Perspectives on formation of medical cannabis market in Ukraine based on holistic approach

BACKGROUND: Nowadays, medical cannabis still remains inaccesible for patients in the former Union of Soviet Socialist Republics (USSR). Even registered medicinal products based on herbal or synthetic cannabinoids, like Sativex, are practically unavailable due to their high cost and narrow scope of application (for example, in Lithuania). However, before the absolute prohibition of medical cannabis in the USSR, in line with Single Convention of 1961, the State Pharmacopoeia of the USSR (eighth edition) published monographs on such medicinal products as “Herba Cannabis indicae”, “Extractum Cannabis indicae spissum” and “Fructus Cannabis”, which could be prescribed by physicians with precaution. OBJECTIVES: Formation of a holistic approach aimed at the creation of appropriate conditions for the development of medical cannabis market and the improvement of life quality and health of Ukrainian patients. METHODS: We analyzed legislation and regulation mechanisms for medical cannabis in the USSR, and the present availability of these products for patients in the former USSR, such as Lithuania, Georgia, Estonia, Russian Federation, and Ukraine. Four hundred thirty-five Ukrainian pharmacy students participated in the quantitative analysis (a survey) that took place on April–May, 2019 at Bogomolets National Medical University (Kyiv, Ukraine). They were surveyed about legalization of medical cannabis in Ukraine, advisability of including cannabis and cannabinoids related data into educational programs, and other issues. Qualitative analysis we applied consisted of the stakeholder analysis and Strength, Weakness, Opportunity, and Threat (SWOT) analysis. We classified the key stakeholders into the patients, healthcare professionals, legislative and regulatory bodies, pharmaceutical companies, pharmacies, etc., and ranked them based on their power and interest in the development of potential medical cannabis market in Ukraine. We also identified their expectations and goals. SWOT analysis allows us to evaluate predictable risks and opportunities, as well as strong and weak aspects of the effective development of medical cannabis industry in Ukraine. RESULTS: According to the survey among pharmacy students, about 80% support the legalization of cannabis for medical purposes. However, two-thirds of them think that there is a risk of illicit turnover. Nearly half of the respondents are not informed or poorly informed about cannabis therapeutic properties. At the same time, nearly 90% consider that materials on medicinal properties of cannabis and cannabinoids should be included in the training program. Nowadays, such stakeholders as legislative and regulatory bodies have the highest power over the development of potential medical cannabis market in Ukraine: more than two million Ukrainian patients still cannot access an effective cannabinoids based treatment. There are over 20 thousand children among them suffering from drug-resistant epilepsy due to the lack of adequate legislation. Moreover, a lot of stakeholders with high level of interest, such as growers, manufacturers of cannabidiol (CBD) products, pharmaceutical companies, pharmacies, higher education institutions, even scientists and healthcare professionals are still waiting for the legalization of cannabis for medical and scientific purposes in Ukraine. SWOT analysis shows that present business structures, educational and scientific institutions, regulatory bodies, and the competency of domestic specialists are strong enough to develop a new market of cannabis-based medicinal products in Ukraine. However, a long-term ban on medical cannabis requires more time for creating the entire ecosystem. This market can be quite attractive in Ukraine. It is characterized by high growth rates, low entry barriers and a substantial demand. Yet, its advancement depends significantly on the appropriate regulatory framework, high level of awareness among health professionals and society as a whole, and involvement in scientific study to become a part of the global medical cannabis market. DISCUSSION: The holistic approach is aimed to improve health and life quality of Ukrainian patients through cannabis-based medicinal products. It consists of three components: changes in legislation and regulation procedures; changes to value orientations in society; observance of stakeholders’ interests and purposes. Specific recommendations are worked out to realize this approach in Ukraine.