The experience of Argentina

Thinking about how medicine can be truly at the service of people implies questioning the limits of the biomedical model. Studying medicine was, for me, an exciting experience, but the day-to-day practice revealed much more complex, sometimes frustrating, nuances. In this attempt to assist others better, my love of plants became a refuge and an answer. This is how I came to train in Phytotherapy, exploring various medical systems and the main plants of traditional herbal medicine. However, throughout this journey, there was one thing that – surprisingly – nobody mentioned: the cannabis plant.

In the same year that I finished, I met a group of people who were looking to use marijuana for therapeutic purposes but had no doctor to support them. At the time, little information was available, and public demand for so-called "medical cannabis" was growing strongly, especially among those facing complex health conditions and seeking relief that went beyond conventional treatments.

I didn't know anything about it. But I started to read, to ask questions, to look for answers.

Karina – a generous and capable grower, who not only grew the plants, but also made extracts for her mother and grandmother – appeared along this journey She taught me my first lesson in dosing: understand the dilution of the extract and always apply the infallible rule of "less to more".

Thus - called by the profound feeling of responding to a need, and the curiosity to discover what this plant was capable of, and together with an interdisciplinary group of health professionals and cannabis users – we founded AUPAC, a non-profit organisation of which I continue to be a part to this day.

I clearly remember the first meeting: patients, professionals, growers and activists gathered together, sharing something as valuable as it is scarce: information. On that day, they performed an extraction from cannabis flowers, and made oils and creams in situ.

This was not an isolated event: it was part of a wider social movement that was beginning to unfold in Argentina. In the same year, Law No. 27,350 on Medical Cannabis was passed, officially recognising its therapeutic use, but also exposing a great paradox: actual access remained almost impossible. The products that were available were imported, expensive and slow to obtain, and in many cases, they were not even considered medicines in their countries of origin, but simply food supplements.

In that context, together with my colleague Varinia, and two psychologists, Ignacio and Soledad, we started to establish interdisciplinary clinical care teams for patients presenting with various conditions: chronic pain, cancer, cerebral palsy, epilepsy. Each story was different, but all shared the weariness of a long pilgrimage through the health system and the hope of finding another form of care.

Many of them had gone through extensive journeys without obtaining relief or significant improvements in their quality of life, and some had already started self-taught experiments with the plant, guided by necessity and intuition. I am deeply grateful to these people: they were the ones who, through their trust, allowed us to take the first steps towards an informed, empathetic and humane clinical practice around the therapeutic use of cannabis.

The need to go deeper and to connect with colleagues who were having similar experiences led me to Chile, and to the Daya Foundation, where I held the International Seminar on Medical Cannabis. There I attended inspiring lectures and met amazing people, many of whom I am honoured to call friends today. Their experiences, their commitment and their humanity marked a before and after in my journey, full of challenges, certainties and insecurities. The biggest encouragement, however, came from people I was supporting: seeing them walk again, stop convulsing, sleep better, hug us and cry together, and trying to understand where medicine and people's wellbeing had become separated.

In a context of increasing connections between clinical practice and growing, the Faculty of Biochemistry of the National University of Rosario (UNR) initiated the first chromatographic analyses of cannabis extracts circulating in our environment. This was a turning point: it allowed us to identify the actual concentrations of cannabinoids present and thus improve therapeutic precision - for the first time, we could know what doses of cannabinoids were being used by the people we saw improving.

In a very short time, the organisation grew at a dizzying rate. Starting with cultivation by patients, family members and supportive individuals, we have begun to assemble a space capable of offering the full range of therapeutic options that the cannabis plant can provide: different chemotypes, routes of administration and formulations adapted to every need.

I found the world of extracts fascinating. Along the way I met Gina, Francisco and Agustín, three fantastic professionals who multiplied the possibilities and developed new preparations according to the specificities of each patient. Together, we came to understand that treatment with cannabis requires recognising the uniqueness of each experience and building the path to relief from there.

