislabeled cannabinoid content of Cannabis plants, concentrates and edibles, as well as the number of health issues and deaths caused by their use. In spite of that, many countries have been making their laws more flexible as to marijuana purchase, sale, possession and consumption. Therefore, the development of methodologies capable of tracing the geographical origin of the seized samples, whether for quality control or forensic purposes, is increasingly necessary. Thus, our objective was to perform an integrative review on Cannabis traceability studies to assess the research being dedicated to this issue. We have found only 20 published scientific papers, using the databases and keywords employed, and several of these papers were published over a decade ago. Gross morphological brain changes with chronic, heavy cannabis use. The British Journal of Psychiatry. Schizophrenia Bulletin. Recurrent stroke associated with cannabis use. Journal of Neurology, Neurosurgery, and Psychiatry. Death by self-mutilation after oral cannabis consumption. Legal Medicine. Variation in cannabis potency and prices in a newly legal market: evidence from 30 million cannabis sales in Washington state. Voelker R, Holmes M. Pesticide Use on Cannabis. Cannabis Safety Institute. Accessed 4 June Forensic Science International. New developments in fiber hemp Cannabis sativa L. Industrial Crops and Products. RAPD analysis distinguishes Cannabis sativa samples from different sources. Organelle DNA haplotypes reflect crop-use characteristics and geographic origins of Cannabis sativa. Genetic individualization of Cannabis sativa by a short tandem repeat multiplex system. Anal Bioanal Chem. Electronic Journal of Biotechnology. Multivariate classification based on chemical and stable isotopic profiles in sourcing the origin of marijuana samples seized in Brazil. J Braz Chem Soc. Tracing geographic and temporal trafficking patterns for marijuana in Alaska using stable isotopes C, N, O and H. Tracing retail cannabis in the United States: Geographic origin and cultivation patterns. Int J Drug Policy. Stable isotope models to predict geographic origin and cultivation conditions of marijuana. The Stable Isotope Ratios of Marijuana. Strontium Isotopes Relate to Geographic Origin. J Forensic Sci. The relationship between chemical composition and geographical origin of cannabis. Forensic Science. Constituents of Cannabis sativa L. Journal of Pharmaceutical Sciences. Martone G, Della Casa E. Analysis of the ageing processes in hashish samples from different geographic origins. Watling RJ. Sourcing the provenance of cannabis crops using inter-element association patterns 'fingerprinting' and laser ablation inductively coupled plasma mass spectrometry. Journal of Analytical Atomic Spectrometry. ElSohly Ed. Totowa: Humana Press, Chan KW. Validating a gas chromatography-mass spectrometric method and sample classification procedure for cannabis profiling using cannabinoids from case samples. Australian Journal of Forensic Sciences. Cannabinoid profile and elemental uptake of Cannabis sativa L. Agronomy Journal. Illicitly imported Cannabis products: some physical and chemical features indicative of their origin. Bull Narc. PMID: Entomological identification of the origin of imported cannabis. Journal of the Forensic Science Society. Origin of samples of Cannabis sativa through insect fragments associated with compacted hemp drug in South America. Revista Brasileira de Entomologia. Journal of Forensic Sciences. Seized cannabis seeds cultivated in greenhouse: A chemical study by gas chromatography-mass spectrometry and chemometric analysis. Journal of Forensic and Legal Medicine. Cannabinoids and Terpenes as Chemotaxonomic Markers in Cannabis. Nat Prod Chem Res. Signaling compounds elicit expression of key genes in cannabinoid pathway and related metabolites in cannabis. Scientific Reports. Journal of Pharmaceutical and Biomedical Analysis. Cannabis and Cannabinoid Research. Frontiers in Plant Science. Med Cannabis Cannabinoids. Plasma Chemistry and Plasma Processing. Lee A, Palamar JJ. Oral health implications of increased cannabis use among older adults: Another public health concern? Journal of Substance Use. Cannabis sativa L. BioMed Research International. Cannabis and heart disease: Forward into the great unknown? Journal of the American College of Cardiology. Medical cannabis and mental health: A guided systematic review. 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