The real work begins on the Medical Cannabis scheme

Media release from Medical Cannabis Awareness New Zealand after the passing of the medical cannabis bill in parliament today:


The real work begins on the Medical Cannabis scheme

MCANZ is delighted at the historic achievement of a solid commitment to produce Medical Cannabis in New Zealand, and is grateful for the amendments that were introduced broadening the scope of the compassionate clause, clarifying a more therapeutic “whole plant” definition of CBD, and allowing for native cannabis strains to enter the market, giving New Zealand Industry a competitive edge over Australia.

MCANZ Does note that the real mahi has yet to start, and close attention was paid to details in the Initial speech from David Clark.  Details were revealed around a consultation phase, with a mention of an advisory committee to be formed.

It is the view of MCANZ that a year has been wasted that could have been spent working on the scheme.
“We challenge the minister to get invitations for an advisory committee out before christmas to demonstrate it is truly a priority.” Says MCANZ Coordinator Shane Le Brun

“The challenge now lies in the MOH and its resourcing, we need the MOH to recruit more staff to assist in forming the scheme, and ultimately administering it, we hope that with a  budget surplus it should be fairly easy to get funds without resorting to the likes of industry levies.”

“Time frames are prone to slipping, especially with such large bodies of work, we hope that they can talk to other governments to learn from their experiences, and ensure that the scheme is implemented on time.”

“Our hope is that with early clarity on the direction of the scheme, manufacturers can be ready for the go live date, delivering products at much more affordable prices on day 1”

Poll suggests more progressive cannabis law reform wanted

People hoped that a new Government, especially one with Greens and Labour dominant, would properly address dysfunctional cannabis related laws. The Misuse of Drugs (Medicinal Cannabis) Amendment Bill is set to be passed this week, probably on Tuesday, but the lack of scope that has made it through the parliamentary system is underwhelming. Many will be disappointed.

A poll suggests that a majority of New Zealanders want more from Parliament – more like moves in a number of other countries, like Canada and United States who are far more progressive.

NZ Herald: Kiwis support medicinal cannabis for many conditions: Poll

A majority of New Zealanders say medicinal cannabis should be allowed to treat chronic pain, sleep disorders and other conditions, according to a new poll.

The Horizon Research poll, which was commissioned by fledgling medicinal cannabis producer Helius Therapeutics, comes just before a bill is expected to pass that will allow the use of medicinal cannabis for people who need palliative relief.

The poll, which canvassed the views of 2105 adults, showed support for medicinal cannabis to be allowed for a range of conditions.

Should be used for:

  • Chronic pain 68%
  • Cancer 58%
  • Epilepsy 52%
  • Multiple sclerosis 50%
  • Anxiety 49%
  • Arthritis 48%

I expect that those percentages would be much higher for those suffering from chronic pain, cancer, epilepsy, multiple sclerosis, anxiety or arthritis.

I wonder how these approval ratings would compare for the use of morphine?

The Government bill requires regulations for a medicinal cannabis scheme to be made no later than a year after the law comes into effect. There will be further consultation on those.

Other findings from the poll:

  • 75% agreed that medicinal cannabis should be treated the same as any other medicine
  • 59% agreed that doctors and nurse practitioners should be able to issue “medicinal cannabis cards” so patients could access cannabis products from pharmacists without prescription

More on that last result from Medical Cannabis Awareness NZ:

Recently Helius has commisioned a Horizons poll outlining attitudes around Medical Cannabis.  With the final reading of the Medical Cannabis bill likely to be early this coming week, it outlines strong support across the political spectrum for significantly more reform than what was offered in the Govt Cannabis Bill.

“A key critique of the govt bill is that it shows no shape or intent outlining the nature of the ‘scheme’. Public support as polled shows strong support for a Card based access scheme similar to what is in place in many US States, and as proposed in Dr. Shane Reti’s private member’s bill” says MCANZ Coordinator Shane Le Brun.

The Headline result shows that support for a card scheme is at 59%, with those opposed only at 18%

“Such results should be taken seriously by the team at the Ministry of Health who will be in charge of creating the scheme. Its a timely poll in that the next phase will be reliant on these unelected officials to balance the demands of the public, along with political expediency and the nature of managing the public health risks and benefits such a scheme may entail”.

