Abstract
Introduction: Cannabis-derived products, even though not incorporated into the SUS, are acquired in various brands, presentations, and prices by municipalities and states in Brazil to comply with legal actions (AJ). The analysis of these acquisitions can contribute to the improvement of procedures for obtaining safer, more effective, and accessible products. Thus, the objective of this study is to describe and analyze the acquisitions of cannabidiol extract (CBD) made from January 2022 to July 2023 by state and municipal SUS management bodies, regarding the number, type, and modality of acquisition, presentation of the products acquired, purchasing agencies, price variation, and sanitary regularity. Methods: Descriptive, retrospective study of an evaluative nature using information from the Health Price Bank (BPS) portal regarding the acquisitions of CBD extract. The data search took place in August 2023 by item description, using the words cannabidiol and cannabis. All CBD presentations found were included. The information was extracted, tabulated and analyzed using Microsoft Excel software. Results: During the study period, 24 CBD acquisition processes were observed by states and municipalities in Brazil in 4 different presentations. The majority (46%) were for the acquisition of CBD 200mg/ml, followed by 25% for CBD 20mg/ml, 17% for CBD 33.33mg/ml and 12% for CBD 50mg/ml. Three quarters (75%) of the processes were for compliance with AJ and the remainder (25%) for administrative demand. Regarding the modality, 75% of the acquisitions were by Auction and 25% by waiver of bidding. More than half of the acquisitions (54%) were carried out by municipal management spheres and 46% by state spheres. Of the acquisitions carried out by municipalities, 6 were from the state of São Paulo and in Alagoas, Bahia, Mato Grosso do Sul and Paraná, 1 municipality from each state. A variation of 48.7% was identified in the price of CBD 200mg/ml, 21.9% in CBD 20mg/ml, 18.2% in CBD 50mg/ml and 0% in CBD 33.3mg/ml. In purchases of CBD 200mg/ml for AJ, the average price was slightly higher (6.7%) than in purchases for administrative services. Regarding health regularity, of the 4 presentations of CBD purchased, 1 brand was not licensed by the National Health Surveillance Agency. Discussion and conclusions: CBD has been studied for several medical conditions, such as epilepsy, chronic pain, anxiety, sleep disorders, multiple sclerosis, neurodegenerative diseases and other conditions and despite the promising results, clinical research is still in the early stages. In 2021, Conitec evaluated CBD 200mg/ml for children and adolescents with epilepsy refractory to antiepileptic drugs, with an unfavorable opinion on its incorporation. In 2022, the Federal Council of Medicine published a resolution approving the use of cannabidiol only for the treatment of childhood and adolescent epilepsy refractory to conventional therapies in Dravet and Lennox-Gastaut Syndrome and Tuberous Sclerosis Complex. The study revealed that in addition to acquisitions for compliance with AJ, there are acquisition processes for administrative supply, suggesting some type of organized access. The variation of up to 48.7% in the price of the same product indicates market asymmetry, such as monopoly and low competition. Another finding of great concern was the identification of acquisition of imported CBD not licensed by ANVISA, conflicting with health regulations and exposing users to health risks. While judicialization preserves the patient's right to comprehensive pharmaceutical care, on the other hand, it puts pressure on the public budget, potentially leading to the system's unsustainability, prioritizes individual needs over collective needs, and in many cases overrides technical health criteria. The results of this study contribute to an overview of the topic; however, due to its limitations, it does not explain the distortions and variances observed, requiring further investigation.
