Medicinal use of cannabis
New Zealand patients need safe legal access to medicinal cannabis
The cannabis plant has been part of humanity’s medicine chest for almost as long as history has been recorded. Hundreds of recent studies validate the therapeutic use of cannabis and cannabinoids. Of all the negative consequences of marijuana prohibition, none is as tragic as the denial of medicinal cannabis to the tens of thousands of patients who could benefit from its therapeutic use.
Modern research suggests that cannabis is a valuable aid in the treatment of a wide range of clinical applications. These include pain relief — particularly of neuropathic pain (pain from nerve damage) — nausea, spasticity, glaucoma, and movement disorders. Cannabis is also a powerful appetite stimulant, specifically for patients suffering from HIV, the AIDS wasting syndrome, or dementia. Emerging research suggests that cannabinoids found in cannabis may protect the body against some types of malignant tumors and are neuroprotective. Currently, more than 60 international health organizations support granting patients immediate legal access to medicinal cannabis under a doctor’s supervision.
Update: Sativex now available on prescription
The UK-made cannabis extract Sativex has been made available on prescription from your GP, although funding remains an issue and Ministerial approval is still required.
The Minister of Health had already approved several applications since October 2008 to import and use the UK-made cannabis extract Sativex. which had followed a petition organised by NORML and the debate surrounding the Green Party’s 2006 medicinal cannabis law reform bill. Health authorities conceded that cannabis does have therapeutic properties and is a valid medicine.
In 2011 New Zealand’s medicines regulatory agency Medsafe gazetted Sativex as an approved medicine in New Zealand. This means patients can now go to their regular GP for a prescription, rather than needing an additional specialist. There is still some red tape, but less of it. This is fairly good news for patients.
Herbal cannabis still denied to patients
It’s great that the cannabis extract Sativex has been made available for prescription under the Medicines Act, and we fully encourage all medical users to talk to their doctor about it. We remain concerned that without any subsidy from Pharmac, Sativex will remain out of reach of most patients. Special Ministerial approval is still required for the imported alcohol-based cannabis extract, and it contains a particular cannabinoid profile that will work for many but not for all. We think there should be more options including giving patients or caregivers the ability to grow their own.
No patient has ever been approved in New Zealand to use real herbal cannabis. The New Zealand Misuse of Drugs Act 1975 prohibits any use of cannabis, including medicinal use by seriously ill patients, however the Minister of Health has the power under section 14 of the Misuse of Drugs Act and associated regulations to issue licenses permitting medicinal cannabis use.
Misuse of Drugs Act regulations allow a patient’s doctor to apply for special permission to import and prescribe a cannabis-based medication that has been approved in another country, or to run an experimental clinical trial (Sativex is one of those, but there are others. Theoretically, it should include the medicinal cannabis found in dispensaries in California and other US states). Your GP must also have the written backing of a relevant specialist, and they must have tried all other available medicines and found that they don’t work. Despite these high hurdles, several applications have been made to various Ministers of Health for patients to be able to consume whole herbal cannabis – which could be imported from authorised suppliers in Canada, the US, Netherlands, Germany or Israel – but so far all applications have been rejected.
What’s the problem?
The excuse for taking so long to approve Sativex and for continuing to deny herbal cannabis has usually been that no clinical trials have been conducted in New Zealand, even though most pharmaceutical medicines have also not had local clinical trials. It seems that for every other drug the government accepts the results of overseas clinical trials, but for cannabis any trials must be repeated in New Zealand.
Several politicians have rejected applications on the grounds that a medicine that is smoked cannot be safe. To that we say any potential harms from smoking cannabis are far from proven, and even if that were true, seriously ill patients and their doctors are more concerned about current suffering that potential future lung damage – especially for terminal patients.
Ministers have also objected on the grounds of not having a ready supply of cannabis to make available. This is simply not true – medical-grade whole herbal cannabis is available from the UK, the Dutch Office of Medicinal Cannabis, HortaPharm in Israel, Health Canada, or NIDA in the USA, or it could come from local police seizures of cannabis, or more simply, patients could be allowed to grow their own supply.
For patients, the problem is not just jumping through all these hoops – which can be difficult if your quality of life is already affected by an illness or condition – but if an application is successful they must then pay for it. Sativex for example can be very expensive for patients. In come cases ACC will help but in other cases patients may need to pay for treatment themselves.
What is clear is that the continuing reluctance to make progress on medicinal cannabis is based on political not scientific considerations. Let’s restore medical decision-making to those who are trained to make medical decisions – doctors and health professionals – and get the politicians out of the way.
What about Marinol, or synthetic THC pills?
In 1986, a synthetic delta-9-THC capsule (Marinol) was marketed in the United States and labeled for use as an anti-emetic. Despite some utility, this product has serious drawbacks including its cost. For example, a patient taking three five-milligram capsules a day would spend over US$5,000 to use Marinol for one year.
In comparison to the natural, smokeable product Marinol also has some pharmacological shortcomings. Because THC delivered in oral capsules enters the bloodstream slowly, it yields lower scrum concentrations per dose. Oral THC circulates in the body longer at effective concentrations, and more of it is metabolized to an active compound; thus, it more frequently yields unwanted psychoactive effects. In patients suffering from nausea, the swallowing of capsules may itself provoke vomiting.
In short, the smoking of whole cannabis is more efficient in delivering THC and, in some cases, it may be more effective.
Medicinal cannabis overseas
The medicinal use of cannabis is legal in 16 states of the USA including California and Washington DC, the Netherlands, Germany, Spain, Canada and Israel. Research shows allowing medicinal cannabis will not effect overall use rates or teenager’s attitudes towards drug use. One million Californians can legally purchase medical cannabis at dispensaries or they may grow their own. In fact, research shows medicinal cannabis law reform in the USA is associated with reduced teen use rates as well as reduced road deaths.