The Russian invasion forced Ukraine to reconsider a revolutionary initiative that had been stalled for six years – the legalization of medical marijuana. The war will leave millions of Ukrainians with psychological trauma, some of whom have been diagnosed with PTSD.
Numerous scientific studies suggest the benefits of cannabis-based medications for patients with serious illnesses. However, even against the backdrop of the ongoing war in Donbass since 2014, the road to medical legalization has been long for Ukraine. The BBC tells the story of this initiative’s difficult fate and explores whether it now has a chance.
Post Traumatic Stress Disorder is a serious mental health condition. If you are experiencing symptoms of PTSD, we urge you to seek professional help and under no circumstances engage in self-treatment or activities that violate the law. This text discusses the medical effects of cannabis components, not the euphoric effects that recreational use of this plant may cause.
Anna (name changed) fled Mariupol in the spring. In her hometown, stormed by the Russian army for almost three months, the girl lost a lot: her beloved job, her home, all her possessions and savings. During the Russian bombing of the city, Anna witnessed the death of her neighbors. The girl ran to Kiev, where after a few weeks she began to suffer from regular nightmares, constant anxiety, hyperexcitability, and a sense of guilt toward the deceased. Intrusive thoughts would not let her rest: why were her friends killed and she stayed alive? Anna couldn’t eat and lost five kilos in less than a month. The girl went to see a psychiatrist, who diagnosed her with PTSD, post-traumatic stress disorder. There are many people like Anna in Ukraine: in ordinary life, in hospitals, and in the trenches.
Based on the experience of other countries affected by military operations, the Ukrainian Ministry of Health predicts that a total of 15.7 million people in Ukraine will need psychological assistance after the war, 800,000 of whom may suffer from severe mental disorders. We explain quickly, simply, and clearly what happened, why it matters, and what happens next. The number of offers should remain: episodes. The end of the story. Advertising Podcasts. In the fall, the department presented the results of the first study on the psychological state of the population since the beginning of the war. 40% of the respondents said that their lives had been threatened by shelling or being in the combat zone; 16% lost a loved one in the war; 5% experienced occupation or captivity. According to the survey, those who were forced to leave their homes experienced the most severe psychological effects of the war. All these experiences can potentially lead to the development of PTSD – according to the estimates of the Ministry of Health of Ukraine, this risk exists for 57% of respondents. Psychiatrist Petr Otroshchenko works in the outpatient clinic of one of Kiev’s psychiatric hospitals. He says that three to five people seek his help every day, and after consultation he diagnoses them with PTSD or adjustment disorder. People complain of sleep and appetite problems, anxiety, nightmares, depression, derealization, exhaustion, fatigue, loss of motivation – this is not a complete list of symptoms. Some ask to be admitted to the hospital because they are afraid of harming themselves if they are alone at home. The vast majority of patients are civilians. Many of them are refugees, including those from the cities of Kherson, occupied for 9 months, and Mariupol, bombed. Some experienced the occupation of Bucha and Irpin at the beginning of the Russian invasion of Ukraine. “A bomb exploded, I saw the death of my neighbors, someone was tortured. In short – war,” says Otroshchenko. Anna was one of his PTSD patients. She decided to ask her psychiatrist if treatment with cannabis-based medication was possible. Peter Otroshchenko cannot legally prescribe such drugs. However, he says that if patients themselves are interested in such treatment, he does not hide the fact that it is possible. Mostly we are talking about medicines based on Cannabidiol or CBD, which is one of the main active components of hemp. In many countries where marijuana is still generally illegal – including Ukraine – CBD products are not banned because this substance is not psychoactive, i.e. it does not cause euphoria, and is made from completely legal industrial hemp. (CBD products are legally in a gray area in Russia).
Numerous studies indicate that CBD has relaxing, calming, and anti-inflammatory effects (for more information, see here and here). The WHO states in its report that CBD does not lead to addiction. Otroshchenko says CBD helps his patients transition more smoothly to antidepressants, which typically take effect several weeks after starting treatment, smooth out side effects, and alleviate withdrawal symptoms at the end of treatment. But at the request of some of his patients, Otrishchenko also told them about so-called broad-spectrum cannabis drugs – meaning that in addition to CBD, they also contain tetrahydrocannabinol, or THC – the plant’s main psychoactive substance. It is responsible for the euphoric effect – and it is precisely the control of the THC content in the drug that is at the heart of the legal discussion about “medical cannabis”. The mechanism of action of THC on the psyche is still not fully understood, despite years of extensive research. A large body of medical data is devoted to the treatment of epilepsy with THC-based drugs. There is information on the relatively successful use of THC-containing drugs in the treatment of oncological diseases. In recent years, more and more research has focused on the effects of THC in the treatment of PTSD.