“The preference of the public is to destigmatize Medical Cannabis, which aligns with our charities views. Essentially we would be satisfied if ‘Balanced’ Cannabis products were treated with the same caution as lighter Opioids and Benzodiazepines such as Codeine and Diazepam, which are prescribed quite freely”

“Unfortunately the wording of the question suggests following the traditional medical development model, which is where cannabis-based medicines hit a snag, its commercial suicide to do large-scale phase 3 trials for Medical Cannabis products, where the compositions etc are not able to be protected by patents”
This leads into our main issue with Medical Cannabis gaining legitimacy, the paucity of Phase 3 RCTs”

It is the hope of MCANZ, that with the successful passage of the bill, that the Minister and the Ministry waste no time in getting the regulatory consultation underway, and use such polls in their initial planning.

After initially indicating they would take urgent action over medical cannabis availability. It has taken a year to get a watered down bill over the line.

It could take up to another year to put it into effect.

 

Labour 100 day medical cannabis promise could be 1,000 days or more

The lack of urgency by the Government on medical cannabis has been very disappointing, after initial promise of it being a first 100 day priority, and especially as it was promoted as important by Jacinda Ardern in the memory of her friend Helen Kelly.

And it was promoted as a 100 day promise:

Labour will hit the ground running in government, with a programme of work across housing, health, education, families, the environment and other priority areas.

  • Introduce legislation to make medicinal cannabis available for people with terminal illnesses or in chronic pain

It is now about 360 days since the Labour-led government took over, and they look nowhere near fulfilling this promise.

MCANZ Coordinator Shane Le Brun: “It is disappointing that the bill’s second reading has been postponed to November due to haggling around supplementary papers to improve the bill.”

“Patients are left disenfranchised and frustrated with the lack of progress on the bill”.

On 1 November 2017 Dylan Kelly wrote (The Spinoff): On a new government, kindness and the (unfinished) legacy of my mother, Helen Kelly

Jacinda Ardern’s programme offers real hope for the issues Mum fought so passionately for, from labour law and cannabis reform to forestry and Pike River.

…Fast-forward to this year’s debate, and Jacinda Ardern’s rapid-fire declaration that legal medicinal cannabis was a no-brainer was considered the savvy political response.

Mum’s final public words were “I want people just to be kind. It would make a hell of a difference.” Jacinda Ardern, in her final interview before becoming prime minister, told John Campbell that her government was going to “bring kindness back”.

We’ve got a lot of work to do. But with Prime Minister Ardern and co in charge, we can finally get started.

Ardern started with talk of kindness, and Labour started with a promise on medical cannabis, but a year later they have not delivered.

A press release from Medical Cannabis Awareness New Zealand:


Government’s 100-day Pledge to legalise Medical Cannabis could slip to 1000 days.

Documents released to MCANZ under the official information act show that the regulations associated with the government medical cannabis bill could take years, with a planned go-live of mid-2020. This go-live date is subject to change and with the current under-resourcing of the MOH, it could be considered a best-case scenario.  Additionally, an advisory committee initially scheduled for March has been pushed back to November, and may yet be pushed back further.

“It is disappointing that the bill’s second reading has been postponed to November due to haggling around supplementary papers to improve the bill. If the Minister of health had consulted widely in the first place when drafting the bill, we wouldn’t be in this fiasco where  essentially anyone who has a stake in the outcome of this bill, whether it’s the patients, the budding industry or indeed the political opposition are all asking for significant amendments to the bill.”

“Patients are left disenfranchised and frustrated with the lack of progress on the bill, and the lack of amendments from the select committee, where the overwhelming majority wished for the exemption to extend to those with severe, chronic and debilitating conditions.”

“It is likely that if things continue as they are, by the time this bill is sorted, nearly 3 years will have passed. Circumstances will have progressed so far that patients will likely be using the referendum as a tool to gain safe legal access, potentially skewing the result in favour”.

