Do We Really Need “Pharma Grade” Medical Cannabis?

Part one of a series of opinion pieces by Shane Le Brun, Coordinator, Medical Cannabis Awareness New Zealand

There is strong public support for significant reform of Medical Cannabis (MC) regulation. The system currently in place, which focuses wholly on pharmaceutically trialed cannabis-based medicines, removes patient and prescriber choice, and costs are prohibitive. New Zealand may have the highest priced MC in the western world – a side-effect of our remote location and small market.

Most other western countries are looking to grow and make their own products to expand treatment options while reducing costs. Australia in particular, with its solid experience in poppy cultivation, is looking to create an export market and has at least a dozen companies exploring the pharmaceutical route, pouring 10s of millions of dollars into trials for a product that they will likely have trouble holding patents on.

We have already proved with one patient, Dr Huhana Hickey, that a comparatively simple standardised extract made in grapeseed oil, can do a better job than the registered pharmaceutical alternative. This is compared to the ‘pharmaceutical grade’ product Sativex, which is essentially “2 strains of hash oil in a spraycan”. The alternative is available from Canada for a much lower cost. Imagine the cost reduction if such products could be produced in New Zealand with our proven scientific capabilities. Our issue with cost can be resolved without granting patients the individual freedom to grow their own.

At MCANZ we have introduced a small handful of products from 2 companies in Canada. These products are not Pharmaceutical grade, but are close to it, yet they cost 30-60% less than Sativex to the patient. I refer to these products as “near pharmaceutical” the quality is good, the product is clean. We have never had a request to prescribe one of these products declined by the MOH and we need to differentiate them from the negative connotations of “non pharmaceutical” in the applications scheme.

These products are not dirty hash oils made in a Californian garage by a “Ganjapreneur”, but are developed under a regime regulated and monitored by the Canadian MOH equivalent, “Health Canada”. For these products, the MOH has said nothing but yes (the trick is convincing New Zealand doctors to apply). These products have been safely prescribed to thousands of Canadian patients already, so why shouldn’t we also use these products?

The cost savings per patient can be immense for customers. However, this also matters for public expenditure as currently, WINZ, ACC and DHBs are funding Sativex on rare occasions. I estimate there are tens of thousands of dollars to be saved per annum by ditching the pharmaceutical only mindset. Naturally, starting from such a low number, the projections will only increase going forward as the evidence of cannabis’ effectiveness for conditions such as chronic pain shores up. (It is trending towards conclusive in general terms.) This has massive ramifications for the potential financial vulnerability/liability for the likes of ACC if they are increasingly asked to pay up for Sativex or other Pharmaceutical grade products in the future. It also matters for patients if they refuse access due to this cost burden.

After our next product roll out, we will reach a point where the only way to get products cheaper will be to make them ourselves in New Zealand. Canada’s system of licensed manufacturers would be ideal for New Zealand. It delivers relatively standardised and safe, sterilised products 80% cheaper than Sativex (the only relevant product preapproved by MedSafe for use in New Zealand) for similar-strength products. Products can double in price when getting shipped internationally, if we allow “near pharmaceutical” products to be made in New Zealand without trials, then we could make these products available as unregistered medicines. Trials cost big money, a cost that is then forwarded on to the patients. With plenty of generalised evidence emerging, there is no need to reinvent the wheel and prove that a balanced cannabis product that is in essence similar to Sativex does the same job.

Instead, lets make the products locally, and make them available to GPs and specialists, and let the medical professionals use their own common sense about when to prescribe. Additionally, by forgoing the insistence on trials, we can race ahead of Australia in getting the potential industry to the export stage, with cost advantages to boot. We snoozed and loosed with Opium production in the 60s, and now Tasmania leads the world in that multibillion-dollar industry, lets not make the same mistakes with Cannabis just because a few conservative MPs can’t differentiate between a medicinal crop and the cash crop down at their local tinny house.

Part 2 of this series of opinion pieces will be published next week and will cover the finer points on the workability of policy allowing patients to grow cannabis at home.

20 Comments

  1. Kevin

     /  September 9, 2017

    There is no reason for low level THC cannabis to be illegal. Misuse of it doesn’t even have a low risk of harm to individuals or society so it shouldn’t be even be classified as a Class C under the Misuse of Drugs Act.

