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Serbian patients fight for cannabis reform

Serbian patients fight for cannabis reform
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Serbia is  the largest and most populous country of the former Yugoslavia. It is home to a strong pro-legalisation movement which is led by activists, patients and researchers. In this case, that opposing force is spearheaded by far-right parties and conservative medical groups who desperately cling to ill-informed stigmas surrounding cannabis.

Serbia has seen its fair share of conflict and division in recent history in the wake of the partition of the Former Yugoslavia Republic. As part of the Prohibition Partners European Country Review, we examine what divides opinion on cannabis legislation and how far they have come on the bumpy road to modernisation. For an in-depth analysis of the European market download The European Cannabis Report: 5th Edition, here.

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Protests and Political Threats to Cannabis Reform

The first pro-legalisation protest, the ‘Ganja March’, was held on May 7th 2005 in Belgrade with a second planned for the Summer of 2007.

However, two days before the event, the Ministry of the Interior received a threatening email from a group calling themselves the United Patriots. Given the violence experienced over the 2001 gay pride protests, the authorities cancelled the march. Advocates had to wait a further eight years to hold their second (successful) Cannabis March in Belgrade, what they called a ‘gathering of the largest disenfranchised minority in Serbia’.

It wasn’t until February 2014 that any serious political progress was made. That month, Health Minister Slavica Đukić Dejanović voiced support for the legalisation of medical cannabis and the first legal association advocating cannabis treatments – the Initiative to Change the Cannabis Legislation (IRKA) – was registered in early 2014.

Despite complaints and disruptions from far right parties in the country, a proposal was submitted to the Ministry of Health to legalise medical cannabis, citing several hundred cases of successful treatments.


Healthcare in Serbia

According to the World Bank and a series of NGOs, Serbia has struggled with corruption in the healthcare industry since its establishment. Wages are low for doctors and unemployment rates have been as high as 20% in recent years. Many doctors feel that accepting bribes is a means to survival.

However, Serbia began a massive healthcare reform in 2017 – allocating €2 billion of the state budget towards the construction of clinical centres, renovation of hospitals and procurement of medical equipment. There is a long term commitment from the Serbian Government in modernisation of the healthcare system and most major international financing institutions are involved in this process. As neighbouring countries begin to loosen restrictions around cannabis treatments, international finance partners could put pressure on Serbia’s government to consider legislation reform.

Additionally, Serbia has one of the world’s highest rates of diabetes in Europe with a reported 11.96% of the population suffering from the disease. Treatments are costing individuals around $666 per month, an extremely high cost for low and middle income earners. To compound this issue, Serbia’s overall pharmaceutical market is relatively underdeveloped, seeing regular medicine shortages and somewhat long waiting times for patients.

There is a growing body of research which indicates that cannabis can be used to stabilise blood sugars, ease nerve pain and reduce inflammation and blood sugars, offering a cost-effective supplementary treatment to a large proportion of Serbian diabetes patients.

As Serbia commits to a modernisation of its healthcare system in partnership with international financiers we may see a more lenient approach to cannabis healthcare if further research can prove to cut-costs and ameliorate the health industry.


Public Fears Costing Patients

In early 2016 the Expert Committee for the Use of Cannabis for Medical Purposes –  composed by the Ministry of Health – proposed legalising three cannabis-based drugs but that cannabis oil should stay illegal.

The use of “dronabinol”, synthetic tetrahydrocannabinol (THC) for the treatment of significant weight loss in HIV / AIDS patients, as well as for the treatment of side effects of chemotherapy in oncology patients is legalised.  Additionally, the use of “nabilons”, a THC synthetic substance, will be allowed for the treatment of nausea and vomiting in chemotherapy patients. The third cannabis medicine that has been applied in Serbia is “sativex” for symptomatic alleviation of motor disorders (spasticity) in patients. All treatments are only available when conventional treatments have been exhausted.

However like the rest of Europe, doctors remain uninformed about these synthetic imports and patients are forced into the black-market for treatments – paying upto €300 for a bottle for cannabis oil. Some cancer patients can go through a bottle of oil in under two weeks, making cannabis reform seem a long way off.

The Commission for the Application of Cannabis for Medical Purposes, while making the decision, was guided by the recommendations of the US Food and Drug Administration (FDA), which did not recognise or approve the cannabis plant as a cure. That is why the conclusion of the Commission outlawed cannabis oils, given the fact that standards for its composition and production had not yet been defined.

Danica Grujicic of the Committee explained that there were still fears among the advisory panel about the ill effects of the drugs on the black market and the lack of standardised processing measures for cannabis oil.

“The only thing proven is that it’s ruinous for adolescent brain development […] I am absolutely against legalising a drug. For me, it is a drug.

— Dana Grujicic

After the announcement of these legislative changes, many organisations, patients, and those who are directly affected felt disappointed and sidelined. Many of them felt that the decision-making process had been influenced by pharmaceutical companies and even financially motivated by other parties. The decision ignored much of the international academic evidence that cannabis oils have provided therapeutic relief to pain patients as Serbia preferred to back the use of opioids.


Light at the end of the tunnel

Despite these fears, progress has been made in Serbia. Imports have been permitted and political task-forces and academics are providing further evidence to demonstrate the therapeutic effects of cannabis treatments.

Hemp is back, after recent attempts to block it from the country’s agricultural catalogue Serbia has partnered with a Canadian company in order to produce hemp-based healthcare products.

Eviana Health Corporation has said it plans to harvest 500 hectares of hemp in Serbia next year, up from 130 hectares harvested in 2017. The Canadian company delivers customised consumer healthcare products using natural hemp strains of cannabis sativa for topical creams, products and cosmeceutical and nutraceutical merchandise.

The company plans to install next week a Euro Prima herb processing and selection machine at its herb processing and storage facility, located in the village of Mladenovo, northern Serbia, to refine and package the hemp in 25 kg bags.


Two steps towards cannabis reform, one step back

On January 5th, 2017, Dragan Alargić, a leading cannabis advocate scheduled to give public testimony on the plant’s therapeutic powers, was jailed before he could give his testimony. This was only part of the controversy around the government’s handling of the proposed cannabis legislation.

First, IRKA and other NGOs were refused the right to participate in the debate that began earlier this month. Then it emerged that the preliminary draft bill was actually more repressive than the current law, which recognises THC—although not the cannabis plant as a whole—as a “psychoactive medicine.”

“The new draft actually prohibits any kind of cannabis—even the use of the word itself […] If this draft becomes law, thousands of Serbians would continue to suffer and engage in ‘criminal’ activities

— Gradimir Veljkovic, IRKA

To counter this trend, IRKA has been organising meetings, workshops, and panel discussions, as well as participating in regional and international conferences. The group have also filmed over a hundred patient testimonies of successful cannabis treatments, more than any other NGO in Europe.

Though legislative progress, for the moment, has been held in a political tug of war, Serbia has been making small steps in the right direction. Imports have been legalised, hemp is being cultivated as we speak and there are more pro-cannabis legislators in parliament than ever before.

There is evidence of change. Historically, Serbia has endured a violent backlash from some sectors of the far-right over gay pride movements. The Belgrade riots in 2001 and 2010 left an ugly taste in the mouths of the activists and campaigners who hoped to see progress among the public on the streets of Serbia. Despite this, last September the country elected its first gay Prime Minister, marking a historic change in public perception aimed at cannabis reform.

Cannabis reform and change is inevitable and the tides of public opinion may quickly swing in favour of pro-legalisation as neighbouring Balkan countries implement cannabis treatments. Progress comes from struggle and it is clear that IRKA, activists and patients are not giving up anytime soon.

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