The people working for medical cannabis

Have we got we have got medical cannabis laws right? Russell Brown asks this at NZ Herald on Medicinal cannabis: For the love of her son:

The death of Rose Renton’s son prompted a dramatic change in the direction of her life. Russell Brown explores whether we have got medical cannabis laws right.

At the request of his family and doctors, Alex became the first New Zealand patient to be granted ministerial approval to import a non-pharmaceutical grade cannabis product in June 2015. The treatment couldn’t save him, but New Zealand’s conversation about medical cannabis turns on the weeks he spent in hospital, his brain in crisis.

In the course of approving the request to import an oil containing cannabidiol (CBD), Associate Health minister Peter Dunne had officials draw up guidelines for future applications, which had been provided for in law for years but never made before.

Helen Kelly applied, unsuccessfully, for another cannabis product under those guidelines. Dunne ordered a review and the Labour Party promised to make access easier.

This year, Dunne removed the requirement for ministerial approval for CBD products altogether.

And now, Alex Renton has landed his mother in court. Rose Renton, who lives in Nelson, is the most high-profile of a series of “green fairies” to face charges of growing, processing and possessing cannabis for supply.

Although Kelly very publicly eased her pain with the cannabis products people brought to her door, no one seemed inclined to make any arrests. That has changed this year.

That’s a shame. Police discretion could be used if it is not in the public interest to prosecute.

Shane Le Brun, who has participated here, has a different approach – to change the medical and legal systems.

A few kilometres, almost in line of sight of Rose Renton’s house, Shane and Kat Le Brun are fighting a very different battle — not to reject the system, but to make the system work better.

They had been married three months, he an army munitions officer, she an early childhood teacher, on the day in 2010 when their lives changed. Kat stepped out on an icy deck at the school where she was working, “my leg went from underneath me and I landed awkwardly on my back and butt. That was it.”

Doctors eventually discovered three of her spinal discs had prolapsed. In the seven years since, the 31 year-old has had spinal surgery and then been re-injured — knocked over by a child in a sandpit — and twice gone into respiratory arrest from opioids administered by emergency medics.

Her condition is managed to some extent with methadone, the only opioid prescribed for long-term use. It’s slowly destroying her teeth.

Over time, she’s had various powerful opioids, ketamine, gabapentin, valium and an anti-depressant (stress is known to aggravate her condition). She has tried cognitive behavioural therapy and acupuncture.

And on one terrible evening in hospital, when she couldn’t stop screaming, she was given an anti-psychotic and shut in a room by herself for the night.

But there is one treatment she’s not allowed — or at least, can’t legally get. Cannabis.
She says that the first time she tried cannabis (“I got it from a family member”) she slept well for the first time in four or five years.

Shane, who now works in IT, had already taken a nerdish interest in her pain medication (to the extent that they suspect he appeared to “know too much” and was incorrectly flagged as a drug-seeker by the system) and turned his attention to cannabis.

He formed a charity, Medical Cannabis Awareness NZ, which campaigns for the availability of affordable medicines via the non-pharmaceutical provisions first used by Alex Renton’s doctors.

Last year, MCANZ was responsible for 80 per cent of ministerial approvals for their use. Ministry officials who were once suspicious of medical cannabis now speak to him regularly.

Ironically, the one he hasn’t been able to help is Kat.

“I do find it very difficult,” she says. “It feels at times that he’s fighting harder for others than he is me. At the height of my pain, I have been known to throw a few pillows at Shane and say to him, you’re doing all this work and you have been for so long and I’m still not further ahead.

Her frustration is compounded by the stigma Shane’s advocacy attracts.

“I have been discriminated against because of what Shane does. I think people hear the world cannabis and freak out — because it’s illegal in their eyes. And all they know of when you say that word is getting high.

That’s a real shame, but eventually, hopefully soon, she will benefit from Shane’s efforts.

Kat’s own bid to be legally prescribed a cannabis product hit a familiar roadblock — doctors. A senior medic at Burwood spinal unit told them there was insufficient evidence for him to prescribe Sativex, the only Medsafe-approved cannabis product in New Zealand.

“I presented the doctor with a printout of a trial of Sativex for allodynia and hyperalgesia,” says Shane. “And he tried to change the topic because I basically knew more than he did.”
Kat adds: “The report came back and said ‘the husband seems to know a lot about cannabis’ and made it seem really dodgy.”

“We had to go doctor-shopping,” Shane says. “It’s disappointing, because she’s exhausted all reasonable options.”

The ministry has since taken a different view, acknowledging that a cannabis product is a benign option for Kat and approving access. Now, they face the other big roadblock for legitimate medical cannabis in this country: cost.

The cost of producing, testing and proving medicinal products is high, especially when there is a very restricted market.

Last year, MCANZ helped Auckland MS patient Dr Huhana Hickey win approval for a functionally identical product made by the Canadian company Tilray.

But that has ended up being more costly than they’d hoped and the couple are now pinning their own hopes on a similar product made by another Canadian company, CanniMed.