“Another issue is the lack of budget at the Ministry of health for external consultation or industry/international experts to assist. We hope that with the surprise surplus government has announced this week, that some of this can be dedicated to setting up the scheme”

“Without additional resources in the near term, it will prove hard for this potential industry to catch up with Australia, costing the country in jobs and revenues, and patients on a cost basis,” says MCANZ Coordinator Shane Le Brun.

Medical Cannabis Awareness New Zealand

https://mcawarenessnz.org/


Jacinda Ardern in 2016 (Stuff):  The pain behind the medical marijuana debate’

It was sometime in the middle of last year when the political suddenly felt personal. It wasn’t a party, it wasn’t even a social occasion. I was visiting my friend who had spent the evening periodically flinching, doubling over, and rocking, and was now reaching for a form of cannabis as she tried to deal with her pain.

My friend was dying.

I think that’s what gets me most about the medical marijuana debate. It’s the perfect example of the brutal reality of people’s individual situations, and the layers of complexity that emerge as soon as you dig into it as a politician.

This is not a new debate – it came up when I first came into Parliament. At that time it was in the form of a member’s bill. It’s fair to say that it had a few holes in it, but those were all details that we had time to fix. I voted in favour of it, others used the drafting as an excuse to turn it down. The bill failed.

And here we are again. Same problem, different political cycle.

That was the last political cycle, before Ardern made 100 promises as Labour Prime Minister.

My friend will never benefit from change in this area, she passed away. But in reality I doubt she ever really cared too much. She was too busy living every single day to the fullest right up until her last breath. Surely we owe it to everyone to give them the best chance they have to do the same, despite the pain.

Surely Ardern and her Government owe it to the people who experience problems and pain on a daily basis, people who die suffering, to bloody well treat this like the priority she promised.

Medicinal Cannabis hearing – first day

The first hearings on the Misuse of Drugs (Medicinal Cannabis) Amendment Bill were heard by the health Select Committee in Parliament yesterday.

RNZ: Medicinal Cannabis Bill prompts calls for broader allowances

Under the Misuse of Drugs (Medicinal Cannabis) Amendment Bill before Parliament, only those terminally ill and with a year left to live would have a legal defence against prosecution for illicit marijuana use.

Drug Foundation director, Ross Bell…

…told MPs on the first day of hearings on the Bill that was not good enough. He said the Bill should be extended to also cover those with severe and debilitating conditions.

“Only focusing on terminal patients isn’t good enough, and in reality, the terminal patients aren’t getting arrested by the police but many other patients are. And the way that police use their discretion means that a lot of people are getting prosecuted still.”

Mr Bell said the same statutory protection should also extend to those who support patients.

“The so-called green fairies, people that will be administering the medicine or even cultivating the medicine, you know. And I think again you’re going to hear stories of people who are on their deathbed or are severely physically limited that they can’t access the medicine, they can’t even administer the medicine.”

Green MP Chloe Swarbrick…

…has backed the Misuse of Drugs (Medicinal Cannabis) Amendment Bill, but she also identified gaps, saying legal protection for the terminally ill stopped short of what is needed.

“That doesn’t address access, it doesn’t address availability, it doesn’t address the quality of the product and it certainly doesn’t address affordability.

“We’re all quite aware of the gaping black hole that presently exists”.

“I’m aware that my Bill was evidently voted down because people were concerned about the provision, the so-called ‘grow-your-own’ provision, but what we have right here is people still needing to get access to cannabis illegally. Somebody has to grow it.”

“We currently have a situation where police on the frontlines are being quite open about the fact that they are defacto decriminalising the use of cannabis for medicinal reasons or recreational reasons or otherwise. What we are – as the Green Party – concerned about there is that there is no rule of law.”

The College of General Practitioners…

…said doctors want the best for their patients, but clinical trials and Medsafe approval are needed before medicinal cannabis is made more widely available.

Asked if those with chronic illnesses should be included in legal protection, the college president, Tim Malloy, said doctors would struggle with who that would cover.

“That’s going to be the issue. It’s not whether this applies to them or not, it’s how do you define it and what are the criteria and what do you have to have tried beforehand. So there’s a whole body of work that needs to be done to define that for us.”

GPs also said they wanted health equity, and part of the reason for the Bill was to improve access to beneficial treatments, including the potential for medicinal cannabis.

