Ukraine excludes PTSD from list of approved conditions for medical cannabis

Ukraine’s Ministry of Health has approved the draft list of conditions for which medical cannabis can now be prescribed, excluding PTSD and other mental health disorders until more research is available.

The impact of trauma and PTSD following Russia’s invasion of Ukraine played a key role in the recent campaign to legalise medical cannabis in Ukraine—ultimately resulting in success in December 2023.

But publishing the list of approved conditions, the Ministry of Health has been clear that more research is needed before millions living with trauma-related mental health conditions can access the treatment.

On 27 September, Ukraine’s Ministry of Health approved the draft list of conditions for which medical cannabis can now be legally prescribed.

This includes chronic or neuropathic pain, nausea and vomiting related to chemotherapy, Parkinson’s and Tourette’s syndrome, refractory epilepsy and weight loss associated with anorexia in HIV patients. An additional item [8] allows for other conditions to be considered for a medical cannabis prescription if approved by members of the medical advisory commission. 

According to the Ministry of Health’s, the list is based on the ‘most up-to-date research and evidence of effectiveness’, and ‘will be revised as new research evidence becomes available’.

‘No time to wait’ for millions with PTSD 

Many patients have been left disappointed by the omission of PTSD and other mental health disorders.

The Ministry of Health has estimated that the number of people experiencing trauma-related mental health issues has “tripled” since Russia invaded Ukraine in February 2022, with around four million people now in need of medical treatment for psychological conditions. 

Last year, President Zelenskyy urged MPs to legalise medical cannabis to help the country recover from the ‘trauma of war’. It followed a Facebook post on 7 June, 2022, in which Health Minister, Victor Liashko, said there was ‘no time to wait’ to approve the bill that would allow more patients to access a ‘necessary treatment for cancer and post-traumatic stress disorder resulting from the war’.

“Unfortunately, the approved list of conditions cannot be called progressive,” Iryna Rachynska, of Patients of Ukraine, told Cannabis Health.

“The Ministry of Health has decided to take a cautious approach, especially in those nosologies where they believe there is not enough research.”

She adds: “Of course, it is crucial to add PTSD to the list as one of the first, because the number of people with mental disorders during the war will only grow.”

Remaining optimistic 

However, Rachynska says the campaign group, which has been involved in discussions regarding the implementation of the legislation, remains optimistic about the potential to expand the list, at least to include those conditions for which it is approved in other countries such as Germany.

During negotiations, representatives defended the inclusion of item 8 to allow for other conditions to be considered for a medical cannabis prescription.

Hanna Hlushchenko, Founder of Ukrainian Cannabis Consulting Group, told Business of Cannabis in August that there is only a ‘small chance’ that the specific list of conditions will be expanded, however this clause will allow for ‘some flexibility’.

“This means that if a patient needs cannabis for a condition not explicitly listed, they can go to a healthcare institution where a commission of doctors can review the case,” she explained. “If the commission decides the patient needs cannabis, they can prescribe it even if the condition isn’t on the original list.”

Research on medical cannabis and PTSD

According to Patients of Ukraine, the Ministry of Health has committed to conducting a study on medical cannabis and PTSD, monitoring its real-world effects on patients in Ukraine. 

“We have a promise from the Ministry to gradually expand these lists,” continues Rachnsyka.

“In particular, by launching a study to confirm treatment protocols for PTSD based on our data in the country.”

While more scientific research on cannabis and PTSD would be beneficial, observational studies from other countries, including the UK, support its use for symptom reduction and quality of life. In one longitudinal study conducted in the US,  participants who accessed cannabis had more than double the likelihood of no longer meeting PTSD criteria by the end of the study.

THC is also understood to reduce activity in the amygdala (the part of the brain that governs fear response), with preliminary studies suggesting that it may help regulate the threat response in trauma-related conditions. It is also thought to reduce REM sleep, which causes intense dreams, making it helpful for patients experiencing nightmares, intrusive thoughts and flashbacks, which are a common symptom of PTSD.

‘Just the beginning’

Under the new legislation, cannabis-based medicines can be obtained through an electronic prescription from a primary care or specialist physician, with all data required to be tracked through the electronic health care system (EHS). Products will only be permitted to be dispensed through pharmacies in possession of a narcotic drug licence, of which there are thought to be around 200 throughout Ukraine.

While a domestic supply is not expected to enter the market until around 2028, a streamlined production registration process for international importers has now been established, which is expected to take as little as 30 days.

As well as supporting the establishment of a robust domestic supply chain, Rachynska says Patients of Ukraine is working with the government with the aim of introducing a reimbursement scheme for medical cannabis prescriptions within the next two years.

“This is just the beginning,” she adds.