Remarkably, the Ministry of Health is now prepared to approve CanniMed’s whole dried cannabis products, for use in vapourisers. It has also tabled work on regulations for growing cannabis locally for research as part of advice to the new Government.

Shane believes local production to precise medical standards is the only long-term answer.

“The patient population views the green fairies and illegal suppliers as heroes,” he says.

“As a charity, we cannot condone or promote illegal activity. But come on — there’s 100,000 people who claim they use cannabis medically at least sometimes and around 50 people in the country accessing it legally at any one time. There’s just a huge disparity.

Lawyer Sue Grey has taken another approach.

She was a specialist in environmental law when, five years ago, she was asked to act for 61 year-old Golden Bay woman Victoria Davis, who had been charged with cannabis cultivation and possession. Davis had been growing for her husband John, a double amputee wracked with phantom pains.

Grey won her client a discharge without conviction, in part by presenting a doctor’s letter to the judge.

She thought she would move on, but in 2015, Davis recommended her to another Golden Bay resident in legal trouble, Rebecca Reider. Reider was facing serious charges after posting herself two bars of cannabis chocolate — which had been legally prescribed to her for chronic pain in California and delivered to her family’s home.

Again, Grey presented medical records and Reider was eventually discharged.

But she also studied the Misuse of Drugs Act and discovered that Reider was allowed to import a controlled drug if it was prescribed and she brought it in herself.

Then, advocating for terminal cancer patient Tom Harris, Grey challenged the Ministry of Health’s position that CBD is a controlled drug under the Misuse of Drugs Act. The Government’s own agency, ESR, wrote in unequivocal support of her argument.

CBD officially remains a controlled drug — but when Dunne announced this year that CBD prescriptions would no longer require ministry approval, it was effectively a surrender.

But the situation remains vague and confusing.

The law, Grey agrees, is a real mess. She says she feels for the police.

“I’ve spent a lot of time working with the Nelson police, the drug squad and the prosecutors. When I first started working with them they had zero tolerance for any excuse for medicinal or any other cannabis.

“Now, they’ve really learned a lot — but they’re in a difficult position because their job is to uphold the law. They have discretion, but they have to report to their bosses. They’re the meat in the sandwich, really.”

Ultimately it’s our MPs, our political parties, and our Government that put the front line police in an invidious position.

Dunne tried to progress things on the medical front, but was hampered by an unsympathetic National government.

Labour have promised progress, Greens should be a shoe-in for support, but it will still require support from NZ First or national to change out of date and hopelessly impractical laws.

But the Minister now responsible for the health side of cannabis, David Clark, could push progress along there.

And surely the Minister of Police Stuart Nash could give some direction on the policing side of cannabis, especially where illness is involved.

Renton, Le Brun and Grey have done a lot and have achieved a bit, but it’s time for our elected representatives to take responsibility for a messy and stupid situation.

If Jacinda Ardern chose to show leadership on this she would be likely to get a lot of popular support. People are suffering necessarily and sadly.

 

15 Comments

  1. Zedd

     /  December 9, 2017

    There are two main ‘stumbling blocks’ apparent;

    1) All the ‘nay-sayers’ in NZ (most on the right) who keep trying to talk it down & say its just an excuse to ‘legalise DOPE’

    2) the fact that USA federal law (global driver of policy) still has Cannabis/’Marihuana’ under Schedule #1; supposedly most open to abuse & of NO known medicinal use or value. Even though more than half the states have now regulated its medicinal use, for a raft of illness/conditions.. talk about, Double-Standards

    Reports from UN have said that it is past time to reform Drug laws & end the WAR.. but here in Aotearoa/NZ, there is still a childish/nonsensical fear, going around that Law reform will lead to ‘the end of the world as we know it’ ! (or at least that seems to be the perception in some quarters ?) even a recent fear-mongering comment in parliament, by a Natz MP, about the possible changes planned.
    its all “TOTAL B-S” sez I&I 😦

    • Kitty Catkin

       /  December 9, 2017

      I have never heard anyone reacting in the extreme way that you and you quote. Who is the second you ?

      I keep finding emails offering it to me in my junk folder, but am not fool enough to send away for it and be sent a bottle of cooking oil or something like that with no comeback…I hope that nobody else is

    • Kevin

       /  December 10, 2017

      The problem is people have been completely brainwashed by the Prohibitionist lobby, including those who think cannabis should be legal. Here are a few typical Prohibitionist lies that are so ingrained people just take them for granted:

      1. Prohibition increases the price of a drug therefore making it less available.
      Truth: Illegal drugs are subject to the same law of supply and demand as any thing else. For example the price of heroin has dropped so dramatically in recent years that in Edinburg it’s now cheaper to get high on heroin that to get drunk on alcohol.

      2. Prohibition decreases use.
      Truth: During alcohol Prohibition in the US there was a decrease in beer consumption but this was more than made up for in a dramatic increase in the consumption of spirits. So not only does Prohibition not decrease use but it dramatically increases use of the stronger form of the drug.