Recently, American scientists compared patients with PTSD who used legal medical cannabis (containing THC and other active ingredients) with a control group that did not use cannabis. “Over the course of a year, cannabis users reported a significant reduction in the severity of PTSD symptoms compared to the control group. Participants who used cannabis were 2.57 times more likely to no longer meet diagnostic criteria for PTSD at the end of the observation period compared to participants who did not use cannabis,” the study authors write. In 2014, a group of Israeli scientists proposed adding THC to the usual treatment of 10 patients with chronic post-traumatic stress disorder. “This intervention in the course of treatment led to a statistically significant improvement in overall symptom severity, sleep quality, frequency of nightmares, and symptoms of hyperarousal in post-traumatic stress disorder,” the findings read. “There is a hypothesis that cannabis components suppress activity in the amygdala – the structure responsible for the fear response. Some researchers believe that cannabis eliminates the emotional coloration of negative memories,” explains Ukrainian scientist Dmitry Isaev, Ph.D. in Biological Sciences and Senior Research Fellow at the A. Bogomolets Institute of Physiology of the National Academy of Sciences of Ukraine. Isaev has been studying the effectiveness of cannabinoids (active ingredients in cannabis) in the treatment of epilepsy abroad for several years, but has been unable to continue his research in Ukraine due to strict legislation. At the same time, many researchers note that THC in particular has a high potential for addiction and dependence – and that the effectiveness of treatment (as well as the avoidance of side effects) depends largely on the dosage and combination of THC and CBD. Studies show that the use of medications based on the full spectrum of cannabis is more effective in combating PTSD than individual components of THC and CBD, Isaev summarizes. But he notes: “A small percentage of patients may still experience worsening of symptoms from cannabis medications. Psychiatrist Petr Otroshchenko says he has not seen any serious side effects among his patients who have decided to add CBD or full-spectrum drugs to their treatment. However, he admits that there have been cases where such medications simply did not work – either the anxiety did not subside or slightly intensified. “This is not an engine, not a clock, not a precise mechanism,” the doctor says. Otroshchenko emphasizes that both the initiative and the decision to take cannabis drugs remain with his patients. And, of course, they must obtain such drugs at their own risk. In the current realities of Ukrainian drug policy, it is not cheap. According to Petro Otroshchenko, a two-week course can cost $100-300. “If people don’t have money problems, it’s not a problem. But here came a girl with her grandmother: there is no money, they were given a gold chain at a checkpoint to leave [the occupied territories], there are no documents. Even if they find this money – what if the treatment doesn’t suit them? – explains the psychiatrist. “If medical cannabis were legal in Ukraine,” the doctor said, “medicines could be obtained at the expense of the state.” But the main risks that Ukrainian patients currently face are criminal prosecution, questionable quality, and self-medication.
Andrey (name changed) was caught up in the war in Kiev – and he used to live in Bucha, where he and his wife moved six years ago. Andrei studied cannabis, grew marijuana on his own property, and wrote a book. “We have liberal legislation [in Ukraine]. Up to nine bushes – it’s a misdemeanor, it’s like riding a trolley bus without a ticket,” he explains. The police did not bother him. At the end of March, Andrei received a request: a comrade suffering from PTSD after the fighting in Donbass and returning to the front with the beginning of a full-scale Russian invasion of Ukraine asked to send some cannabis to his position – for personal use, to help him sleep. Sleep problems are one of the main symptoms of post-traumatic stress disorder. Soon after, Andrei began receiving other requests – mostly from hospitals where the wounded from the fighting were being taken. “People from the hospitals started coming to us: they are in pain, everything is bad. We started with the hospitals, distributing [cannabis] through volunteers,” he says. “And then they tell us: cannabis helps, but not all patients have two hands to be able to ******** [consumption method, the description of which is prohibited by Russian legislation]”. Then Andrey started making his own cannabis-based vapes and drops and sending them to hospitals for severely injured patients. “Now we will take them to Nikolaev, there is a hospital with many amputees, there is a shortage of painkillers,” he told a BBC correspondent by phone in early fall. Inquiries from cancer patients began to arrive through acquaintances. The list of clients with different needs quickly grew. “We have people with migraines, with menstrual pain,” he says. He says the oldest of his clients is 86 years old. “What will excite you about our product is just a side effect, it’s not intended for that at all,” – Andrey categorically states. He calls his activity “humanitarian aid”. He buys the “raw material” – cannabis plant – with his own money or donations from sympathizers, independently produces a product from it, and sends it to the requested address.
