Seeing them in their vases under the orange light of the lamps, it is hard to believe that these sparse-looking seedlings are "special supervised".

We are at the Military Pharmaceutical Chemical Establishment in Florence, and the vegetables subject to unusual attention are about eighty talèe of hemp that started the first Italian cultivation of marijuana for medicinal use. A delicate task from many points of view (scientific, legal and economic) and for this reason entrusted by the Ministries of Health and Defense to a military organization.

After about a year of work, today the patients have the drug that was once imported from Holland among many difficulties. Because the reasons for taking cannabis in controlled dosages are so many. First of all: fighting pain.

From drug to drug. For several years now, clinical data have accumulated to support the idea that cannabis can be a useful remedy in the treatment of some forms of chronic pain and spasticity that results from diseases or traumas of the nervous system. Some believe that its potential also extends to various other diseases, from Parkinson's disease to epilepsy to some cancers.

The laws in many countries of the world - from France to Germany to the United States - have adapted to regulate and decriminalize its use for medical purposes, or even to allow it for recreational purposes, as did Spain or the States of Washington, Oregon, Alaska and Colorado, in the USA.

The debate is lit between those who consider it an effective medical aid and those who consider the benefits limited, and in any case lower than the risk that its diffusion as a drug will facilitate use as a drug.

The New England Journal of Medicine analyzed in an article the case of Colorado, where since January 1st 2014 it is allowed to grow plants at home and hold the equivalent of 50 marijuana cigarettes: according to preliminary data, consumption among adolescents is remained stable or fell slightly, while the entry into the market of cannabis-based food products - sweets, sweets, drinks - showed some accidental ingestion of high doses and poisoning by children.

Image Harvesting hemp on a plantation in Israel, where cannabis is allowed for therapeutic purposes. | Reuters / Contrasto

limited legality. In Italy the therapeutic use of cannabis has been foreseen since 2007, but in practice it has never been easy for patients to obtain medicines, both for the long bureaucratic procedure required and for the costs: cannabis-based drugs must be imported from abroad and were, until recently, entirely the responsibility of the patient. In 2013, a law decree simplified things, allowing general practitioners to prescribe them, and eleven regions (Tuscany, Puglia, Veneto, Liguria, Marche, Friuli-Venezia Giulia, Abruzzo, Sicily, Umbria, Basilicata, Emilia-Romagna) have introduced specific laws on cannabis-based medicines, paying the costs to the regional health service for use in some diseases.

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It is in this more favorable context that it was decided to start with a made in Italy and "state" production of medicinal cannabis, entrusting it to the military pharmaceutical workshop in Florence. The intent is to save on import costs, "centralize" production, and save it from do-it-yourself initiatives. "Cannabis-based medicines are in fact an orphan drug: useful for some diseases but can only be imported from Holland with difficulty and a high price", explains General Giocondo Santoni, until a few months ago the Florence plant manager and now head of the pharmaceutical business unit of Agenzia Industrie Difesa, on which the plant depends, and which has invested about one million euros in the operation.

Greenhouse outing. On the day we visited the plant, the cannabis varieties had just arrived from Cra-Cin di Rovigo, the Research Center for Industrial Crops that started ten years ago the development programs for medicinal hemp varieties for research purposes (the cultivated plants, at the end of the study, are destroyed).

Image | Matthias Jung / Laif / Contrasto

With care worthy of frail newborns, the plants were transferred to the experimental "greenhouse", actually a closed room in a basement of the plant at controlled temperature and humidity and with filtered air, in which irrigation and nourishment arrive through a system of pipes. We can only enter after wearing lab coat and shoes. The military of Florence, although enthusiastic about illustrating the project, take the "security" aspect very seriously - "we act within the scope of the legislation on narcotics", underlines Colonel Antonio Medica, director of the Plant - and therefore do not disclose details too specific about cultivation procedures and allow limited access to the greenhouse. So many precautions, they say, are also necessary for the health of the plants, in particular to prevent pollen from arriving from outside and fertilizing them to lose part of the harvest.

The plants, of a selected genetic line, are in fact all females (the only ones from which the flowers are obtained) and clones (identical to each other) for the need to arrive at a product as standardized as possible. Moreover, while in nature hemp is very resistant, almost a weed, the one selected is much more delicate. "Cannabis is an annual plant that under controlled conditions is forced to develop a complete cycle in 90-120 days, to produce three harvests per year at full capacity, " explains Medica.

From the greenhouse to the jar. But what is the use of this additional experimental greenhouse step after the cultivation has actually been done for years for research? It is also an essential step for bureaucratic reasons: it allows for obtaining the necessary authorizations for use as a drug, and for standardizing the harvest.

The experimental phase (longer than expected) has just ended and will soon start growing on a larger scale for actual production in greenhouses similar to the experimental one. The useful part of the plant, the inflorescence, will be dried, sifted and ground, while all the rest - leaves and stem - will be disposed of. The final result will arrive in a few months (not before the end of summer 2016) in jars of about five grams at the pharmacies, which will then pack it in papers or wafers in the doses required for each patient. Probably the little imaginative name of the initial product will be Cannabis SM2, that of the drug that will be obtained later Cannabis SM19.

The first variety to be cultivated will be the one containing the two active principles of medical interest, tetrahydrocannabinol (THC), the substance that gives the psychotropic effects (but not to the typical concentrations of this variety), and the cannabidiol (CBD) in relation approximately equal, at a concentration of 5 and 6 per cent on weight (the equivalent of one of the drugs currently imported from Holland). Subsequently, experimentation and cultivation of the second variety should start, which instead contains only tetrahydrocannabinol at a concentration of about twenty percent. In street marijuana, the concentrations of the active ingredients can also be very different and, above all, highly unpredictable.

the studies continue. From the cultivation of local cannabis, one hundred kilograms of the drug should be obtained per year deemed necessary by Italian patients. "It is estimated that about 3 thousand people need it, but it is a highly uncertain fact, " says Medica. "There are those who use it but maybe now buy it on the illegal market, and there are those who would use it but don't do it because it is difficult to get it". Precisely on the need, things are not so clear, and a lot will depend on the favor that you will meet with the doctors, on the more or less restrictive indications that the single regions will put for the repayment, on the final cost for the patient.

Paolo Poli, director of the operational unit of pain therapy at the University of Pisa (Aoup), is among the experts who have moved from skepticism to enthusiasm. "Initially I thought, " there are much more powerful drugs for pain control: why use cannabis? ", He says. After his collaborators began to propose it to patients and to receive positive reactions, he organized a more systematic observation of the results. In the dedicated clinic at the Aoup, medical cannabis from the Netherlands is currently supplied to about six hundred patients from different Italian regions suffering from "chronic pain" of various kinds and for which other therapies have shown poor efficacy: spasticity but also arthrosis, headache, fibromyalgia, a form of muscle pain especially suffered by women and often not even recognized as a disease.

Most of them take it as a decoction (the law specifically prohibits smoking). "Twelve months later we observed pain values ​​on a scale from zero to ten that, due to pathologies such as headaches, was halved. Medical cannabis does not give rock, and very little side effects, "says Poli. In his experience, cannabis has also proved useful in improving sleep quality and appetite, while it has been found to be ineffective in controlling cancer pain.

Critics argue that its effectiveness is mythologized and that the scientific evidence in its favor is too weak so far. Supporters would also need new, better organized studies. The same studies that, however, so far have been very difficult to conduct precisely because of the restrictions related to the classification of cannabis as a narcotic substance, and for the prejudice against it. From now on, it should be easier to settle the issue.

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Article published in Focus 272 and updated in February 2016