Starting in August 2025, the Unified Health System (SUS) in São Paulo began distributing cannabidiol (CBD) for the treatment of various health conditions. This measure aims to expand access to effective treatments for severe and refractory diseases, previously difficult to access for the population. 

Which diseases are treated with cannabis in the SUS in São Paulo?

Initially, the SUS in São Paulo provides cannabidiol for the treatment of three specific diseases:

1. Dravet Syndrome

Dravet Syndrome is a rare and severe form of epilepsy that usually manifests in the first months of life. It is characterized by frequent seizures and resistance to conventional treatments. The use of cannabidiol has shown efficacy in reducing the frequency and intensity of seizures. 

Therapeutic use of cannabis

The study published by Foco magazine analyzed the use of cannabis oil in patients with Dravet Syndrome, a rare and severe form of childhood epilepsy resistant to conventional treatments. The results showed significant reduction in the frequency and intensity of epileptic seizures, as well as improvement in quality of life and cognitive and motor performance of the patients monitored. The work reinforces the potential of cannabidiol (CBD) as a safe and effective therapeutic alternative, presenting only mild adverse effects, such as drowsiness and decreased appetite. However, the authors emphasize the importance of new controlled and long-term clinical studies to confirm these findings, define optimal dosages, and ensure adequate monitoring of patients treated with cannabis derivatives in the public health system.

2. Lennox-Gastaut Syndrome

Lennox-Gastaut Syndrome is a rare epilepsy that begins in childhood and is characterized by multiple types of seizures. In addition to seizures, it can cause delays in cognitive and motor development. Cannabidiol has been used as a therapeutic option to control seizures in patients with this syndrome. 

Treatment with cannabidiol in refractory epilepsies

The article “Clinical efficacy and safety of cannabidiol in refractory epilepsy: a systematic review and meta‐analysis” (PMC9273119) examined the use of cannabidiol (CBD) in different forms of refractory epilepsy, including syndromes like Dravet and Lennox–Gastaut, showing substantial reductions in seizure frequency, with a significantly higher proportion of responders (≥ 50% reduction in seizures) compared to placebo. The study also indicates that the most common adverse effects — such as drowsiness, gastrointestinal changes, and elevated liver enzymes — were generally mild to moderate, being well tolerated in most cases. The authors emphasize the need for dosage standardization, regular laboratory monitoring, and additional long-term investigations to assess the impacts of CBD therapy in different age groups and subtypes of refractory epilepsy.

3. Tuberous Sclerosis

Tuberous Sclerosis is a genetic disease that causes the growth of benign tumors in various organs, including the brain, heart, and kidneys. In addition to tumors, it can trigger epileptic seizures. Treatment with cannabidiol has shown benefits in reducing seizures in patients with this condition.

Cannabidiol in refractory epilepsies

The article published in Epilepsia Open (doi:10.1002/epi4.12956) presents the recommendations of a panel of experts for optimizing the use of cannabidiol (CBD) in the treatment of refractory epilepsies, focusing on the Dravet, Lennox–Gastaut, and tuberous sclerosis syndromes. The study highlights that CBD, marketed under the name Epidiolex®, is approved for treating seizures in these conditions. The guidelines emphasize the importance of individualized dosing, rigorous monitoring of adverse effects, especially hepatic changes and drug interactions, and the need for continuous therapeutic adjustment to maximize clinical benefits. The experts also recommend the implementation of follow-up protocols to assess the long-term efficacy and safety of CBD, aiming to improve the quality of life of patients with difficult-to-control epilepsies.

Evaluation of cannabidiol in pharmacoresistant epilepsies

The article published in Epilepsia Open examines robustly the clinical results of treatment with cannabidiol (CBD) in patients with refractory epilepsies, including severe syndromes like Dravet, Lennox-Gastaut, and other refractory forms. The study reports that adjunctive use of CBD is associated with significant average reductions in seizure frequency, with a high proportion of patients classified as “responders” (≥ 50% reduction in seizures), as well as cases of complete or near-complete remission in selected subgroups. The most reported adverse events include drowsiness, diarrhea, loss of appetite, and elevation of liver transaminases, although mostly of mild to moderate grade and reversible with dose adjustment or monitoring. The authors also highlight that individual response variability, drug interactions (especially with antiepileptics like valproate), and the lack of prolonged data (regarding cognitive, motor, and quality of life long-term impact) require well-designed future studies.

How to access cannabidiol treatment in the SUS in São Paulo?

To obtain treatment with cannabidiol, patients must:

• Present a medical prescription issued by a qualified professional.
• Go to the reference municipal pharmacies to collect the medication.
• Sign the Free and Informed Consent Form (FICF), as required by current legislation.

It is important to emphasize that the use of cannabidiol is regulated by the National Health Surveillance Agency (Anvisa) and follows the established standards to ensure the safety and efficacy of the treatment.

Expansion of medicinal cannabis use in the SUS in São Paulo

In addition to the three initially covered diseases, the SUS in the city of São Paulo is expanding the use of cannabidiol-based medications for the treatment of other conditions, including:

• Difficult-to-control epilepsies.
• Chronic pain.
• Neurodegenerative diseases, such as Alzheimer's and Parkinson's.
• Autism spectrum disorders.
• Rheumatic diseases

This expansion aims to provide a more accessible and effective treatment for patients who previously faced difficulties in obtaining the necessary medications.

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The inclusion of cannabidiol in the treatments offered by the SUS in São Paulo represents a significant advancement in access to effective therapies for severe and refractory diseases. With the expanded use of medicinal cannabis, it is expected to improve the quality of life for many patients and reduce the dependence on judicial treatments to obtain medications.