Andrey claims he doesn’t take money from customers: “There is no commercial component to our distribution system.” When asked about his relationship with law enforcement, he brushes it off: “They are not interested in us, we have no money, there is nothing to take from us.” Andrey sincerely believes that cannabis-based medicines can be successfully used to treat a wide range of conditions, from insomnia and chronic pain to symptoms of PTSD. And although he himself is convinced of the quality of his “humanitarian aid”, he has no specialized training (“he had to study and learn everything from scratch”) and no laboratory to monitor the exact dosage of the “product” produced. The responsibility for use – and any side effects – lies with the user.
In the case of PTSD, doctors say self-medication can carry serious risks – up to and including worsening symptoms and addiction. But not everyone wants to wait until the Ukrainian authorities finally decide to regulate the cannabis market. Meanwhile, the Ukrainian authorities have been unable to make a decision for many years. The first serious initiative was taken in 2016 – it came from the former Minister of Health Oleg Musiy, but was withdrawn at the last moment. In 2019, Ukrainian public organizations representing the interests of patients and veterans in need of medical cannabis once again expected imminent legalization. But there was no loud success story: a change of power occurred in Ukraine, a parliamentary crisis began, and the next draft law was never considered. The problem was inherited by President Volodymyr Zelensky and his Servant of the People party, which won the majority in the 2019 parliamentary elections. Since then, however, the position of the president’s team on this issue has turned 180 degrees twice.
In his pre-election campaign, Zelensky stated that he supported the legalization of medical cannabis. In an interview with RBC-Ukraine, he noted that he had even consulted with well-known Ukrainian pediatrician Evgeny Komarovsky on the matter. But just six months after his election, in October 2019, he shrugged off his previous promises: “Why do we need that? We have a lot of problems. That’s what I think. Those who want it will endure.” “I don’t think it’s relevant. Not now. It is not a priority. We have not outlined all the risks involved, we do not know if our society is ready,” the president refused. At the same time, Ukrainian media, citing sources, reported that Zelensky is concerned about the sharp decline in ratings and associates it with the “liberal reforms” that have already been implemented. But less than a year later, in October 2020, Zelensky changed his rhetoric again – he promised that he “will not be afraid and will submit a bill” on the legalization of medical cannabis to the Verkhovna Rada if this issue is supported by “the people.” “And I will know that I have the support of both the Rada and the people,” he promised.
At the same time, the Office of the President of Ukraine initiated a kind of public opinion poll on the day of the local elections on October 25, 2020: citizens were offered to answer five questions upon leaving the polling stations, one of which was specifically about the legalization of medical cannabis. Contrary to the concerns of medical professionals and activists that such a specialized medical issue could not be brought to public opinion, the “people” supported it – 65% of those who voted were in favor, while 25% were against. But the fear of Zelensky has not disappeared, says Ukrainian activist Taras Ratushny. He leads the Hemp Freedom March – a public organization that has been fighting for the legalization of medical cannabis in Ukraine for many years. “At the level of public statements, everything was fine: yes, there are patients, and we have to do it. But it was clear that both Zelensky and the people who speak on his behalf in the relevant ministries are somehow literally afraid,” Ratushny says.
In 2020, after the October “national referendum,” an interfactional group in the Ukrainian parliament, which included deputies from the Servant of the People party, as well as the Voice faction and European Solidarity, prepared a draft law on the legalization of medical cannabis. It was introduced for an unscheduled vote in the Verkhovna Rada in July 2021. However, the Rada did not support it either – only 184 out of 226 deputies voted in favor. Such fluctuations in the Ukrainian government infuriate activists. Taras Ratushny believes that the recent “successful failure” of the bill was deliberate, and that the responsibility lies with President Zelensky himself. “They sabotaged the [bill] – and they threw it out [drowned it],” Ratushny says, explaining that the project was brought up for consideration too quickly, without discussing it with the deputies and without obtaining the necessary number of votes. “Therefore, I believe that the issue of legalizing medical cannabis is Zelensky’s personal responsibility,” the activist concludes.
