Med­i­cal mar­i­juana

Ef­forts to legally mon­e­tize Le­banon’s most no­to­ri­ous cash crop

Executive Magazine - - FRONT PAGE - By Jeremy Ar­bid

If you ask the farm­ers of the Bekaa Val­ley, they will ex­plain that cannabis cul­ti­va­tion in Le­banon pre­dates the es­tab­lish­ment of Le­banon’s repub­lic by gen­er­a­tions. Lo­cated some 30 kilo­me­ters east of the cap­i­tal Beirut and nes­tled be­tween the west­ern Mount Le­banon range and the Anti-Le­banon Moun­tains to the east, the Bekaa Val­ley has for a long time been the heart of Le­banon’s drug coun­try. Now, ad­vice from an in­ter­na­tional con­sul­tancy, a state­ment by Par­lia­ment’s speaker that le­gal­iza­tion is be­ing stud­ied, and plans by a lo­cal uni­ver­sity to es­tab­lish a medic­i­nal cannabis re­search cen­ter all might kick-start a new branch of Le­banon’s phar­ma­ceu­ti­cal in­dus­try.

HIGH HOPES

There cer­tainly are cred­i­ble dream­ers in­vested in the idea. At a uni­ver­sity cam­pus north of Beirut, Mo­ham­mad Mroueh has high hopes. A pro­fes­sor of chem­istry and ex­pert on medic­i­nal plants, Mroueh plans to one day es­tab­lish a medic­i­nal cannabis re­search cen­ter and study the po­ten­tial of the Lebanese cannabis plant.

The in­tent to es­tab­lish the re­search cen­ter at the Lebanese Amer­i­can Uni­ver­sity (LAU) was an­nounced in late May, with Mroueh lead­ing the cam­paign. In the time since, McKin­sey & Com­pany, as part of its five-year plan to boost the coun­try’s stag­nant econ­omy, has ad­vised Le­banon to le­gal­ize cannabis for medic­i­nal ex­port and man­u­fac­tur­ing. In late July, Speaker of Par­lia­ment Nabih Berri tasked a com­mit­tee to ready leg­is­la­tion to that end.

Un­der Le­banon’s 1998 nar­cotics law, cul­ti­va­tion of the plant is il­le­gal. In 2014, the In­ter­nal Se­cu­rity Forces (ISF), Le­banon’s na­tional po­lice force, re­ported it had dis­cov­ered 35 square kilo­me­ters of cannabis fields but that none were de­stroyed. The agri­cul­ture grow­ing size of the Bekaa Val­ley, ac­cord­ing to Min­istry of Agri­cul­ture fig­ures from 2010, the lat­est avail­able, is 165,660 dunum (roughly 166 square kilo­me­ters). The ISF does oc­ca­sion­ally raid cannabis fields but the pro­tec­tion of many grow­ers has been so pow­er­ful that crops are not de­stroyed, nor are ship­ments seized, to stem the drug flow.

But pre­vent­ing re­search may just come down to plain old pol­i­tics. The per­spec­tive at Le­banon’s Min­istry of Pub­lic Health (MoPH), ac­cord­ing to di­rec­tor gen­eral Walid Am­mar, is that li­cens­ing

for cannabis re­search is not a prob­lem be­cause re­search into any­thing is not pro­hib­ited. Ob­tain­ing the cannabis needed for study would be the com­pli­ca­tion be­cause of its le­gal pro­hi­bi­tion. Am­mar says the law would need to be amended, and that would re­quire a po­lit­i­cal will.

STUDY­ING THE STRAIN

Back at the LAU cam­pus, Mroueh says the May an­nounce­ment was the cul­mi­na­tion of three years of pro­posal writ­ing, build­ing con­sen­sus with the uni­ver­sity ad­min­is­tra­tion, and pub­lic re­la­tions ef­forts. He says the goal of the in­sti­tute would only be to con­duct re­search on cannabis. “Let us an­a­lyze the plant and the govern­ment can make use of the re­sults and can le­gal­ize or not. But at least al­low us to ex­per­i­ment,” he adds.

