Benito Díaz
Cristina Sánchez is professor of biochemistry and molecular biology in the Universidad Complutense in Madrid. Since the 90s, her interest has been the study and possible applications of cannabis and cannabinoids in the medical field. She has taken part in some of the most important lines of research that our country has ever seen. We talk to her about her work and the latest news in the world of cannabis.
Dr Sánchez started working in the group that investigated signalling through cannabinoids, a pioneer group in this subject. This group also included Dr Manuel Guzmán. In 1996, Sánchez delved further in the study of metabolism of the central nervous system. “We went from there to cancer and then I focused on making analysis of the glioblastoma”, a particularly aggressive type of brain tumour. “Later, that line of investigation has been carried forward by my colleague Guillermo Velasco. In 2004, the year I came back to Spain, I focused on a line that leads, above all, to breast cancer”, says Sánchez, who completed a three-year post-doctorate at the Irvine University in California.
“The price they are charging for those products is not sustainable, not for the families who need to buy them. And I do not think it is ethical that our social security system should pay those prices, not even to protect the patients. It is not justified. Epidiolex is not worth its price. Sativex is not worth its price”
Researcher Cristina Sánchez
Research
“We have worked on breast cancer for a long time. We have been able to observe that there are similarities between this cancer and glioblastoma: specifically, the fact that cannabinoids induce the death of the tumour cells and inhibit the progress of tumours. It is something found in many different tumours, like brain, breast, pancreas tumours… in other words, all the classifications that we have been able to analyse, not only us, but also other groups of investigation around the world. We know that the active mechanisms are different but it’s the same response to anti-tumour cannabinoids”, the investigator explains, adding that when cannabinoids are consumed, they are distributed over the whole organism, producing different responses in the central nervous system, in a breast tumour, even in the blood cells. “The aim are all cells, but if we talk about tumours, the effect produced is that one, death of the tumour cells”.
Professor Sánchez explains that, nowadays, Spain is one of the most advanced countries in applying cannabis to cancer therapy. “There are many laboratories working on these lines of research, cannabinoids and cancer. In the Universidad Complutense we have two of them at this moment. Guillermo Velasco’s lab, which deals with brain tumours, and ours, focused on breast cancer. There are others in Italy, USA, Germany, the list is enormous. Here we have got many groups in universities and hospitals, disseminated but potent, pioneers in the study of cannabinoids”.
Dr Sánchez’s group has an advantage when it starts its projects, because it deals with pre-clinic research, which means they do not experiment on human beings. “I have never found, during my career, any obstacle associated to working with cannabinoids. The hurdles I find are the same that all researchers face: lack of funding of research and development”. The removal of cannabis from the UN’s and WHO’s international control lists of narcotics has not made much difference on their work: she claims she has been working on the same field for 25 years and has never suffered any delays due to prohibition. “I have not heard either of other groups having problems to obtain their research supplies, at least in Spain. Anybody who wants to perform pre-clinic research, with no patients, can do so without any problems. The ones affected may be the scientists performing clinical research, but not us”, the doctor explains.
Exceptionalism
We ask Sánchez about the exceptionalist argument, according to which there is a bad particle (THC) and a good one (CBD). “In my opinion, there is no difference. There are good uses and bad uses. When we talk about therapeutic application of cannabis, we talk about both molecules. We refer to THC, which has applications that are really promising; we talk about CBD, which has them as well. As with any other substance we need to pay attention to the possible secondary effects, but that is something that is true for any other medicine or substance as well. Even water, for instance. Problems can come from drinking too much water. If you use too much THC, undesired effects can appear, but this does not mean in any way that cannabis use cannot have therapeutic purposes”, the researcher concludes.
“At this point, there is no clinical evidence on controlled tests that would allow us to assert that a patient needs a substance richer in THC, in CBD, or others”, she comments. “In the case of epilepsy, it looks like CBD is the main responsible for the therapeutic antiepileptic effects. In the case of glioblastoma, the only clinical test performed has been done with Sativex, which apparently contains the same amount of THC and CBD. Nevertheless, as we say, there is no scientific evidence yet that suggests that a patient may need more ratio of one or the other”.
There is evidence
“If someone said to me that there is no scientific evidence that proves the effectiveness of cannabis treatments, I would ask that person to open their eyes and see what is going on in countries like the USA, Canada, Germany, the rest of Europe, Uruguay, Mexico, Colombia, Israel, Argentina, Chile… all these countries, and more, have implemented programs of medical use of cannabis. They have done this because there is scientific evidence that supports using cannabis. No government of any colour is going to authorise the medical use of anything that is dangerous for the patients or has a bad risk-benefit balance that hurts ill people”, claims Sánchez.
