One of the key barriers to improved access to Cannabis Based Products in the current framework is cost. Sativex, available on-label for MS, has less than 12 people using it in NZ for that purpose, out of a patient population of 3000+ where trials demonstrate that a little over 40% of medium to severe patients gain sustained clinical benefit, there are hundreds of patients with this one condition who are missing out on a better life due to cost.
It is clear that cost is a huge barrier, with Sativex currently costing in the vicinity of 80c per mg of Cannabinoid in NZ. Street values of cannabis, meanwhile, assuming 10% potency at $15 a gram, come out at 15c per mg, and can be much cheaper when brought in bulk. However that increases the risk of police interference, as has happened to a Quadriplegic in Auckland who was graced with a Police search and confiscation of his Medicine.
Epidiolex, from the same company that makes Sativex, is not available yet. It is a CBD only extract being used for Epilepsy, and the doses can be in the range of 200-300mg per day, some estimates put the annual cost at 25,000 to 45,000 US Dollars when it finally gets to market, unless a government agency pays, its unlikely to be used in New Zealand due to this cost. Essentially though Epidiolex is a just a liquid infused with Pure CBD, there are others already available, Tilray has a liquid that is Grape seed oil infused with pure CBD to “near pharmaceutical” standards. Despite it’s availability, NZ Specialists are unwilling to use it for Paediatric Epilepsy, and as it stands the preference is to accept patient mortality over the next few years awaiting the arrival of Epidiolex, despite it being broadly similar.
It is clear that there are significant costs that went into clinical trials for Sativex that need to be recouped, however doing so denies treatment to those who could benefit. So what could be done to have a product that is “trusted” in medical circles without the costs associated with 8 figure clinical trials? Tilray Global is pursuing pharmaceutic-ally prepared products to be available for patients AND trials, so that initially they are unregistered medicines, the added benefit of this is the rapid availability of products, Tilray recently celebrated their 3rd birthday, and are already shipping internationally, compared to the decade long gestation of GW Pharmaceutical’s Sativex.
Canada has its own cultivation regime that is not pharmaceutical grade, but does ensure the quality of the product. This is referred to as Good production practices,(GPP) and is a prescriptive list of do’s and don’ts. Examples of this are the list of chemical contaminants to test for, and a list of chemicals that are permissible, and banned during the cultivation of the products to ensure they are safe. This is important as some products are commonly used but unsafe, one example Myclobutanil, which is safe to use on foods such as grapes, and is readily sold in NZ stores such as Hyalite (formerly switched on Gardener). This chemical when heated up (smoked) breaks down to Hydrogen Cyanide and poses a significant health risk. This GPP scheme leads to a significant cost reduction versus the pursuit of pharmaceutical grade, as demonstrated by the price difference between Tilray Global vs Tilray Canada’s products, and those of their competitors such as Cannimed.
The next cost reduction is going to Raw Cannabis, which the current Government is vehemently opposed to. Despite this the MOH have deemed Bedrocan’s product to be acceptable for applications, as they received GMP (Good Manufacturing Practice aka Pharma grade) certification in the Netherlands this year. Bedrocan is unique in the Raw cannabis space as they have been around for over a decade, and the accuracy of the THC and CBD dosing is stable across all their strains since inception, no other company has standardized raw cannabis to the level they have. Due to the lack of processing required, Bedrocan’s products actually come close to rivaling the black market in cost, while far exceeding them in quality.
One of the key issues many countries have, is international shipping of Cannabis based products is onerous, and adds additional cost, Sativex was already considered expensive in the UK, and is astronomical in NZ by comparison, this is why Australia has opted to cultivate their own, even with onerous requirements, (their site security for cannabis plantations is stricter than the New Zealand Defence Forces Ammunition Depots) it will eventually lead to cheaper products than would otherwise be available.
Even New Zealand has a large enough market to justify Domestic cultivation, Israel, with 8 million people has 8 main businesses cultivating, and servicing just over 20,000 patients now, for a program that is a decade old.
The current Government is satisfied with the most expensive option available, locking out all but the top portion of the socioeconomic ladder from legal access, (at 12 sprays per day it costs approx $15,000 per year). Much could be learned from Australia’s resolve to solve their own supply issue, and Canada’s desire to find a compromise on product quality vs cost to the patient, as Cannabis is merely an Essential Oil, it needn’t cost the earth if their is a political will to resolve the issue.
The challenge is to the political parties to look at the cost structures and examples taken by other countries, and rather than talk about the “what” of Medical Cannabis, start thinking about the “how”. MCANZ is ready to help and advice on the pros and cons of various implementations, our current situation is the implementation of the most expensive model in the world.