After the legalisation of marijuana took effect last month allowing people to grow the plant at home and buy cannabis products, Sarayoot Buranapanich has found a glimmer of hope in weed. A 46-year-old terminal cancer patient, Sarayoot has turned his back on the mainstay of treatment.
In the early days, he was in agony. After five months of battling nasopharynx cancer, a doctor gave up and let him go home. Radiation and chemotherapy were unable to cure the final stage of the tumour, which grew larger than 6cm and spread to other parts of the body.
"I have run out of treatment options," he recalled the doctor's last word.
He lay in bed suffering. His wife refused him a depleting supply of prescribed morphine, which could damage his kidney. It wasn't until he asked for a gun that she began to explore uncharted territory -- medical cannabis -- and took him to a well-known traditional medicine practitioner.
"I doubted his treatment because weed was often used for recreation, but it was the only option left for me. I received treatment from Uncle Tu [Bantoon Niyamapa] and his wife. At first, I took cannabis extract oil under my tongue. After hesitation, I had it administered anally," he said.
At home, he continued the same recipe and recovered in a week. When the pain went away, he could walk again. Earlier this month, he came third in a charity race. He now uses only a small amount of cannabis extract oil for good sleep and appetite every day. A check-up shows that his health has improved.
"I won't go through chemotherapy again. I can't say that I have been cured of cancer, but the symptoms have disappeared. Much to everybody's surprise, I can live a normal life again." he said. "I don't know much about cannabis, but it should be thoroughly studied."
Thailand tightened its narcotic law in 1979, which banned the consumption, possession and sale of marijuana. It became the first country in Southeast Asia to legalise the plant for medical research and use under supervision in February 2019. In fact, it features in traditional remedies dating back to the reign of King Rama V.
"Cannabis became legal, but still faces opposition from some groups, especially doctors," said Daycha Siripatra, the founder of the Khaokwan Foundation, who has been a vocal supporter of medical marijuana. After family members, including his mother, died of cancer, he ventured into the use of cannabis for treatment.
He has developed his own recipe for a decade. It can be administered through many parts of the body. After two years of research, his cannabis extract oil is more than 80% effective for treating diseases, including migraine and cancer. In his view, people should have the right to choose their preferred treatment.
"It is now included in the national list of essential medicines and the universal health coverage scheme," he said. "Cancer patients have legal access to my drug, but in practice, doctors will decide whether to prescribe it. With a background in modern medicine, they tend to avoid it and encourage chemotherapy."
Daycha said following legalisation, he is teaching local people to make the herbal drug at home. He claimed that it has many therapeutic roles, including the possibility of cure and providing palliative care. Unlike modern medicine, his method combines a herbal remedy, food and dhamma practice.
"I believe bad karma partially causes cancer. If those you have wronged in present and former lives remain vengeful, you will continue to suffer from cancer. We must make merit until they forgive. While folk healers take a holistic approach, doctors tend to focus on treatment only," he said.
After the government relaxed stringent restrictions on cannabis last month, doctors have come forward to warn of unchecked use and side effects. Featuring over 100 substances, only two of them -- tetrahydrocannabinol (THC) and cannabidiol (CBD) -- have medical benefits.
Assoc Prof Dr Srivieng Pairojkul, head of Karunrak Palliative Care Centre, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, told a forum that studies have shown marijuana is probably most widely used by patients who suffer from terminal cancer or are receiving palliative care.
"Because it was once a narcotic drug, there has been little research on its potential, but medical practitioners must rely on evidence for safety. Cannabis is used for treating symptoms associated with chemotherapy, neuropathic pain and demyelinating disease. However, there is no evidence that it can cure cancer."
Dr Srivieng said when it comes to terminal cancer and palliative care, the effectiveness of cannabis extract in relieving pain is 10 times less than opioids, especially morphine. "It is not a first-line drug, but can be used for complementary therapy to reduce overuse of opioids," she said.
Asst Prof Dr Sahaphume Srisuma, a lecturer at Mahidol University's Ramathibodi Poison Centre, echoed the same view in a seminar, citing a study to compare the effectiveness of cannabis extract and a placebo. While there is very little difference in reducing pain, there is some in making patients feel better.
"It isn't as effective as modern medicine and therefore is not the first choice. But if patients still feel pain after taking drugs, cannabis can come in handy. We don't give priority to it to reduce potential risk and unnecessary side effects," he said.
Dr Attasit Srisubat, a senior adviser to the Department of Medical Services, urged patients to receive staple treatment, but if it doesn't work, medical cannabis can be used in a complementary manner to improve the quality of life. "It is not a cure for cancer itself and patients should be treated by doctors," he said.
Dr Attasit worries that if they mistake feeling better for being cured and forsake modern medicine, they will miss the golden period of effective treatment of the disease itself.
"Currently, there is no evidence that it can cure cancer. Studies show that they can relieve symptoms only," he said.
Information from the Ministry of Public Health.
What are the official guidelines on medical cannabis?
There are three groups of medical use.
First is the treatment of patients who suffer from epilepsy, spasticity, multiple sclerosis, neuropathic pain, and appetite loss caused by HIV infection, and those undergoing chemotherapy or in palliative care.
Second, it helps patients who are vulnerable to Parkinson's disease, Alzheimer's, generalised anxiety disorder and demyelinating disease.
Last, it may be used for cancer treatment in the future, depending on the result of ongoing research.
