How Patients Could Access Medicinal Cannabis by Christmas

Medicinal cannabis is legal in New Zealand right now – although it would be easy to miss.

The cannabis tincture Sativex has been available for several years. An exemption from criminal prosecution has also been created for patients undergoing palliative care, allowing them to use, possess and obtain illicit cannabis for medicinal purposes. The non-psychoactive cannabis derivative cannabidiol (CBD), highly indicated for seizures, pain and anxiety, can be prescribed by any doctor.

While great progress is being made, these measures haven’t helped most of the 180,000 New Zealanders who currently use cannabis for medicinal purposes. Sativex is still difficult for doctors to prescribe, palliative care patients cannot provide for themselves, the availability of CBD products has not changed, and no products are being made locally yet.

That could change in December of this year, when the full Medicinal Cannabis Scheme is due to come into effect.

But here’s how it could play out, if the Government is not careful: Regulations are issued by 18 December, meeting the requirements of the medicinal cannabis amendment, but licences could still take 12 months or more to be issued, so producers might start growing in 2021, well after the adult-use referendum in 2020. That would complicate the referendum. And while patients would continue to be denied the medicine that works for them, licenced producers would be forced to destroy their research crops and refined oils. That’s not a good look for anyone and goes against the objectives of the scheme.

Here’s my ten picks for how to ensure patients can access medicinal cannabis as soon as possible. These can all be done within the regulations set to be developed this year. There are other measures which could increase the pace of patient access, such as allowing patients to provide for themselves (ie home growing, which I advocated for) and allowing patients with prescriptions to import cannabis medicines for their own use, however these would require changes to legislation and are outside the scope of what I’m proposing here.

1.    Allow both herbal and pharmaceutical cannabis products

Most patients are using herbal cannabis, but most doctors would prefer to prescribe products made to regular pharmaceutical standards. While this is allowed under the current law, it could take several years to have pharmaceutical products researched, developed and approved. The new Medicinal Cannabis Scheme is expected to allow products to be manufactured to something closer to herbal- or food-grade standards. This will allow producers to grow and make cannabis products in a much shorter timeframe. Win!

2.    Let research go commercial

Currently, the handful of firms with research licences must destroy any cannabis they produce, while patients go without. Let them stockpile what they produce and then sell it to doctors and pharmacies as soon as the new Scheme comes into play, if their stockpile meets the new product standards. Likewise, regulators could simply amend existing research licences to allow commercial sales, rather than making them start again with a new licence application (which could take 6-12 months). This is an easy, overnight fix.

3.    Be ready and resourced

The key to making this happen is to properly resource the regulators. But they are funded mostly by licence fees, and licences are not yet being issued in earnest. Policy makers and licence assessors need a top up, probably equivalent to a dozen or so new workers. It’s a pittance in the grand scheme of government but would make a huge difference to improving patient access.

4.    Up the limit

New Zealand is currently limited by the UN’s International Narcotics Control Board to importing a total of 7kg of cannabis product per year for research and medicinal uses. Imports will be an important backup while local producers get going (dependent on points 1-3 above). But with one-in-twenty New Zealanders already using cannabis for medicinal purposes, at an average of around 1 gram per day, we have a total consumption of around 65 tons per year. There is an urgent need to update the UN with the amount New Zealand really requires.

5.    Let any doctor prescribe it

The whole point of legalising medicinal cannabis is that any doctor should be able to prescribe it, and any pharmacy dispense it, so that any patient can access it. Don’t silo medical cannabis among specialists. All GPs need upskilling and high-quality clinical guidance to keep up with medicinal cannabis and the endocannabinoid system. It’s the largest neurotransmitter system in the body, and all doctors should know about it. Let them learn and let them prescribe.

6.    CBD could be OTC

In most countries cannabidiol is an over the counter health supplement. It is non-psychoactive and has a remarkable safety profile. Allowing certain forms of CBD to be sold OTC (over the counter) could let Kiwis immediately access CBD products already sold all around the world. Over the counter formulations could be, for example, topical emulsions or tablets under certain dosages. The Medicines Classification Review Committee could be asked to reclassify CBD (or certain forms of CBD) before the Scheme goes live. There’s no reason to wait.

7.    Let hemp go medical

To really get costs down and increase patient access, we could allow existing hemp farmers to sell their waste biomass to licenced medical producers. That biomass often contains cannabinoids which although at very low levels can be extracted and made into medical oils or other formulations. The scale of outdoor hemp farming would mean this could be done very cheaply. They are currently prohibited from doing this, through an artificial distinction. Other countries allow it, and it also solves the problem of how hemp farmers can dispose of their “waste” contaminated with cannabinoids. Licenced producers can, of course, be licenced to take this and produce medicines from it. There is no law preventing this from happening.

8.    Pharmacies will be our dispensaries

Patients will obtain their medicinal cannabis products from pharmacies, just like other medicines. There might be a range for patients to choose from, or a brand prescribed by the doctor. Patients will have lots of questions and particular needs. We need to ensure pharmacies are ready, ahead of the Scheme going live. While any doctor should prescribe cannabis products, it’s probably a good idea to have specialist pharmacies, at least in the beginning. The law governing pharmacies is being reviewed right now, so it’s important we identify any potential fishhooks that could inhibit access to medicinal cannabis products.

9.    Allow communications for unapproved products

Doctors and pharmacies need new information and guidance to enable confident dispensing. But we have a problem: all new cannabis products, whether herbal or pharmaceutical, will have the status of “unapproved products”. These cannot be marketed, and any communications with doctors and pharmacies may count as marketing. But to me this is over-thinking it: simply allow clear, impartial, information but not spin. Complicating things, this is also being reviewed now as part of the Therapeutic Products consultation. This includes another proposal to remove the ability of doctors to prescribe any “unapproved” products. But as I identified above, all medicinal cannabis products will be “unapproved”, at least in the beginning. This needs to be changed, or patients will find access a lot more difficult.

10.    Streamline the process

The current process for prescribing cannabis products is cumbersome, confusing, and just too difficult for most doctors to squeeze into a 15-minute consultation. The new Scheme should simplify this process, so it is like any other medicine. But if it doesn’t, I’m working on a solution. Zeacann is developing an online portal to guide prescribers through the process and ensure they are fulfilling their compliance requirements, which is a huge factor in making doctors hesitant to prescribe. Other companies are working on other solutions. Support them and encourage innovation and technology-based approaches.

These ten fixes can all be done this year though regulations or updates to policy, with no law change needed. I want New Zealand to be a world leader in medicinal cannabis, and for patients to have legal access by Christmas this year. Let’s do it!

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Chris Fowlie is the CEO of Zeacann Limited, a medicinal cannabis producer; serves on the executive of the New Zealand Medical Cannabis Council; is president of the National Organisation for the Reform of Marijuana Laws NZ Inc; a co-founder of The Hempstore Aotearoa; resident expert for Marijuana Media on 95bFM; blogger for The Daily Blog, and court-recognised independent expert witness for cannabis. The opinions expressed here are his own.

Originally published on The Daily Blog, 5 April 2019:
https://thedailyblog.co.nz/2019/04/05/how-patients-could-access-medicinal-cannabis-by-christmas/

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