Pain, pot and politics

Is fear, prejudice and ignorance on the part of our decision makers denying many suffering New Zealanders the help and relief that medicinal marijuana use could provide? A mere whiff of the term seems enough to scatter the herd in the political fraternity.

The Misuse of Drugs (Medicinal Cannabis) Amendment Bill sponsored by Green Party Associate Health Spokesperson Metiria Turei would allow registered medical practitioners to prescribe cannabis to patients with specific serious medical conditions. The bill is due to be heard in Parliament in May.

Sarah Daniell looks at the issues around the legalising of medicinal marijuana and the arguments put forward by both advocates and opponents.

Ancient medicine, anecdotal evidence and widespread consensus suggests that medicinal cannabis has value in treating people with serious conditions who may not respond to other drugs.

It is known to have benefited people who have cancer, HIV/AIDS, MS and other neurodegenerative diseases. Studies have shown it also helps paraplegics prone to body wasting, and sufferers of Tourette’s syndrome, epilepsy and motor neurone disease.

New Zealand may lead the world in many areas, but advocates of legalising medicinal marijuana say we lag behind the rest of the world on the issue. In Canada, the United States, the Netherlands, Germany and New South Wales in Australia, it is legal to use cannabis for strictly medicinal purposes. Despite its C-class status here, prosecutors take a tough line on cannabis which is supplied to relieve pain. In just one high profile case in 1998, Neville Yates, was convicted of using medicinal cannabis.

The law may be emphatically in favour of teaching medicinal users a harsh lesson, but it would seem the public of New Zealand is behind Turei. In July 2006, a 3 News/TNS poll showed 63 percent of New Zealanders would support a law change allowing doctors to prescribe cannabis as a painkiller. And on 22 November 2006, Turei herself tabled in Parliament a 3000-signature petition organised by NORML in support of a law change to allow the use of medicinal cannabis.

In a survey of 225 doctors in 2003, 32 percent indicated they would consider prescribing medicinal cannabis products if it were legal. Six percent said they had prescribed medicinal use of cannabis.

The biggest obstacles to medicinal cannabis, according to advocates, are politicians and prejudice.

Bruce Kilmister, of Body Positive, an organisation which supports people suffering from HIV/AIDS, has had many years at the coalface of the issue.

“Over probably 20 years I have watched as the AIDS pandemic has raged through various countries, including New Zealand. I’ve lost a partner to AIDS, I’ve seen many people die from AIDS and I have questioned the legitimacy of withholding what could be a comfort to those people suffering the physical effects of AIDS. I’m referring to nausea, body wasting and pain – pain through every part of the body from cancers or pneumonia.

“I defy anybody to compare or put the morality of medicinal marijuana up against the pain and suffering that people have. This is not for recreational or social use. I’m advocating medically prescribed marijuana for a medical situation for which there is no other form of relief.”

Metiria Turei believes prejudice is at the heart of the issue.

“We have a potentially useful medicine here and we are denying sick people because we have a prejudice about the nature of cannabis and recreational drugs. The opposition to the use of cannabis is not based on research or evidence, it’s based on prejudice and that cannot be justified in a so-called modern, democratic, liberal society.”

She says scientific evidence increasingly supports the benefits of medicinal cannabis.

“It’s been demonstrated in a number of studies to be useful for some conditions, particularly muscle spasm control for those who are paraplegic, and control of nausea and maintenance of appetite for those who have cancer or HIV, or who are taking other drugs that are causing those kinds of symptoms.”

Turei also refuses to accept that the issue is too ‘hard-basket’.

“We’ve been through these kinds of debates before. Abortion is one example, homosexual law reform is another. We’ve just had the civil union debate. We can tackle these issues sensibly.

“Hopefully the bill, or the discussion around the bill, will help people see these issues more clearly.”

But proponents of medicinal marijuana may not only be up against politics and prejudice. In July last year, New Scientist reported that while there was clear anecdotal evidence that medicinal cannabis works in some cases, results of clinical trials have been mixed. The problem is there’s no way of targeting the drug to a particular place, it said.

Experts at the Federation of Neuroscience Societies meeting in Vienna last July said the human body had its own endocannabinoid system which helps regulate pain, hunger and anxiety. Medicinal cannabis interferes with that system.