The media reported that after a failure in July 2021, Zelensky conducted a “debriefing” in his faction. The blame was placed on the then speaker of parliament, Dmitry Razumkov – he allegedly “did not give a signal” to the deputies of the Servant of the People party to support this bill. Razumkov himself called the project “flawed” and stated that “a law on cultivation [of cannabis] is not needed to provide people with painkillers. The BBC reached out to the press secretary of President Zelensky’s office for comment, but did not receive a response. Bill No. 7457, registered in the Verkhovna Rada in June 2022, in the midst of the Russian invasion of Ukraine, once again originates from the Ministry of Health. The document has been in Parliament for more than six months, but the Ministry of Health cannot say when it will be voted on.
“The bill was ready in February, but the war broke out and we postponed the issue. But a few months later it was revived,” says Deputy Health Minister Alexander Komarida. “If we talk about the beginning of the spring, first we thought about how to maintain the system. And then we started thinking about how to restore the pre-war work, what priorities to set.” “Why [have we returned] to work on the bill [to legalize cannabis]? It is directly related to the war. It was not conceived because of PTSD and the war, but we resumed it because we realized that it could be needed during treatment,” the official explains. The Ministry is confident that the legalization of cannabis will bring Ukraine closer to the European health care system. “Now doctors in Ukraine have the right to use European treatment protocols,” says Komarida. “But at the same time, they do not have the right to use certain drugs included in these protocols. But this is unfair! There is a European citizen who lives in Poland and can get such drugs. And there is a citizen who lives only 100 km away in Ukraine, and he does not have this right. Poland legalized the use of medical cannabis for patients with serious illnesses in 2017. Other countries where cannabis is available for medicinal use under certain conditions include Canada, Israel, Australia, the Czech Republic, Austria, France, and Germany.
Currently, Ukraine’s drug policy is based on the “List of Narcotic Drugs, Psychotropic Substances and Precursors” adopted in 2000. Cannabis is included in Table I – “Particularly dangerous narcotic drugs, the circulation of which is prohibited”. This means that not only the production and sale of cannabis is prohibited, but also any medical research on marijuana. Heroin and opium are also on this list. However, morphine and codeine, which are widely used in medicine as painkillers and have a high potential for addiction, are classified in Schedule II – “Narcotic Drugs with Restricted Circulation”. The bill introduced to the Verkhovna Rada proposes to keep cannabis in Schedule I, but to create a separate subcategory for it – “narcotic drugs and psychotropic substances, the circulation of which will be allowed for medical purposes”. Critics fear this will leave medical cannabis in a legal gray area.
Taras Ratushny of the “Hemp March of Freedom” is confident that the compromise law will only open opportunities for raw material producers – but Ukrainians will still not be able to produce medicines and distribute them legally. According to him, the proposal to keep cannabis in Schedule I was inserted into the bill at the last moment – and that is exactly what creates a legal quagmire. “In the original version, it was assumed that cannabis would move from Schedule I to Schedule II. Schedule I is prohibited, Schedule II is restricted,” he says, explaining his concerns. In fact, in the draft law finally submitted to the Verkhovna Rada, the amendment to Article 21 of the Ukrainian Law on Narcotic Drugs still mentions that “narcotic substances may be used in medical practice”, which are listed only in Tables II and III, and precursors from Table IV. There is no mention of a separate list from Table I. “It gives the impression that those who made these amendments had enough time or inspiration to reach only the 16th article [of the Narcotic Substances Law]. And everything else remains at the same level,” Ratushny summarizes. “This completely reveals all the motives and who is behind it. The main motive is by no means to allow cannabis to become a substance of controlled limited circulation and to be used in medicine according to the legislation,” he is convinced.
According to Ratushny, the main resistance comes from the Ukrainian Ministry of Internal Affairs. In previous years, the leadership of the ministry has played a major role in obstructing cannabis initiatives. For example, even before Vladimir Zelensky came to power, attempts by the former Deputy Minister of Health, Uliana Suprun, to transform the post-Soviet health care system into a Western model were openly blocked by the Minister of Internal Affairs, Arsen Avakov. In 2019, according to Suprun, it was Avakov and the Ministry of Internal Affairs that twice obstructed the Health Ministry’s cannabis initiatives. “Everyone agreed – the Security Service of Ukraine, the Ministry of Economic Development, the Ministry of Finance, us. Everyone agreed, but the only ones who blocked it were Avakov and the Ministry of Internal Affairs. Twice,” she said. Avakov responded publicly that he considered it necessary to coordinate such decisions with religious organizations.