      3. Legalising a drug make is socially acceptable and will result in more children using it.
      Truth: In the US where cannabis has been legalised there has been no significant increase in teen use and in some places it has actually gone down. It’s the public that decide whether a drug is socially or acceptable or not, not the law, For example if methamphetamine was legalised tomorrow I doubt many people would regard it as a socially acceptable.

      So if you believe that cannabis should be legal but MDMA and LSD kept illegal but sorry, you’re still brainwashed by the Prohibitionist lobby. If you think that legalising heroin will result in an epidemic of heroin addiction then sorry, still brainwashed by the Prohibitionist lobby too. And if you think the idea of legalising methamphetamine is one of the most dangerous ideas you’ve ever heard then, you guessed it, still brainwashed by the Prohibitionist lobby.

  2. david in aus

     /  December 9, 2017

    Medicinal Cannabis lobby is hodge-podge of free drugs crowd, and people clutching at straws with their illness. I do not doubt for some of them, there is a genuine claim for benefit.
    Medicinal cannabis is just another way of proceduring legal weed for some.
    What is lacking is robust medical evidence. The placebo effect is very strong for pain relieving medication.
    New Zealand should offer to the world, randomised double blinded clinical trials for medicinal cannabis.
    The emotive aspect of this debate is so strong, it is difficult for people to make an informed decision.
    Let evidence triumph over emotion with some science.

    • placebo is pretty piss weak for chronic pain, I have yet to see Placebo as an opioid sparing agent the same way Cannabis is.

      • Zedd

         /  December 9, 2017

        keep up the good work Shane.. we will get there, hopefully one day SOON 🙂

        As Ive said before; many kiwis ‘just cant see the cannabis for the weed’ (genuine Med-use). Prior to 20th century, it was one of the most widely used medicinal plants, then the hysteria began.. many have just accepted the nonsensical drivel that still continues today; ‘reefer madness’ etc. 😦

        • david in aus

           /  December 9, 2017

          Opium was also a widely used plant prior to the 20th century. We have heroin as well as medicinal forms. Also foxgloves(digitalis) used for the medicine digoxin; bark of willow tree for aspirin.
          Why can’t cannabis follow the same process, do some clinical trials.

          • Gezza

             /  December 10, 2017

            Well, it can, & my understanding is that there have been clinical trials, hence why it is approved in some countries. As you mention willow bark for aspirin, yes there have been plenty of clinical trials, and aspirin has well know uses & side effects & contraindications – but you can also buy and use willow bark without a prescription.

            • david in aus

               /  December 10, 2017

              It’s alway some ‘trials’, very vague. No good trials. Just poor quality anecdotes. Pain relief, as in the references, is strongly affected by placebo. If it is not a placebo controlled trial it is worthless.

      • david in aus

         /  December 9, 2017

        Pain. 2016 Dec;157(12):2766-2772.
        Open-label placebo treatment in chronic low back pain: a randomized controlled trial

        Compared to Treatment as Usua(TAU)l, Open Labelled Placebo (OLP) elicited greater pain reduction on each of the three 0- to 10-point Numeric Rating Scales and on the 0- to 10-point composite pain scale (P < 0.001), with moderate to large effect sizes. Pain reduction on the composite Numeric Rating Scales was 1.5 (95% confidence interval: 1.0-2.0) in the OLP group and 0.2 (-0.3 to 0.8) in the TAU group. Open-label placebo treatment also reduced disability compared to TAU (P < 0.001), with a large effect size. Improvement in disability scores was 2.9 (1.7-4.0) in the OLP group and 0.0 (-1.1 to 1.2) in the TAU group. After being switched to OLP, the TAU group showed significant reductions in both pain (1.5, 0.8-2.3) and disability (3.4, 2.2-4.5). Our findings suggest that OLP pills presented in a positive context may be helpful in chronic low back pain.

  3. david in aus

     /  December 9, 2017

    The most worrying feature in the article is that GPs are asking a lay person for advice. That person treated one person, who did not respond to treatment. Doctors have no scientific trials or reliable dosing to go on. This should give people pause for thought, do you think?

    New medications need to go through three phases of clinical trials.

    Do you want your elderly parents on this medication not knowing at what doses are toxic? Knowledge about drug-interactions, side-effects such as delerium and psychosis. That you could be causing more distress and harm?

    • Kevin

       /  December 10, 2017

      CBD doesn’t cause psychosis. Yes, too much THC can but the psychosis lasts only as long as the effects of the THC. In fact the only drug that I’m aware of that may cause permanent psychosis is DMT.

      In any case medical cannabis is defined as cannabis with low levels of THC, ie, levels low enough to not have any psychoactive effect.

  4. david in aus

     /  December 9, 2017

    Medicinal cannabis should treated like any other medicines. It should go through Medsafe, prove its effectivessness and safety. Not emotional political campaigns.

    • Kevin

       /  December 10, 2017

      Why? It’s a herbal remedy and so is exempt under under the Medicines Act. It has no psychoactive effect so the Psychoactive Substances Act doesn’t apply. That leaves just the Misuse of Drugs Act which begs the question why a drug that has no psychoactive effect is illegal under the Misuse of Drugs Act?