Civil Disobedience and Bottom-up Governance of Cannabis for Medicinal Use in Brazil: The Role of Patient Associations

Access to cannabis for medicinal purposes in Brazil faces many restrictions. The country does not have a law establishing clear regulation for this issue, creating a context characterized as a “weak legal governance.” This allowed social actors to build their own dynamics of access to the plant and its products, often on the fringes of the law, by using strategic mechanisms of action. The most expressive case is the creation and functioning of non-profit cannabis patient associations (CPAs), whose activities have redefined the policy design “space” of cannabis medicinal use in the country. The specialized literature still lacks an analysis of these cases and their contribution to the new governance of cannabis regulations. The article intends to address this gap. To this end, a literature review in the field of public policy and related areas, as well as a qualitative analysis of secondary data, was conducted. To complement this information, primary data was collected through five semi-structured interviews with key representatives from CPAs and with the Legal Network for Drug Policy Reform. The conclusion is that Brazil has an alternative bottom-up cannabis regulation model created by a “leadership configuration” in which CPAs are protagonists. They assume this role by acting based on the idea of civil disobedience to the drug law and functioning as social devices for politicizing medical cannabis use. This alternative regulation promotes more democratic access to cannabis-based medicines but remains embedded in Brazil's racist and classist prohibitionist framework, adding a new layer to it rather than replacing it..