  2. NOEL

     /  September 9, 2017

    This product I hope is only for sufferers of chronic pain where pain specialists have determined the usual options are ineffective. Given the small number cost shouldn’t be a factor. Or can a stoner go to his GP claiming his back is sore?

    • Bill

       /  September 9, 2017

      Noel, speaking as someone who broke their back in a motorcycle accident earlier in life I can you assure you the cocktail drugs supplied by Doctors make it hard to live a normal life. I don’t know if you realize it, but stoners are already getting their drugs.

      • NOEL

         /  September 9, 2017

        ” I don’t know if you realize it, but stoners are already getting their drugs.”
        On the public purse?

  3. what is this Govt.s real agenda on cannabis ?
    when it seems like med-users have got over one barrier.. they put up another !
    actually its clearly the thing, they constantly criticised Labour for; “Nanny state’ !! total CONTROL

    I heard this morning that Canada is set to legalise/regulate recreational use in 2018, they allowed medicinal use in 2001. Maybe NZ might catch up one day.. BUT dont hold your breath folks 😦

  4. PDB

     /  September 9, 2017

    If we make a non-test exemption for medicinal cannabis doesn’t this open the door for other ‘exemptions’ for drugs which may cause harm if not tested properly? Isn’t that why with have a one-rule-for-all process? It may seem over-the-top I agree but isn’t public safety and consistency in our drug approval process that is of most importance here?

    • Cost to patients, if we drop 50 million dollars on a series of trials to prove an extract of cannabis works for nerve pain then that is transferred to the patients, hence why sativex is so expensive. It merges into a social issue, where sick people either break the law and grow their own, or go bankrupt trying to fund Trailed products, there has to be a third way, and there is.

      • PDB

         /  September 9, 2017

        I just think you go down a slippery slope if you start exempting stuff from the process because it appears ok. I’m sure there are other drugs in a similar position. Drug approval needs to be a robust, overly-thorough process to the point of being pedantic.

        Interested to read your follow-on post.

        • Gezza

           /  September 9, 2017

          Not sure why you got downticked. Both your posts upticked for raising good questions & promoting intelligent discussion.

          • PDB

             /  September 9, 2017

            Go to the end of the alphabet for one of those down-tickers…..

            • Gezza

               /  September 9, 2017

              🤔 Maybe the first “I” – but surely not the “&I” ? 😳

        • the slippery slope is allready here. sativex for 1200 bux is half an ounce equiv. im introducing non pharma grade equivalents with 100% success rate on MOH decisions. Meanwhile most people who would qualify blaze up illegally, with increasing encouragement from their doctors too, I had a specialist ask me for a reccomendation on illicit suppliers…… awkward times. I will point out that Canada’s system works quite well.

      • @SLB
        The question is.. why is this Govt. constantly ‘reinventing the wheel’ on this issue ?
        methinks its all part of their ‘we know best & everyone else is wrong !’ attitude

        Nearly every other OECD country is accepting broad use of medicinal cannabis & moving forward with it.. all I hear & read from this minister/govt. is excuses to maintain the status quo OR push 1-2 imported Big Pharma products/synthetics. Its time they just cut the CRAP & fear-mongering & allow patients who can benefit from this plant, to grown it in NZ & create a local industry; as per the Greens bill (J A Genter) which I hear they are still sitting on the fence with…

        **they obviously have another agenda sez I&I 😦

        • The other question; why have they got stricter controls over a Class C drug (med-use Cannabis) which is supposedly less harmful, than Opiates (class A) ?

    • Bill

       /  September 9, 2017

      I agree new drugs should be tested to a high standard and the synthetic market shows that clearly. However the Cannabis plant has been around as long, if not longer than us and is a very safe substance. If someone uses Turmeric for instance as a cooking spice, should it be held to a higher standard because you can buy it from a chemist.

      • Kevin

         /  September 9, 2017

        As I understand it cannabis is classified as a Class C drug because of the THC, i.e, users get stoned off the THC and there’s a chance they’d do something stupid. But since “medical” cannabis has such low levels of THC that it has no psychoactive effect it shouldn’t be classified as a Class C drug.

        I’d like to see the EACD charged with the responsibility of considering recommending the declassification of low-THC cannabis as a Class C drug. But since the EACD moves slower than a turtle I wouldn’t hold my breath.

  1. Do We Really Need “Pharma Grade” Medical Cannabis? — Your NZ – NZ Conservative Coalition