Medical marijuana has become a vociferous, multi-million dollar industry in the United States. With the legalization of recreational cannabis in some states, like Colorado, more patients are seeking access to medical marijuana. Many are getting it through the mail and purchasing it off the black market as their access is difficult to regulate. Thailand, in particular, is a country where it is difficult to find a legal medical marijuana provider.
While the Thai government has made strides to legalize medical cannabis, companies that want to get into the medical cannabis business must first win the approval of the Department of Public Health (DPH), who are now tasked with ruling on whether the product meets standards of quality and safety.
Over the past four years, the Thai government has implemented legislative reforms to create a market for medicinal cannabis. The ability to generate significant economic benefits and help patients in need remains a question: What will be the government’s priority: profits or patients?
While these two objectives are not necessarily mutually exclusive, it is important to understand the motivations behind the reforms so that policymakers can strike a balance between them. It is becoming increasingly clear that health is too important a public good to be managed by market forces, especially since the profit motive is contrary to public health principles.
In January 2017, cannabis (fibers from the stem of the cannabis plant) was decriminalized in a pilot project by the Narcotics Control Board of Thailand. In December 2018, Thailand’s National Assembly voted unanimously to amend the country’s legislation in favor of medicinal cannabis. In February 2019, cannabis and cannabis extracts were removed from state control, and in August 2019, products containing cannabis were reclassified.
A year later, further reforms allowed private health companies to grow and sell these plants. In December 2023, authorities removed other parts of the cannabis plant from the criminal code. In March 2023, Deputy Prime Minister and Health Minister Anutin Charnvirakul announced that households could legally grow up to six cannabis plants.
Medical cannabis is in high demand among patients suffering from 38 different diseases. In the three months before the plant was legalized, more than 30,000 people registered for access. Although initially only a few dozen people were treated due to serious licensing issues, 10,000 bottles of cannabis oil were distributed to patients with a prescription in August 2019. As of November 2023, 14,236 patients have received medical cannabis, representing a slight increase in availability.
Strict government control has led to licensing problems. As of January 2023, 442 medical cannabis licenses have been issued, of which more than 400 are being used for distribution – although supply remains a major issue to be addressed through home production.
The problems with the infrastructure to facilitate access have been partially resolved by the rapid expansion of the ambulatory network. As of November 2023, there were 311 clinics operating, mostly in Bangkok, while the government had pledged that there would be at least one clinic in each province. That’s more than two one-day courses in May 2019. Despite the growing number of clinics, it is still not known how many patients currently have access to medicinal cannabis, as there is no evaluation of medical dispensaries.
The government has stated unequivocally that the primary motivation for its policy on medical cannabis is profit. Deputy Prime Minister Charnvirakul said marijuana and cannabis are economic crops [that] offer a new income opportunity for local residents. He goes on to say that households can earn 12,000 baht ($385) a year by selling plants to the industry. Marut Jirarattasiri, director general of Thailand’s Ministry of Traditional and Alternative Medicine, said medicinal cannabis offers more opportunities to make money.
The press repeats the promise of financial benefits, with many articles about the potential economic benefits being published in the health section rather than the business section. The value of the cannabis market in Thailand is expected to reach $660 million to $2.5 billion by 2024. Not surprisingly, many segments of society are eager to find the pot of gold and join the green frenzy.
But there are concerns that the promise of benefits can lead to shortsightedness and shifting priorities. Putting profit before public health is a common response to public health crises, such as the recent COVID-19 pandemic. Experts warn that allowing commercial interests to prevail over public health interests could have negative and irreversible consequences for Thai society.
In Thailand, the medical needs of patients and the potential health benefits of cannabis seem to be secondary to the potential economic benefits of market growth. If patients were more important than profits, we would see a rapid increase in patient access and independent efforts to identify bottlenecks and improve access. Experts and officials will promote the medical benefits of cannabis. Instead, access to cannabis has been restricted, no evaluation has taken place, and rhetoric touts the potential economic benefits to the country, the government, and businesses.
Thailand has successfully protected patients from free riders in the past by issuing mandatory licenses to ensure the availability of essential medicines. It is important that the government sticks to the same priorities and positions itself as a leader in the medical cannabis market in Southeast Asia.