“There is an equity issue here as Pharmac does not currently fund Sativex and most people would not be able to afford it — a thousand dollars a month — without funding.”

Shane Le Brun of the Medical Cannabis Awareness New Zealand charity…

…said those most at risk of being prosecuted for illicit cannabis use were not the terminally ill at all.

“I’m quite plugged in with who’s getting busted by the police and it’s not terminal patients. There’s no one who’s two months from death’s door that has the police knocking on their door, so that whole part of the Bill was actually toothless.”

Mr Le Brun also questioned whether others who were very ill but not near death needed medicinal cannabis for pain relief too.

“Are we happy with really sick people to be hauled before the courts for growing something that helps them, especially when the legal options cost thousands of dollars a month?”

Shane has done a heap of very good work on this issue, and is busy networking with those of possible influence on the Bill.

On demand video of submissions and future live streaming: Health Select Committee (Facebook)

Medical cannabis: Terminal vs Severe and Debilitating?

Medical Cannabis Awareness NZ wants the Government’s medical cannabis bill to be expanded to cover people suffering from ‘severe and debilitating’ illness. It currently only allows an exemption from prosecution for using cannabis for people certified to have less than a year to live (but growing is still illegal, as is the supplying of cannabis to them).


Terminal vs Severe and Debilitating?

The exemptions outlined for the terminally ill by Labour’s Medical Cannabis bill do not go far enough, and have been universally panned by patient advocates and policy experts.

MCANZ Coordinator Shane Le Brun:

“David Clark’s excuse for failing to deliver on Labour’s election promise is that there is a high portion of New Zealanders with chronic pain, many of those however would not be severe such as those who suffer from comparatively mild conditions such as osteoarthritis”.

“The Ministry of Health’s Non-pharmaceutical application guidelines have a terminology of  “severe or debilitating condition” using that definition instead of terminal would be a far more effective way of protecting patients. If such terminology is good enough for prescribers it should be good enough for police and the courts.”

“If such a change creates any extra administrative load for the courts to determine ‘severe or debilitating’ it would be short term only, as police would be on the receiving end of an attitude adjustment, the cost in administration pales into comparison against the significance of what it offers a very ill and vulnerable cohort of New Zealanders”

MCANZ Feels that the best solution to the criminalization of patients is to disrupt police prosecution
habits directly, before they get to court.

“The Solicitor General’s prosecution guidelines could be easily reviewed and updated to include a specific clause in the public interest test section. Such a clause counting against prosecution could be worded along the lines of ‘where the Misuse of Drugs Act has been breached for a significant therapeutic benefit”.

“Intervention before prosecution is critical to the safety and wellbeing of patients, most of whom are on benefits who can ill afford costly legal battles, and the seizure of what for many is an essential medicine”.

MCANZ Spokesperson Dr Huhana Hickey MNZM”

“The contradictions in allowing terminally ill to access but not providing them with a way of doing it, is as bad as denying all with pain the chance of taking a medicine that works. We need to educate society over the benefits of medicinal and how it can change lives.”

“To deny Medical Cannabis any longer is to show a disregard for people in chronic pain and who are in effect suffering at the hands of government policy. Change it now, it’s need not be complex, it can be simple, but they need to work with those of us who can no longer take opioids and other strong drugs who want our quality of life back.”

What’s in Labour’s Medical Cannabis bill?

Labour promised to something about medical cannabis in Taking action in our first 100 days:

  • Introduce legislation to make medicinal cannabis available for people with terminal illnesses or in chronic pain

And there is also the promises to Labour stalwart Helen Kelly to honour as well, after she openly admitted using cannabis to alleviate the symptoms of the cancer as she died.

Medical Cannabis New Zealand worries about ” “a sense of dread in the patient community that Labour’s bill will be more tinkering around the edges”:


What’s in Labour’s Medical Cannabis bill?

With the looming introduction of a bill by Labour for Medical Cannabis, the patient community is sceptical, and bordering on pre-emptively hostile due to the lack of consultation, and the comments from Jacinda Ardern about pharmaceutical grade Cannabis Based Products. Considering the lack of information coming out, we wish to publish our bottom line positions. These positions were promulgated to David Clark and other MPs with Health portfolios pre election, and represent what we feel is the minimum that needs to be done to drastically improve health and legal outcomes for patients.