Everything was moving forward with unstoppable force. The subject was attracting increasing media interest, and the number of patients was growing rapidly. Very soon the problem of having enough medication for everyone emerged: at times we could not start new treatments without jeopardising the continuity of existing ones. Added to this was the worry of working within an uncertain legal framework and ensuring legal certainty for growers, patients and professionals.

In this context, a group of mothers of five boys and one girl, with very complex health conditions, asked me to support them - together with Jésica and Gabriela, two lawyers, and a psychologist, Soledad - in a legal and media action to ensure access to, and protection of, treatment. Thus, in an unprecedented act in our country, a habeas corpus and an injunction to cultivate for these treatments were presented.

Testifying before the judge was one of the biggest challenges of my career: a young doctor, with barely a year of experience in the therapeutic use of cannabis, explaining the reasons behind the indication of extracts to paediatric patients.

When I showed her the clinical records, the studies, the reports and, above all, the visible changes in the children, the judge was moved. After listening to the mothers' testimonies, she did not hesitate a second longer: she issued an exemplary ruling authorising us to cultivate, produce oils and carry out quality controls together with the university.

This ruling not only ensured legal security for six children and their families but laid the foundation for what would eventually become a public health policy.

Soon after, the pandemic began in Argentina and around the world. And, against all odds, something extraordinary was about to happen: a new regulatory decree that would mark the beginning of a decisive chapter in the history of medical cannabis in the country: the creation of REPROCANN.

I was enormously surprised: I could not believe that everything we had done for years, often in the shadows, was now legal. There was even a computer system to record information. It is not easy to flourish in hiding, and this new regulatory framework - however still in need of perfection and transitory - was fertile ground for a group of professionals who wanted to grow: community cultivation projects, new formulations, and a human team united by empathy and responsibility all emerged.

I then had the great opportunity to apply and be selected as an advisor for Law 27.350, thus supporting the implementation process of the new decree.

With so many simultaneous tasks and the physical impossibility of responding to growing demand, I clearly understood the dimension of the social challenge we were facing: it was essential to train many more colleagues so they could truly support the population, who could not wait another day.

Based on the need to integrate clinical experience into the academic environment, I developed a course proposal that I presented as an elective subject at the University. During evaluation, it was considered that its length and depth exceeded the planned format, so the proposal was upgraded to a Postgraduate Course aimed at healthcare teams. Together with Shirli, Sabrina and Soledad, we turned this initiative into an annual 200-hour course called ¨An Integrated Approach to the Cannabis Plant for Health. It has been run for five consecutive cohorts and has trained hundreds of professionals who are now committed to working on the issue.

Over the years the clinic became more solid, and with it came the need to study, to record, to understand. We began to systematise thousands of care visits, to participate in ethics committees, because what we had experienced also deserved to be inscribed. Conferences and academic events were a great springboard to disseminate this work and start publishing it.

In Argentina, we understood the value of the whole plant. Therefore, although today we already have pharmaceutical-grade products, most people access treatments through community-grown crops promoted by social organisations, whose processes and quality controls are carried out together with universities in a virtuous system of participatory certifications.

We managed to build a social network that produces health in multiple ways, because we understand that guaranteeing quality is not enough: it is also essential to ensure access. The Medical Cannabis Programme continues to operate through changing times, and new challenges arise in a regulatory environment that is still evolving. One of these is the emergence of a new figure: that of the medical director, responsible for reporting on the progress of patients and the daily doses of cannabinoids used by people who are supplied through an organisation. While this makes access more bureaucratic, it also allows for higher levels of professionalism and systematisation of valuable real-world evidence.

The cultural characteristics of this country shaped a unique process, in which creativity became a fundamental resource for designing tools and collective devices capable of realising the right to health in a concrete and specific manner.

Our greatest challenges today are to formulate the knowledge we derived from practice, to recognise the evidence that emerges from the ground, and to create forms of access that balance the ideal and the possible, so that the word "efficacy" is not only a way of questioning therapeutics, but what makes a medicine at the service of community health a reality.