Mroueh says the chem­i­cal com­po­si­tion of Le­banon’s cannabis is not well stud­ied and the ra­tio of the psy­choac­tive tetrahy­dro­cannabi­nol (THC) to the non-psy­choac­tive cannabid­iol (CBD) is not known. He also points out the plant is a spe­cial strain com­bin­ing in­dica and sativa (two species of the plant). “But it is un­der-re­searched to the most ba­sic level of genome typ­ing, and it is un­known how en­vi­ron­men­tal fac­tors af­fect the qual­ity of the strain [for ex­am­ple soil qual­ity, rain­fall, and tem­per­a­ture] and [how] those af­fect the strain’s chem­i­cal com­po­si­tion.”

To ex­per­i­ment, Mroueh would ex­tract cannabis oil from the plant through a sim­ple process. “I don’t ex­pose the plant to heat. I soak it in al­co­hol and evap­o­rate the al­co­hol us­ing a spe­cial ma­chine, and I’ll end up with cannabis oil.” He says dif­fer­ent sol­vents can be used as part of the ex­trac­tion process and the flower can be sat­u­rated in the sol­vent for dif­fer­ing lengths of time, de­pend­ing on the ex­per­i­ment. In test­ing the medic­i­nal po­ten­tial to treat can­cer he ex­plains the start­ing point is in vitro. “We take cells in the lab. We test can­cer cells, from the brain, breast, or colon. For colon can­cer and skin can­cer we have an an­i­mal model.” Suc­cess­ful in vitro tri­als would lead to in vivo test­ing, mean­ing on the whole an­i­mal. Then, study­ing phar­ma­coki­net­ics would de­ter­mine how a newly de­vel­oped drug would in­ter­act in the body, be­fore the very long process of hu­man tri­als can be­gin.

He ex­pects re­search­ing Le­banon’s cannabis to span 50 years, re­quir­ing at least five aca­demic dis­ci­plines in­clud­ing chemists, bi­ol­o­gists, physi­cians, and later agri­cul­tur­al­ists to work on grow­ing con­di­tions. “We may have some re­sults within a cou­ple of years, at least the chem­i­cal anal­y­sis.”

Mroueh also says LAU’s school of medicine at the Byblos cam­pus al­ready houses the nec­es­sary equip­ment re­quired to an­a­lyze the plant. The pro­posal for the re­search cen­ter has in­ter­nal buy-in, and Mroueh be­lieves the cen­ter can bring vis­i­bil­ity and do­na­tions to the uni­ver­sity. Al­to­gether he es­ti­mates a start­ing bud­get of $1 mil­lion to hire re­search staff and to have ded­i­cated equip­ment for the cen­ter on a pro tem ba­sis us­ing the med­i­cal school’s pre-ex­ist­ing equip­ment.

There are only a hand­ful of cannabis-fo­cused re­search cen­ters around the world, and LAU’s ini­tia­tive could be amongst the first in the re­gion if it gets the green light and the state amends the nar­cotics law. Other coun­tries have amended their nar­cotics laws to al­low the cul­ti­va­tion of cannabis for med­i­cal and re­search use. And cannabis-based drugs have al­ready been ap­proved for use in other mar­kets as can­cer treat­ments in the form of eas­ing chemo-in­duced nau­sea, as an ap­petite stim­u­lant for anorexic AIDS pa­tients, to ease seizures from a spe­cific form of epilepsy in chil­dren, and to ease neu­ro­pathic pain in di­a­bet­ics.

PHARMA PO­TEN­TIAL

The use of cannabis for re­search and, pos­si­bly later, pro­duc­tion of cannabis-based medicines comes with sig­nif­i­cant costs. These costs are gen­er­ally as­so­ci­ated with the in­fra­struc­ture needed to cul­ti­vate the cannabis such as the cost of land or green­house con­struc­tion, se­cu­rity, grow­ing ma­te­ri­als, elec­tric­ity, costs to ob­tain govern­ment li­cens­ing and main­tain com­pli­ance with

Cannabis-based drugs have al­ready been ap­proved for use in other mar­kets as can­cer treat­ments.

reg­u­la­tions, in­sur­ance, costs to ex­tract oil from the plant, and salaries for lab­o­ra­tory tech­ni­cians. These fac­tors need to be mod­eled in the Lebanese sce­nario and the costs can be quan­ti­fied in a ball­park way.