“There is a sense of dread in the patient community that Labour’s bill will be more tinkering around the edges”.

“While I am pessimistic, we hope that a majority of our redlines are met, and that there is an engagement and commitment toundertake further reform, particularly around licensed production, which doesn’t lend itself easily to the hundred day fix”.

“It is concerning also that there has been zero consultation with the patient community on the bill being put forward, and that any briefings or BIMs David Clark has had on this topic are being refused release”.

“To enable something rapid for patients, the only affordable option is home growing, despite this being undesirable from a medical perspective, any imported products are still going to be unobtainable by the patients who need them most, sickness beneficiaries and ACC Claimants.” Says MCANZ Coordinator Shane Le Brun.

MCANZ Redlines

  • Medical necessity must be a legal defence. Due to the postcode lottery of medical specialists, a legal defence needs to be in place for those stuck in the backwaters or with backwards-thinking doctors. This would force police to more carefully consider the public interest. The police have demonstrated a fixation on cultivation and are prosecuting patients with severe medical needs, an amendment to the crimes act to include this defence is needed.
  • A non-smoking provision. In the age of the portable vaporizer, there is absolutely no need to smoke cannabis, and no one should. Any Politician citing excuses around smoking being bad for health should be soundly ignored, as no one is credibly arguing to smoke a medicine, This is already in line with the theoretical acceptability of Bedrocan, a standardized, granulated raw cannabis product, which MOH officials have said would be covered under the smoke free laws anyway.
  • GPs to prescribe. Schedule 22 of the current Misuse of Drugs Act needs changing so that all cannabis-based products can be prescribedby GPs. THC has a far better safety profile than other GP prescribed options such as Fentanyl, Diazepam, Methadone etc. This would also greatly reduces the barrier to access for patients, and would allow Cannabis to be prescribed as freely as Medicinal Cocaine. (theoretical, it’s on the books but no one prescribes it).
  • Notifiable prescribing. Instead of seeking Ministry approval to use Medical Cannabis, GPs should have a simple form to notify MOH of the prescribing, so MOH can gather data and look for unusual prescribing patterns. There is potential for this to become a survey of sorts and become part of the clinical data going forward – if there are several N=1 trials for a condition such as fibromyalgia for instance, the collective data may be used to measure benefit and even go as far as findings published in a medical journal article.
  • Made in NZ. It is important that the law is changed to allow Medical Cannabis to be grown for commercialized product. Our current law requires trials and facilities that could end up costing well over $20 million, for no ability to sell a finished, trialled product. Cultivation for trials has been legal since 1977 – yet it would be commercial suicide to undertake it in New Zealand.
  • A concerted medical education campaign. Many doctors are poorly informed when they talk to their patients about the benefits versus risks, and some try to avoid even prescribing Sativex to the point of misinforming the public. Even former NZMA chair Stephen Childs has made inaccurate statements on TV about the purity of the Botanically Derived Solution (BDS) that goes into Sativex. We note that the UICbranded symposiums held in Australia every year are hugely successful in bringing world-leading experts on Medical Cannabis to speak and generate conversation, piggy-backing off those efforts and mirroring that in New Zealand would go some way to addressing the barriers posed by senior Medical Staff.

– Shane le Brun, MZANZ Coordinator

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.

 

Medicinal cannabis oil available in NZ

There is improved availability of medicinal cannabis oil in New Zealand, with it now being available for GPs to prescribe. It is a cheaper option but could still be prohibitively expensive.

RNZ: Medicinal cannabis oil arrives in NZ

The arrival of a new, cheaper medicinal cannabis product in New Zealand is good news for patients but will still be prohibitively expensive for many, advocates say.

The cannabis oil, produced by Canadian company Tilray, was first granted an export licence to New Zealand in February, but until now has only been shipped to Middlemore Hospital in Auckland.

However, the first shipment that will be made available for GPs to prescribe has now arrived in the country.

It contains cannabidiol (CBD) – a cannabinoid that has been shown to have therapeutic properties, but is considered a class B drug under New Zealand law so cannot be advertised or promoted by the company.