“The same evidence that has been sufficient for these countries is available to our healthcare and regulating authorities. What I would tell them is to please have a look at what is happening around us and abandon the small-town mentality that claims that, if the scientific evidence is not generated in Spain, it does not exist. In the case of Coronavirus, for instance, we did not need to wait until clinical essays were made here to see if the vaccines worked. The scientific experiences generated in the rest of the planet were good enough. In this case it is the same thing. Whoever sustains that argument is accusing the governments of the USA, the government of Canada, Israel… of being irresponsible”.
New health subcommittee
Sánchez has mixed feelings about the creation of this new group in the Spanish Congress of Deputies. “On the one hand, I am happy because it is a step forward. We have been stuck for years on this matter and we lag behind as a country. We are leaders in investigation and stand last on transporting that investigation to patients. On the other hand, I am not optimistic. I think the discussion is going to focus on whether there is scientific evidence or not, as we were commenting. I think that is a mistake, the discussion should be focused on what model do we want to implement in our country. It is a glimmer of hope anyway; better this than nothing”, the doctor sums up.
An ideal regulation would, according to Sánchez, come from forcing the committee to review the experiences in other countries, and see “what regulation they have there, what kind of therapeutic approaches have been carried out, what has worked and what has not. If you want my opinion, I opt for a model of coexistence with the drugs approved by the FDA (USA’s Food and Drugs Administration), Sativex, Epidiolex and any others that might appear in the future. I think the plant and its derivates should have space too if the products are high quality and regulated. I believe that not all of them need to be developed by the pharmaceutical industrial production; they could follow different approaches, like nutritional supplements, but therapeutic. I also believe that homegrowing should be contemplated in this ideal legislation. These three possibilities should coexist, so that people can choose one or another, depending on the illness they suffer”.
As to recreational cannabis, Sánchez exposes that, regardless of her posture on the matter, it is essential not to mix those two uses. “We need to be pragmatic: I think that we will go forward quicker if we start by regulating medical use, which I honestly think is far more urgent. It is a debate that needs to be made in two stages. However, I understand the arguments of those people who say that an integral research needs to be done. I can share those ideas, but I still believe that the ones with urgent needs are the patients. Once we have a regulated medical use, obviously we should engage in a dialogue and we should decide what to do with recreational cannabis, and not only cannabis but any other drug too”.
Drug’s price
Sánchez thinks the prices of medicines for cannabis therapy are irrational, here and in the rest of the world. “I know there is a strong investment in research and development behind these products, I am not taking anything away from the company that produced them, and I am not against the returns of such investments. I am not opposed to pharmaceutical industries, but the price they are charging for those products is not sustainable, not for the families who need to buy them. And I do not think it is ethical that our social security system should pay those prices, not even to protect the patients. It is not justified. Epidiolex is not worth its price. Sativex is not worth its price”, Sánchez denounces.
Advances
“The subcommittee has six months to issue a report. This is already a deadline that needs to be met, but as I said I am not optimistic. There might be some hope if we consider international pressure. Reality is stubborn and the government will not be able to ignore this call that is coming from everywhere; all places are advancing in the same direction. I am sure that we are going to join that movement. The question is whether we will keep making a fool of ourselves internationally or whether we will implement a project already”.
Sánchez declares that, in this moment, even outside of a regulation, we find contradictions such as the AEMPS (the Spanish Agency for drugs and medical products) granting licenses to Spanish companies to grow cannabis that will be used outside of Spain with therapeutic purposes, therefore assuming the plant’s potential, while at the same time telling the Spanish patients that they cannot use that same cannabis that is being exported, because “there is no scientific evidence”. Hence, a regulation that equates the rights of all European patients is needed.
Spanish Medicinal Cannabis Observatory
Cristina Sánchez was also a key part in the OECM’s foundation. “I embarked on this project after meeting its current president, Carola Pérez. When you work on research of components that have a possible therapeutic application, you always dream that the things the components do in the laboratory, to cells or mice, end up benefitting a real patient. Knowing Carola beyond her position, meaning knowing her as a person who has been helped by cannabis therapy, made me realise that there was a reality unknown to me: the fact that there are a lot of people that have illnesses cannabis is helping with. Seeing what the situation was for these people, who had to resort to the black market to obtain their medicine, made me commit to this group”, she sums up.
Cristina Sánchez looks at the future. “We have many open lines of research currently. We want to try using the cannabinoid system to get information on whether the tumours are moderately aggressive or very aggressive. We want to use it as a screening tool. We also want to find out whether cannabinoids could be a good therapy tool for patients who have not responded to other anti-tumour treatments. Not only do we want to know why it does what it does, we want to know how it does it on a molecular level. Accordingly, we investigate if cannabinoids are a therapy option for tumours resistant to chemotherapy or other treatments and why this happens. These are only two brief examples of everything we are doing, since we have several theses, several projects going, even a new line around pancreatic cancer”, she concludes.