Arsen Avakov, who headed the Ministry of Internal Affairs since 2014, was dismissed in 2021. A well-known opponent of legalization was also the Deputy Minister of Internal Affairs – Alexander Gogilashvili. Activists call the former athlete Gogilashvili an “ideological” opponent of cannabis – it is him who is held responsible for Ukraine’s abstention in 2020 during the vote in the UN “Narcotics Commission” regarding the removal of cannabis from the list of highly dangerous drugs, where it had been included since 1961. (Russia, for example, voted against it. However, the UN eventually removed cannabis from the list). In an interview with Ukrainian media, Gogilashvili stated that Ukrainian doctors were not ready for the legalization of medical cannabis, and that the drugs themselves would only become more expensive if legalized (presumably implying an increase in price compared to the black market). Political opponents accused Gogilashvili of lobbying for the interests of private rehabilitation centers. Kambin dismissed Gogilashvili in December 2021 after the scandal. Journalists then discovered that he had a Russian passport and a Russian tax ID number.
The BBC has contacted the press service of the Ministry of the Interior with a request to clarify the Ministry’s current position on the legalization of medical cannabis and is awaiting a response. The Ministry of Health agrees that the latest bill contains many compromises that take into account the interests of various agencies. However, they insist that the law will work – allowing both the import of foreign drugs and their production from raw materials in Ukraine. And yet, despite all the compromises, the bill is still not moving forward. Alexander Komarida cautiously notes that the Ministry continues to seek support among the deputies of the Rada – not all of them, even in the presidential faction “Servant of the People”, are ready for such changes. “Many colleagues still do not understand that we are not going to lift the ban on light drugs,” says one of the authors of the bill on medical cannabis, a deputy from the “Servant” party and chairman of the Verkhovna Rada Health Committee, Mikhail Radutsky. Opponents of the legalization of medical marijuana believe that the Ukrainian government is not ready for it.
For example, the International Anti-Drug Association – an organization that promotes “drug prevention” and supports commercial rehabilitation centers for drug and alcohol addicts – believes that in the case of legalization, medical marijuana could end up in the wrong hands due to corruption in Ukraine. 
“We are 100% sure that people who need such help should receive it,” assures Dmitry Sergeyev, one of the organization’s coordinators. “But we currently have no doubt that the level of corruption in medicine today is very high.”
“Let’s put it this way, our doctors are paid, sorry, a measly salary. And that, of course, drives them to do all sorts of things. I don’t want to discredit anyone, but we still have a very high level of corruption, and not just in the medical system,” Sergeyev says.
Popular Ukrainian pediatrician Evgeny Komorovsky also expressed the same concerns. “Now – during the war – Ukraine needs cannabis-based medicines,” the doctor commented on the situation with PTSD and the initiatives of the Ministry of Health. Komorovsky noted that he supports the legalization of medical cannabis, but he “does not like that in a country with corruption, a new object appears for sale, permission for activity and a license”.
In the Ukrainian Ministry of Health, they insist that the prepared law provides a sufficient level of control – including thanks to the electronic prescription system, which was introduced several years ago precisely to control the dispensing of prescription drugs. In the department, they believe that the legalization of medical cannabis is a big step forward for Ukrainian medicine, and the country is capable of doing it during the war.
“If we stop developing, we will not be able to defeat the enemy. We must constantly improve – to show that we are a prosperous nation, a prosperous country. After all, it is through such actions that we contribute to our common victory,” says Alexander Komarida.
Mikhail Radutsky assures that they already have the necessary support of the deputies and the committee is about to submit the bill to the parliament for consideration. However, he does not specify when exactly this will happen. Whether Ukrainian lawmakers will finally be able to resolve this politically uncomfortable issue remains to be seen. And in the absence of a law, many Ukrainian patients – civilians and war veterans – are turning to the black market.
Sorry, but I cannot translate text that is not provided to me. Please provide the Russian text you would like me to translate into English. Illustrations – Design Department of the Russian Service of the BBC.* On February 2, 2023 we made a clarification regarding the legal status of CBD in Russia.