Medical Cannabis Awareness New Zealand coordinator Shane Le Brun said the product had arrived “in the last week or so”.

“It is now available for GPs to prescribe… [but] as an unregistered medicine they can’t make therapeutic claims and as a controlled drug they can’t advertise … so it’s kind of snuck in under the radar.”

Since September, doctors have been able to prescribe CBD products without needing approval from the Health Minister.

The often unfairly maligned ex-MP Peter Dunne deserves some credit for this.

Trials are underway to test Tilray products’ effectiveness for treating childhood epilepsy, post-traumatic stress disorder and nausea and vomiting in chemotherapy patients.

Paediatric doctors here did not want to over-sell the benefits of the oil, “but certainly it does play a role for some of the severe [epilepsy] patients”, Mr Le Brun said.

“Without there being substantial evidence, they still think it’s worth a shot.”

Because it’s one of the few options that offer hope of improvement. But it is still very expensive.

The wholesale cost of a single bottle of the oil was about $600 – about half the cost of the only other widely available medicinal cannabis product in New Zealand, Mr Le Brun said. However, he expected the retail mark-up would probably put the price to patients at between $900 and $1000 a bottle.

Because Tilray was not a registered medicine, it was ineligible for Pharmac funding.

“Depending on the weight of a child for epilepsy, that bottle might only last three or four days, so without a political solution on the cost it still doesn’t change anything for the patients who are most in need.”

Most parents will not be able to afford that.

A much larger evidence base would be needed to get the product registered as a medicine and seek Pharmac subsidies, he said.

Labour has made medicinal cannabis one of it’s first 100 days priorities:

  • Introduce legislation to make medicinal cannabis available for people with terminal illnesses or in chronic pain

As well as this commitment they have the legacy of Helen Kelly to honour – Kelly openly talked about using cannabis products to ease her suffering as she died of cancer.

The Greens should also support it. They have an agreement with Labour to take cannabis law further, but later – “and have a referendum on legalising the personal use of cannabis at, or by, the 2020 general election”.

However Parliament needs a majority. Labour are committed, as are the Greens, but either NZ First or National (unlikely given their past lack of fortitude on medicinal cannabis) to get it passed into law.

New Zealand remains reliant to a large extent on progress in research of medicinal cannabis internationally.

A major anomaly remains – it is legal to drown your sorrows and self medicate with alcohol, but puffing away your pains is policed and punishable.

“Green Fairies” are a symptom of unmet demand

A media release from Medical Cannabis Awareness NZ:


“Green Fairies” are a symptom of unmet demand

On Newshub’s 6 o’clock news last night, it was revealed 2 of the larger compassionate supplier’s aka “Green Fairies” are being prosecuted by the police, to the detriment of hundreds (potentially thousands) of patients.

“With over 140k people estimated to use Cannabis at least sometimes for medical purposes illicitly, it is no surprise that there are a growing number of compassionate suppliers in both quantity, and scope of their operations”.

“With the continued failure at the political level to resolve legal supply of safe sterilized Cannabis based products that a sickness beneficiary can actually afford, these people will be seen as martyrs and heroes to the patient community, and unfortunately it reflects poorly on the police”.

“The police seem quite able to turn a blind eye to the dealing of Class B Cannabis based products if your name was Helen Kelly, however the mere act of cultivating a C drug is viewed as a heinous crime that is beyond police discretion.”

“Police Discretion is an empty promise by Politicians to dodge the issue, Police I have dealt with fear setting a precedent by exercising discretion” says MCANZ Coordinator Shane Le Brun.

“MCANZ would like to see a political solution far more ambitious and detailed than provided by either of the major parties. We look to Canada as an excellent example to follow, where Cannabis products are so affordable that less than 2% of Medical Cannabis users seek permits to grow their own.

“Cannabis-based products are relatively simple, It’s just another Essential Oil.

“The Current regime ensures that only expensive products will be vaguely available, and that means patients will continue to break the law, often with the support of their specialists, and making criminals of otherwise law-abiding citizens.

“The costs are so high that I am aware of GPs and Specialists that are referring patients to “Green Fairies”.

“This is a direct response to increasing acceptance of its medical benefit, and the refusal to accept the cost of Sativex which is borne solely by patients”.

