I was in Vancouver last year, and medicinal cannabis shops were everywhere. We checked one out. The deal is we had to go and get a certificate from a doctor (some of the shops have a doctor onsite) to say we had a medical condition (you know pain, nausea, loss of appetite, difficulty sleeping) that would benefit from using cannabis, and then we could buy whatever we wanted in all sorts of smokable, edible and drinkable formats.
Some other jurisdictions (eg California) have this approach too. It is precisely what opponents of medicinal cannabis access are concerned about, because it’s legalised supply with the thinnest of veils over the top.
Difficulty sleeping – I mean, seriously?
Unfortunately the illegal status of cannabis has led to this kind of approach and has confused the meaning of the term “medicinal cannabis”, with the unfortunate consequence that we lose support for medicinal cannabis from those who would be open to genuine medicinal uses but who are opposed to recreational use for whatever reason, thereby slowing down and complicating progress.
My personal position, as most people probably know, is to support legalisation of the possession, use, cultivation, sale and supply of cannabis for recreational use, although each of these should be subject to some level of regulation. I support the development of a framework that is consistently applied to all recreational drugs including both currently licit and illicit ones, with the heftiness of regulation being in proportion to the risk of harm from a drug (the only basis I can think of for the State to be involved at all). When such an analysis has been undertaken previously, the risk of harm from cannabis has generally been found to be significantly less than that of alcohol, for example, so it’s not unreasonable to think of recreational cannabis being regulated in a similar way to alcohol is now (though regulation for alcohol should probably be stronger). There are various models for doing this being experimented with around the world as the ‘war on drugs’ thankfully begins to fall apart, so while there are some interesting debates to be had (state supply like Uruguay, or free for all like Colorado, for example) these are questions for another day.
Suffice to say that in the same way that some people might get home from work and drink some alcohol to relax, enjoy food more or sleep better, we should expect that some of the recreational use of cannabis is and will be for these same kinds of effects. This is not what the medicinal cannabis debate should be about.
Instead the medicinal cannabis debate, in the absence of the distortions caused by illegal recreational use, ought to be about finding and using compounds and combinations of these in the same way that we use other medicines. Research has been hampered worldwide by the legal issues (how do you test an extract from cannabis if it’s illegal to grow it?) and so definitive strong evidence of efficacy is weak, but there is considerable indicative and anecdotal evidence of efficacy of different cannabis extracts in treating a range of conditions. In the same way that other medicines have to be put through a rigorous trials regime to establish safety, effectiveness and then value for money, these tests also need to be passed by cannabis extracts. If the medicinal use of cannabis extracts is to be scientifically meaningful, it is also essential that we know exactly what compounds are being used, and what their dose is. This is not about smoking dope, but about taking medicines derived from cannabis.
A bunch of issues emerge. We need to encourage and support research. Because progress has been hampered by recreational prohibition we need to be very active in reviewing the safety of products with a view to making them prescribable here, we need to work with doctors to overcome their reluctance to prescribe, we need to encourage manufacturers to submit their products to Pharmac for funding support and we need to encourage Pharmac to take the legal history into account in assessing applications for funding for Cannabis-derived medicines. And in the interim we need a more streamlined process for doctors to be able to use cannabis-based medicines, when they have yet to be registered as medicines in New Zealand.
One last area, which I have blogged on previously. In the early days of the HIV/AIDS pandemic we didn’t have any treatments and people were dying. Those people who were terminally ill fought for the right to be able to use treatments that had not been proven or which carried risks for their health. These are sometimes referred to as catastrophic rights. While I think the debate on medicinal cannabis rightly relates to manufactured products sourced or extracted from cannabis in precise formulations and doses, it seems to me that somebody who is terminally ill, or who has a grievous and irremediable condition should simply be able use more or less anything they want if it improves their subjective experience of life. The most straightforward way of achieving this, while not being completely satisfactory, is for having such a condition to become a complete defence against the prohibition on the cultivation, possession and use of cannabis and its extracts. Other jurisdictions have taken this course, and our Government should do also.