While the ini­tial costs might seem large to es­tab­lish a re­search cen­ter, the po­ten­tial ben­e­fits may be sig­nif­i­cant be­cause they might re­sult in a new branch of Le­banon’s phar­ma­ceu­ti­cal in­dus­try with high qual­ity ad­van­tage in out­come util­ity. The state could also con­trol the raw ma­te­rial by li­cens­ing who can cul­ti­vate and sup­ply the cannabis. This also is not eas­ily quan­tifi­able at this point, but Le­banon’s caretaker econ­omy min­is­ter, Riad Khoury, ac­cord­ing to re­cent me­dia re­ports, thought the ex­port of cannabis for med­i­cal use could be worth be­tween $500 mil­lion and $1 bil­lion an­nu­ally, if its cul­ti­va­tion were le­gal­ized.

Glob­ally, the med­i­cal field is wit­ness­ing a huge change in cost struc­tures re­lated to treat­ments driven mostly by in­no­va­tions in can­cer ther­apy. Biotech drugs are be­com­ing more ex­pen­sive, and risky, more in­va­sive drugs like those for chemo­ther­apy are on their way out. We do not know how the mar­ket will de­velop in global terms for medic­i­nal or other al­ter­na­tive medicines, but the past few years have shown it will grow.

Health­care spend­ing made up 7.5 per­cent of Le­banon’s GDP in 2017, ac­cord­ing to MoPH data, com­pa­ra­ble on av­er­age to other coun­tries around the world. This 7.5 per­cent equates roughly to $4 bil­lion. One tenth of this spend­ing, which might be in the low hun­dred mil­lions, could be di­verted to medic­i­nal mar­i­juana de­riv­a­tives and treat­ments.

Le­banon may not do­mes­ti­cally be­come a multi-bil­lion dol­lar mar­ket, but, if mar­keted and ex­ported suc­cess­fully, the lo­cal in­dus­try could reach that size. This might turn into a boon for the econ­omy, and to farm­ers and the agri­cul­ture sec­tor specif­i­cally, which in 2016 con­trib­uted less than 4 per­cent to the na­tion’s gross do­mes­tic prod­uct ac­cord­ing to World Bank fig­ures. But this in­dus­try will take time to de­velop and re­searchers of the medic­i­nal qual­ity of Lebanese cannabis, med­i­cal prac­ti­tion­ers, busi­nesses, and grow­ers will all need to be li­censed.

Lebanese cannabis could be­come a cor­ner­stone of do­mes­tic pro­duc­tion at scale of medic­i­nal drugs. But that is only if the state es­tab­lishes tight con­trol and spe­cific li­cens­ing pro­ce­dures for its cul­ti­va­tion, in­clud­ing a level of pro­tec­tion­ism for grow­ers and man­u­fac­tur­ers to kick start the in­dus­try.

The il­le­gal grow­ing of cannabis for use as a recre­ational drug is a prob­lem of the gray and black econ­omy. Phar­ma­ceu­ti­cals want­ing to mar­ket Lebanese cannabis as a qual­ity in­gre­di­ent of their medicines could not put Lebanese cannabis on the pack­ag­ing if it were ac­quired il­le­gally and out­side cul­ti­va­tion stan­dards. Sub­sti­tu­tion pro­grams to root out il­le­gal cul­ti­va­tion by fi­nanc­ing and sub­si­diz­ing al­ter­na­tive crops to wean the Bekaa Val­ley econ­omy off cannabis were not sus­tain­able be­cause they did not yield enough to be a vi­able al­ter­na­tive. Cannabis as a med­i­cal al­ter­na­tive seems more rea­son­able if the po­lit­i­cal risks and le­gal ob­sta­cles can be re­solved, and it could be a healthy high for the Lebanese econ­omy.

Lebanese cannabis could be­come a cor­ner­stone of do­mes­tic pro­duc­tion at scale of medic­i­nal drugs.

Dif­fer­ent strains of the mar­i­juana plant.

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