Kilmister rejects the notion that medicinal cannabis is a blunt tool.

“Where HIV/AIDS people are concerned we have always been on the cutting edge of science. I can’t begin to tell you the number of people who have died more from medication in the very early days, than the virus itself. They became the willing guinea pigs of the pharmaceutical industry in an attempt to stay alive.

“All I can say is I see what actually works. I do see people who are using marijuana for medicinal reasons and it works where everything else has failed. Most of the physicians we work with have no difficulty seeing their patients use marijuana when they have identified nothing else seems to work.

“They will simply turn a blind eye or even sometimes suggest to the person, ‘Have you tried this?’ knowing full well that it is illegal and knowing full well it could be the only form of relief for that person.”

Currently in Britain the only cannabis-based product which can legally be used is a treatment for MS - a nasal spray called Sativex. Cannabis derivatives supplied in a synthetic form may be the ultimate compromise for those in the medical community who cannot countenance patients smoking it for medicinal purposes. A spokesperson for the New Zealand Medical Council said it supported research and debate on the issue, but didn’t support people being allowed to smoke the substance as that came with other health issues.

But the problems with synthetic derivatives, says Turei, are the expense and time involved in research and the issue of efficacy.

“My concern is that the government may be committed to looking at pharmaceutically tested products as opposed to whole plant extracts, and I think that’s a real shame because the whole plant extract is shown to be more effective, and we end up with a system where medicinal cannabis is made really expensive and really difficult to access.”

In The Netherlands there is a strictly regulated system where agents grow cannabis. It’s tested to make sure it’s clean and doesn’t contain any contaminants and the genus of the plant is assessed. They know through testing and anecdotal evidence what kinds of plants are suitable for certain conditions and supply them on that basis.

Kilmister says if the public needs reassurance, it needs only to look to the United States.

“If ever there was a bastion of conservative attitude in terms of the medicinal or morality aspects of marijuana, the United States would be the absolute heart of it. Yet the US has accepted the legitimate, legal use of marijuana. It is prescribed with a health card that allows the patient, under the very strictest control, to secure marijuana for medicinal purposes – much to allay some of the concerns I briefly mentioned, particularly pain.

“It helps a great deal with other things such as appetite. Nausea destroys appetite and causes body wasting – all of those things which contribute to the on-march of the AIDS virus through the body could be allayed with the use of medicinal marijuana.

“When you are taking a barrage of medication, morning, noon and night, just simply to stay alive, that affects the whole psychology of a person. And to simply shift aside from that briefly, with the support of medicinal marijuana, not only defers the symptoms they’re suffering at the time but also gives them some slight relief.”

So what’s the guts of Turei’s Bill?

“The Bill is set up to allow a doctor to decide whether a patient would be helped by cannabis. They decide the best dosage and the patient applies to the Ministry of Health for an ID card which has dosage, how many plants they can grow, what condition the marijuana is for and the name of the prescribing doctor.

“That information is all passed on to the police so they know who medicinal users are. If the person is unable to grow the plants themselves, they can designate someone to do that for them and that agent becomes registered with the Ministry and the police as well.

“The card provides protection but only to the level specified. It must be done under medical supervision. The patient can access the plant very easily and cheaply because they can grow it themselves.”

Turei accepts that some doctors are against people smoking cannabis, but says there are other alternatives, such as a tincture, a vaporiser or ingesting.

Bruce Kilmister says he is unconvinced by pharmaceutical derivatives.

“We’ve looked very closely at the [cannabis derived] pill but our concern is that it takes too long to work. When a person needs relief they need it immediately. You don’t want to take a pill and wait for an hour when simple marijuana provides instant relief.

“If Turei’s Bill is adopted it would reduce the abuse of our members, many of whom are already living in poverty, purely on a pension. They cannot absorb the exorbitant costs that fuel the profits of the inappropriate growers and dealers. If legislation was passed that allowed for medicinal use only, and it was strictly controlled, I think it would improve the situation for many so that they would not be put further into the clutches of poverty, or risk real violence in dealing with people they would never normally associate with.

“The biggest obstacle is finding sufficient politicians with the fortitude and moral responsibility to meet this debate honestly and sincerely.”

Sarah Daniell is a freelance journalist based in Auckland.