As of May 2017, medical cannabis became legal in the Cayman Islands as a prescribed drug to treat pain management, nausea from chemotherapy and a number of other conditions. This remains a controversial topic and the recreational use of the drug is still illegal and can result in penalties and imprisonment. There has been discussion on holding a national referendum, with a view to decriminalising possession of small amounts of the drug. In September 2023, the CI Government suggested such a vote may be added to General Election ballots in 2025, but not before.
As of May 2017, the Cayman Islands joined a list of approximately 50 countries where cannabis is legal for medical use when prescribed by a locally licensed medical doctor. Cannabis in Cayman remains a controlled drug and its recreational use is still illegal with penalties that may include imprisonment.
The term ‘medical cannabis’ encompasses any sort of cannabis-based medicine used to relieve symptoms. The active ingredients in cannabis are the cannabinoids, the most well studied being tetrahydrocannabinol (THC) and cannabidiol (CBD). Most cannabis products contain some combination of the two and their ratio is usually provided on product packaging. In general, the psychoactive effects of cannabis come primarily from THC whereas the physical effects can be largely attributed to CBD.
Cannabis can be prescribed for a wide range of illnesses including epilepsy, multiple sclerosis, Parkinson’s Disease, insomnia, and chemotherapy-induced nausea, as well as multiple chronic pain syndromes. It is anticipated that as medical cannabis becomes more mainstream and more clinical research is done into its benefits, the number of conditions it can be used to treat will increase. For optimal patient safety, an individualized approach should be taken and it is preferable for patients to be under the care of a physician with significant experience prescribing medical cannabis.
Medical cannabis products available in Cayman include oral capsules and liquid oil drops that are ingested by mouth as well as vaporized cannabis that is inhaled. The overall effect of cannabis on an individual is generally determined by the ratio of the cannabinoids consumed, the dose administered and the route of administration. More than any other factor, the dose determines the effect of cannabis on its users. As with other medications there is a “therapeutic window,” which is the targeted amount of drug in the patient’s system after taking their medication. In this window, the drug’s benefits are achieved but adverse effects are either non-existent or minimal. Doses that exceed this window tend to cause side-effects as is often the case with recreational cannabis use.
The choice of route of administration can be influenced by multiple factors but a significant consideration is the time profile of each route. In general, conditions with persistent symptoms (such as chronic pain) are best managed with oral oil drops or capsules, which are slower in onset but have longer durations of action. Conversely, patients with conditions that require fast-action, such as for the initiation of sleep, or to treat nausea or migraines, are often better managed with inhaled vaporized cannabis, which is faster acting but has a shorter duration of action.
It is illegal to travel in and out of Cayman with all forms of cannabis even when prescribed for medicinal purposes.
Any visitor who uses medical cannabis should reach out to a licensed medical doctor in Cayman prior to their visit to establish a reliable plan to ensure seamless continuity of their treatment during their visit.
Doctors advise that patients who face drug testing at work discuss the matter with their HR departments prior to using medical cannabis.
There are multiple well-established reasons that medical cannabis may not be appropriate for some individuals. These reasons include personal or strong family history of psychosis or bipolar disorder, pregnancy (or planning on becoming pregnant), breastfeeding, being under 25 years of age, or a history of a substance use disorder.
There are many additional factors that a medical doctor will consider when assessing a patient’s suitability for medical cannabis. Past medical history, participating in a safety-sensitive occupation, and using other medications associated with sedation or cognitive impairment are just a few.
Cannabis has the potential to cause side-effects. These may include anxiety, nausea, dizziness, diarrhea, vomiting, fatigue, dry mouth, and cognitive impairment.
In general, it is the THC component of medical cannabis that presents the significant safety concern with respect to driving or safety-sensitive occupations. Unfortunately, there is significant variability in the duration of action of cannabis, regardless of the form used. Not surprisingly, there is a similar lack of consistency among the advice of experts regarding the duration of impairment. The safest practice is to abstain from driving or participating in any safety-sensitive occupation for the remainder of any day in which that medical cannabis is consumed.
Moratorium of 2019
In September 2019, all local facilities were ordered to stop prescribing and selling vaporizable cannabinoid products after the Health Practice Commission issued a cease notice. An investigation was opened (and is now closed) into the use of cannabinoids in medicine, and all healthcare practitioners were requested to stop issuing, processing, dispensing, or selling any cannabinoid which would be used by vaporisation. The Cayman Islands Medical and Dental Society (CIMDS) suggested that this order was related to the unethical advertising of prescription drugs. However, there is no legal barrier to the promotion of the product or its prescription. As of August 2020, Chief Medical Officer Dr. John Lee ordered to lift any alleged prohibitions on the dispensation and prescribing of Medical Cannabis in the Cayman Islands. Treating patients with medical cannabis subsequently resumed.
EVALI outbreak of 2019
In the US in 2019, there was an outbreak of a condition now known as E-cigarette or Vaping product Use-Associated Lung Injury (EVALI). Investigations found that THC and/or vitamin E acetate was in the majority of affected patients, either by history or confirmed by toxicology. Vitamin E acetate was a viscous liquid widely used to dilute THC in cannabis e-cigarettes between 2018 and 2019. Vitamin E acetate is now known to alter lung surfactant function and cause respiratory impairment.
According to the CDC: "Vitamin E acetate is strongly linked to THC-containing products used by EVALI patients." Vitamin E acetate is no longer used in vaporizable medical cannabis. The outbreak peaked with 215 admissions during the week of September 15, 2019. Since then the number of new cases has steadily declined.
As with any medical condition or pharmaceutical, Caymanians who seek more information about medical cannabis are encouraged to discuss it with their physician. It is often a family doctor who has the most experience prescribing and monitoring medical cannabis usage. Some physicians in Cayman have arrived from countries where cannabis has been legal for medical use for decades and have first-hand knowledge that could be valuable for patients interested in this emerging treatment option.
Doctors Express is a walk-in clinic in the Cayman Islands that offers urgent healthcare at affordable pricing.