Palliative Medicine: Why Mexican Pharmaceutical Landsteiner Began Researching Cannabis

This article by Hernán Panessi was originally published on El Planteo.

Landsteiner is a Mexican company focused on traditional pharmaceuticals, mostly generic medicines. However, in tune with plant medicine and the herbal tradition of Mexican medicine, the company recently began researching cannabis-based medicines.

"Plant medicine is pre-Hispanic," warns Alejandro Lara Terrazas, a surgeon, anesthesiologist, pain and palliative care specialist for oncology patients who’s responsible for Landsteiner's medical direction and development.

Landsteiner noticed society's demand for a return to herbal and cannabis basics. "As a good doctor, I've seen that many patients have been coming to the appointments with their little vials of infusions for the last 10 or 20 years," he says.

That forced physicians to pay attention to them and to continue studying the subject.

Nevertheless, since there were no regulations, there was a great deal of disorder.

In the words of Lara Terrazas: "When the law comes out, it sets the rules. But the field is set by the regulations. And its appearance is very recent. It's very new and it came out as we thought it would. The regulation allows for research-focused medicinal use."

But since medicine is not an exact science: Landsteiner is developing controlled clinical studies to measure the efficacy, safety and quality of cannabis-based medicinal products.

"As an industry, we had gone ahead and developed an herbal line. At Landsteiner, we are experts in allopathy, but today we are venturing into herbal medicine," he says.

In the meantime, they are conducting clinical studies that measure doses and toxicities, which will be scaled up in large population studies to measure the quality of the inputs, the safety of the products and their efficacy.

Palliative Medicine

Landsteiner developed a palliative protocol for oncology patients.

"It serves to prevent suffering, control anxiety, depression and ten other symptoms. But we don't like to talk about 'dignifying'. We have to ensure the quality of life. Where am I going with this? Cannabis products don't cure, but they control. The holistic aspect is to control the symptoms."

According to Dr. Lara Terrazas, this is the first time that patients in the terminal phase gain weight instead of losing it.

But how come?

"Because I give them cannabinoid-based products," he explains.

"These products potentiate the chemo, lower the doses, prevent nausea and vomiting. They give an overall benefit."

-And how will these products be administered?

-As a pharmaceutical industry, we are not going to prescribe smoking. The drugs will have to be pharmaceutical developments: tablets, creams, drops, nasal sprays, discs. That is where pharmaceutical medicine adds value. We know the profiles of how it is absorbed, metabolized and eliminated. The ultimate goal is for the patient to be in the best living conditions for as long as God allows. My role is to see that the patient gets through it in the best conditions. As a pharmacist, we are not at odds with medicines, but we know the added value of a cannabis line that enhances and has a real benefit for the population.

For instance, Dr. Lara Terrazas' approach to cannabis research came about by chance: because of pets.

"There are more and more pets living in apartments and they get very nervous: we noticed that, if a cannabis compound is added to the food, they calm down. That generates social harmony because it controls the mood and disposition of the animals and their owners."

Currently, cannabis science determines that, depending on the origin and traceability, medicines can be developed that enhance the analgesic effects. "With cannabis-based medicine, we can stop the progression of some diseases. We can't cure, but we can stop," he says.

In this research, the Landsteiner lab maintains a close link with the academy. "Four of our cannabis protocols are being developed in conjunction with the university, which adds a lot of value. You can't be judge and jury in research," he says.

Landsteiner has a cooperation agreement with the Universidad Autónoma del Estado de México.

Mexican Regulation

As the medical cannabis regulation in Mexico is very new [January 2021], Landsteiner is still looking for balance.

"The regulation allows for research and development of medical products. We need to develop practice and expertise. Pharmaceutical is one of the most regulated industries second only to aeronautics. It requires a lot of paperwork because we are talking about lives," Lara Terrazas voices.

The company is still looking to find a way around that regulation and ensure what the law requires, but - at the same time - make things happen.

"Excessive control is limiting. No control generates chaos. We have to find a balance. We are proposing to perfect the regulations. That they allow us open access without losing control," he identifies.

-And how does Landsteiner position itself in the face of this new challenge?

-We are in the midst of a fast-paced transformation. We want to be among the first players to place products at a continental level. It's a global game. Canada, Holland and Australia have proven it, and I see them as the future.  S I believe in the added value of an effective product that, for example, reduces refractory epilepsy. It is a very noble end, very ultimate. We have urgency. We want to be the first.

-How is Mexico in comparison to the rest of the world?

-We have an advantage: for better or for worse, we are adjacent to the United States. We handle FDA and European Union standards. That forces us to have high standards as regards the rest of the continent. We are based on the NAFTA and T-Mec agreements. As our neighbor is the one that sets the guidelines, we have to comply with them. And the government has an interest in making things happen. Today, there is a proximity with large countries. We have become globalized. If we maintain our neighbor's standards, we will not have problems.

The Future

Arturo Morales, vice-president of corporate affairs, and Nohemí Juárez, manager of regulatory affairs, add their views on the future.

Morales maintains that "progress in Mexico has been timid. The position is conservative and the government had to put up with the pressure. The first step was taken for the pharmaceutical companies, which was to approve cannabis for medicinal use. The law has not yet been approved, but there is a regulation. Therefore, allowing legal planting would provide quality control, it would not criminalize farmers and it would help to monitor agricultural inputs such as fertilizers. We have to continue with developments on the pharmaceutical side."

Juárez concludes: "This is a very important step for herbalism. Cannabis is a plant that has a lot of attention because of its medicinal benefits. It opens up an opportunity to take other plants seriously. The regulatory issues are also a huge opportunity. This is an important time to emphasize going back to plant knowledge."

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