17th of October 2020 is the date of the Referendum on the Cannabis Legalisation and Control Bill.

While this bill is intended to legalise cannabis for all adults, it also offers improved access for those seeking to use cannabis for therapeutic (medicinal) purposes.

For more general information regarding the referendum, go the official referendum website here.

 

But isn’t medical cannabis already legal?

Sort of. The coalition government has legalised a prescription regime, where any authorised prescriber can prescribe any product, for any condition.  However coupled with this are very high quality standards that are causing unaffordable prices and reduced product availability. We have already seen casualties, with New Zealand’s only medicinal cannabis lozenge taken off the shelves. Rather than improving access in the short term, the new law has had the opposite effect on reducing choices available.

Why can’t patients just get it on prescription?

Unfortunately, most doctors in the New Zealand public health system are still unwilling to prescribe medical cannabis. In Canada and Australia, expensive specialist cannabis doctors are the best way to gain access. This further increases the cost, making it unreachable for sickness beneficiaries.

But isn’t medical cannabis just cannabidiol (CBD)?

No. Tetrahydrocannabinol (THC) is very therapeutic. Initially known for reducing eye pressure in glaucoma, it’s been especially effective in studies for spasticity in multiple sclerosis, chemotherapy-induced nausea and vomitting, various forms of chronic pain, treatment-resistant Tourette’s syndrome, and as a mild dissociative for those experiencing severe bouts of pain that can’t be treated with regular drugs.

Could the referendum make medical cannabis cheaper?

Absolutely. Retail cannabis is likely to be far cheaper than prescription products. In Australia, a prescription ounce of Bedrocan herbal cannabis costs $650AUD, while in California, a high-quality ounce of a medical variety costs $210USD on average. Converted to NZ prices, prescription cannabis is twice as expensive as similar cannabis in over-the-counter markets.

Furthermore, if companies cultivate cannabis for both the general and medicinal markets, they will be afforded economies of scale which could drive prices down. Additionally, some of the levies from cannabis sales are intended to be reserved for health purposes, and while it’s a long shot, MCANZ will be pushing for some of the tax take to subsidise medical cannabis for genuine patients.

Why is cost so important?

Due to the illegal nature of cannabis, and due to its therapeutic use over thousands of years, few have been committed to spending tens of millions of dollars on gold standard clinical research. Because of this, there isn’t enough evidence from standard pharmaceutical trials for PHARMAC to consider funding cannabis medicines.

So while potentially dangerous drugs like morphine and Fentanyl cost a patient $5 a month due to government subsidies, the most researched medical cannabis product, Sativex, typically costs $950 a month with no funding, and the severe MS patients who need it most are on sickness benefits. Furthermore, this product has only about $150 worth of cannabis as an ingredient (if it were made using black market prices).

Finally, the ability of patients to grow their own cannabis for therapeutic use under the referendum, or to have family and friends grow it for them, would dramatically reduce costs for many.

Isn’t smoking bad for you?

Yes, absolutely. There are devices called vaporisers which reduce the risk from inhalation by 90-95% for the good units. Unfortunately, in his infinite wisdom, former Health Minister David Clark only legalised the most expensive medically certified devices, again an issue for beneficiaries and pensioners. MCANZ sells vaporisers, breaking the law, and has even had customs seizures, despite the clear benefits these devices offer. Legalisation will open up access to more affordable vaporisers, and with an education campaign and greater uptake, the public health burden from respiratory harm will be greatly reduced. This could also be done immediately by the Minister of Health, but he lacks the initiative to do so.

Is homegrown cannabis reliable enough for therapeutic uses?

Yes. While homegrown cannabis will not have a standardised dose like a purchased medicine, it is still safe to administer as a medicine. When dealing with THC, particularly inhaled via a vaporiser, patients can easily adjust their serving size according to the potency of the cannabis. While historically smoking joints was common, today most patients often get by with very small amounts of cannabis (less than 0.3grams) in chambers of pipes and preferably vaporisers. There is a well-known mantra that applies to dosing for all cannabis users: “Start low, and go slow.”