The domestic market in Canada is considered by MCANZ to be the closest model to ideal, where products are prescribed by GPs, and the cost per mg of active ingredients are 80% less of what is paid in New Zealand currently. Nevertheless, MCANZ is committed to advocating for patients for legal access in the current system, which can take over a year of advocacy to gain approval under the non pharmaceutical scheme and then months extra again to arrange import.

Shane Le Brun
Medical Cannabis Awareness Coordinator
http://www.mcawarenessnz.org

Let The People Grow (They Do Anyway)

Part Two in a series of opinion pieces by Shane Le Brun, Coordinator, Medical Cannabis Awareness New Zealand (MCANZ)

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.

MCANZ has avoided the issue of ‘grow your own’ cannabis partly to avoid the stereotypes around the more strident and vocal supporters of MedCan, partly to be seen as the sensible voice on the issue. As a charity it is essential that we have repeat business with medical specialists in order to enable us to best advocate on behalf of patients. For this reason we often find ourselves biting our tongues and generally try not to do anything that would be perceived as too negative or critical of the medical profession. Another part of our advocacy with doctors is our decision to take a stance that is completely against the smoking of cannabis for medicinal purposes. Smoking cannabis doesn’t fit with the Ministry of Health targets for smoke-free New Zealand by 2025, and when there are alternative options such as vaporising or edible products, there is no longer any reason for patients to smoke cannabis.

Some western countries have recognised the ability to grow one’s own medicine as a basic human right. Canada in particular went down this path. The Canadian Supreme Court overruled Parliament, to rule in favour of patients rights in this regard. Essentially, patients took the Canadian government to court and won. For this reason the initial Canadian cannabis regime was set up in 2001. Other western countries have followed suit. Some states of Germany are more pragmatic, by allowing patients to grow their own cannabis if they exhaust all routes for accessing funding for the expensive pharmaceutical options available. (In a New Zealand context that would mean, if Pharmac does not subsidise the product then you would have the right to grow.) In South Africa, most recently the entire cannabis law was erased legalizing both medical and recreational use. Again in this case this was recognised as a human rights issue.

Unfortunately New Zealanders’ human rights don’t appear to count for much to the current government as displayed by Paula Bennett’s faux pas several weeks ago on the issue of the rights of gang members. There appears to be no accessible mechanism by which to challenge the goverment on the cannabis issue on human rights grounds. For this reason alone, MCANZ has completely detached itself from the debate around making cannabis a human rights issue under the current government.

Instead, we have focused on Canada with success in getting reasonably priced Canadian products to our shores and into patients’ hands. From this experience, I would point out that with a good domestic industry, the demand to grow our own would be greatly reduced. In Canada, over 200,000 patients are registered for access, yet less than six and a half thousand have permits to grow. This lack of desire to grow cannabis compared to that existing in New Zealand is directly linked to the ease of access. If licensed cannabis in NZ was stronger AND cheaper than illicit cannabis and already processed into edible forms, then the demand equation would shift quite rapidly and people wouldn’t bother with the extra effort required.

The single greatest benefit of ‘grow your own’ to patients is cost. Even with a “near pharmaceutical” regime the cost can still be several hundred dollars a month. If there is no political will to fund even those low costs (Compared to the thousands to tens of thousands of dollars pharmaceutical options cost) then for beneficiaries and ACC claimants the only realistic option is to grow their own. Thousands of patients are already doing this, so this rather controversial law change would merely be decriminalising what is already happening.

The most important thing is making patients safe from police interference, as the police treat cultivating a class C drug as a heinous crime meaning charges are immediately laid on arrest. Triple amputees and people who have been battling leukemia for several years have been prosecuted for cultivating. It is the view of MCANZ that this is not in the public interest, and at the very least a legal defence of ‘medical necessity’ needs to be put on the books to ensure police leave patients well enough alone.

The main concern raised around a ‘grow your own’ policy appears to be around medical cannabis leaking onto the black market. This is, if anything, a minor harm – more people will be able to access cannabis without dealing with organised crime such as tinny houses et cetera. A sickness beneficiary or an ACC claimant making a little extra cash from surplus cannabis is certainly at the lower end of social harms, however a robust system would have measures in place to prevent such offending by controlling plant quantities. This would not be a free-for-all and there would be penalties for abuse of the system as there are now.

The other concern is about control in a clinical setting. Doctors will have to rely on the patients declaring how much they consume if they seek to keep tabs on use. This hasn’t been an issue in Canada where doctors don’t directly prescribe particular cannabis products but effectively grant the patient access with an upper limit on how much they can consume. The patients then order products that meet the requirements of this prescribed amount as they see fit.

One of the risks of a ‘grow your own’ system that is not widely known is the risk to property from people growing indoors. We don’t have a major issue with this in New Zealand, however in California there are multiple house fires each week in some regions from indoor grow-ops catching fire. This can be due to a multitude of reasons but primarily people get greedy and install more and larger lights than tents were designed to house (lights can be up to 1000 Watts). All it takes is a single cooling fan to fail while the person is at work and they return to a burnt down house.

A simple solution to the safety issue is to have a licensing scheme with annual inspections. If recreational cannabis is to remain illegal then people’s medical grows will be highly desirable and patients will revert to growing indoors for greater security from theft. Safety inspections on an annual basis could keep tabs on how big peoples grows are getting and also mitigate the fire risk by ensuring there are smoke alarms and other safety equipment and perhaps ensuring that there are not too many heat sources such as lights in a small area.

In other countries there are also limits that are placed on the size of a grow patients. Many of these limits aren’t terribly effective, for example in Colorado there is a ninety-nine plant limit. Initial thoughts would be that this is an absurd limit, but it was set with compassionate suppliers in mind. However with the ability to grow massive outdoor plants, these plants limits take on less meaning. A better solution is to institute an area limit, of a certain area per patient (for example 4m2 in flower at any one time).


Cannabis in Oregon, making a mockery of plant limits such as those proposed by The Opportunities Party

Another issue that must be addressed is product quality for the safety of the patients. In the underground world of “Green Fairies” or compassionate suppliers in New Zealand, the long-term growers, on the whole make very high-quality products. However, there is a new wave of enthusiasts and get rich quick types, some of which are preying on patients by making products that are substandard. There are accusations of people lacing their topicals with DMSO, a potentially dangerous ingredient. In other cases there have been people making butane extracts and not purging or evaporating the butane, leaving dangerous residue in the products for the patients to consume. I have personally met someone who qualifies for the Darwin awards, for cooking Butane Hash Oil in a caravan unventilated. He is permanently disfigured from the resultant explosion.

Such risks can be countered with education, some of which is already happening illicitly as cooperatives are beginning to be set up. Generally the illicit market is improving and self-professionalising, lately there has been dramatic improvement in labelling and specification of roughly what ratio of THC/CBD is in the products. As the availability of specially bred medical strains with known cannabinoid ratio’s increases in New Zealand, this standard will no-doubt continue to improve.

Despite these negatives, many countries and states of the USA have implemented successful home grow regimes that greatly enhance patient access and reduce the final cost to the patient of medical cannabis. The main issues are around safety of the grow itself and the safety of the finalised products should the patient wish to make concentrates. All of these issues can be mitigated quite substantially through a mix of education and regulation. There is a perk to being late to legalising medical cannabis, we can see what has worked and what hasn’t worked overseas and plan for the unintended consequences that may emerge after law reform.

The patients already grow, no amount of cracking down will change that. In the interests of recognising cannabis as a health issue, which even the current government has accepted, the best thing to do would be to design a regime that focuses on nullifying the negative effects encountered overseas, and providing the right knowledge and tools to patients and compassionate suppliers to ensure the products are as clean and safe as can be reasonably expected in a domestic environment. Prohibition has been futile, as is continuing it. So long as the only options on the table legally cost thousands per month for small doses, thousands of patients will opt out of the legal supply chain and grow/make their own cannabis medical products.

Note:

To have your say on Medical Cannabis go to the Scoop’s HiveMind page and vote on various statements on the issue or submit your own views.

Part 1 of this series of opinion pieces covered whether New Zealand really needs ‘Pharmaceutical Grade Cannabis.’ It is available to read here.