The snowball and the avalanche: medical cannabis in Australia

Stories of personal suffering, where debilitating symptoms are eventually eased by medical cannabis, are appearing ever more frequently in the news. Andrew McMillen argues it is these sorts of stories that have engendered compassion in Australia, eroding the stigma around medical cannabis use and paving the way for science and more evidence- based legislation.

The story of medical cannabis in Australia is much the same as in other countries around the world that have tiptoed this path before us. Here across the ditch, as in New Zealand, the United States and many other advanced economies, it is a situation where two strange bedfellows have been pitted against one another: stigma and science. For many years, because of their preconceived attitudes, staunch opponents of illicit drug use have remained wilfully blind to the benefits of medical cannabis experienced by sick people. Here, as elsewhere, this is not a campaign for the impatient. Change is slow, often painfully so, as it relies on a willingness for opponents to reconsider their positions in light of compelling evidence.

In the last few years, though, the situation has appeared to change rather quickly and dramatically. The appropriate image is that of a single snowball rolling down a hill, gradually gaining mass and momentum until it forms an unstoppable avalanche. To this end, a raft of touching personal stories have been told in the national media. As a result, many state and federal politicians have sensed a shift in public sympathy towards sick people who are attempting to access medical cannabis without further complicating their lives by crossing paths with the criminal justice system.

Support for plant-based medicine has gone mainstream, as evidenced by a July 2014 ReachTel poll that found that almost two-thirds of Australians believe cannabis should be made legal for medical purposes. It is telling that compassion is the driving emotion here, rather than fear – long-time advocates might well wish they had cottoned on to this tactic earlier.

These personal stories don’t come more dramatic and heart-wrenching 
than Dan Haslam’s. In fact, his journey to accepting and using medical cannabis has become emblematic of changing attitudes to the drug across Australia. Dan was the snowball, and his descent down the hill began when he was diagnosed with terminal bowel cancer in February 2010 while living in the regional New South Wales (NSW) city of Tamworth. There,
the then 20-year-old eventually discovered that the only treatment that soothed his nausea and stimulated his appetite while undergoing chemotherapy was cannabis.

His parents wished there was another way. The fact that his father was head of the Tamworth Police Drug Squad made this desperate decision even more ethically and legally tortured than usual.

Yet the simple, unavoidable fact
 was that medical cannabis eased Dan’s suffering. This anecdotal evidence helped change the mind of NSW Premier Mike Baird, who began funding medical trials only after meeting the Haslams. Compassion softened the stigma, which in turn opened the door to scientific inquiry into a global industry estimated to be worth AU$250 billion annually. Prejudice and preconceived attitudes seeped out the window. The Premier
got it, and he communicated his understanding to the country’s most populated state, in which more than a third of Australians live. They got it too: medical cannabis can – and does – help sick people, and this fact of life is worth further exploration and discussion.

That singular snowball was stopped, sadly, when Dan Haslam died in February 2015 at the age of 25. But the avalanche continues unabated in his absence. Indeed, its strength is increasing.

“I will never forget the look in his eyes the first time I met him, and it will stay with me forever,” said Mike Baird after Dan Haslam’s death.

“Dan made a lasting impression on everyone he met, but more than that, 
he left a legacy in New South Wales that will be felt across the nation and,
I believe, the world. Every step we take on medical cannabis will be built on the footsteps he left behind.”

——

Compassion has been a driving force but not the only one. The potential economics of legalised medical cannabis in Australia is increasingly being used as an incentive to win over holdouts, particularly those within the Liberal National Party

The path to Australia’s success in medical cannabis legislation has been paved with defeats. In 1999, then NSW Premier Bob Carr announced that his government would investigate the use
of cannabis for medical purposes, which was followed by an announcement in 2003 for the Carr Government’s intention for a four-year medical trial. This was not pursued. In 2004, the Drugs of Dependence Amendment Bill 2004 was introduced in the Australian Capital Territory, with the backing of the Greens and Democrats. The Bill would have allowed eligible medical users or nominated caregivers to grow cannabis. It was defeated. In 2008, the Controlled Substances (Palliative Use of Cannabis) Amendment Bill was introduced in the South Australian Legislative Council.
It, too, was defeated.

While all of this feels like ancient history from the vantage point of 2016, these defeats were a necessary part of the process towards the legalisation of medical cannabis. Each failed bill, each postponed trial, each discussion paper planted seeds of doubt in the minds of those who write legislation and represent constituents. From the level of local council and small community debates, up to the offices of state and federal politicians who wield enormous power and influence as individuals, the key idea – that medical cannabis can, and does, help people – needed time to propagate. Change is slow, but on this matter, it is inevitable. All it takes is for closed minds to be opened,
one at a time.

Compassion has been a driving force but not the only one. The potential economics of legalised medical cannabis in Australia is increasingly being used as an incentive to win over holdouts, particularly those within the Liberal National Party (LNP), which governs

the country and four of its states and territories, including NSW. If compassion doesn’t crack open the minds of free marketeers in the LNP and other politically aligned organisations, the shiny lure of cold, hard cash is an almost irresistible option in the toolbox. On a purely financial basis, it’s tough to argue with the tax revenue gained by overseas territories such as Colorado in the United States, where the legalisation of cannabis raked in US$44 million in tax revenue during 2014, its first year of operation.

For Dr Alex Wodak, President of the Australian Drug Law Reform Foundation, the economic appeal of taxing cannabis use is only one reason why we should follow this path. “But it’s an important reason,” he told GQ Australia in late 2015.

“If we can generate revenue and produce savings, that becomes quite a powerful argument.”

Dr Wodak notes that Colorado set aside a portion of its new-found income for upgrading its public schools.

“Some of the revenue from the sale of recreational, legal cannabis has gone towards building schools, and they have done very well out of it,” he says.

“Who can be opposed to building new schools for kids?” (To be clear, no Australian state or territory governments are currently considering the legalisation or taxation of recreational cannabis – a separate matter that is beyond the scope of this article.)

While no Australian government
has yet outlined a clear plan for how licensing for growing and selling medical cannabis might work, it’s a subject to which Dr Wodak has devoted a lot of thought. He advocates a similar approach to how we currently deal with alcohol, where only those aged over 18 years may legally purchase the substance.

“That wouldn’t be perfect, because the alcohol age restrictions aren’t perfect, but they exert some control to require proof of age and make it comparable with alcohol arrangements,” he told GQ.

“We could also mandate what lawful cannabis would contain.”

In addition to packaging that displays health warnings, like cigarettes, product information panels could accurately list the percentage of THC – the primary psychoactive component in cannabis – and assure consumers that the product

is free of any adulterants.
“We should also learn some of the

painful lessons we’ve learned from regulating alcohol and tobacco, such as getting in first by banning advertising, before there is a cannabis industry,” said Dr Wodak.

In partnership with the NSW Government and the University of Sydney, Canadian company Tilray will soon begin the world’s largest clinical trial of chemotherapy patients. Their goal will be a better understanding of how cannabis products can provide relief to cancer sufferers whose symptoms of nausea and vomiting cannot be controlled by standard treatments.

“In Australia, we think medical cannabis has potential to be a billion-dollar industry, and can create thousands of skilled jobs and generate tens of millions of dollars in foreign investment,” Tilray’s Global President Brendan Kennedy told news.com.au in March.

“We hope to invest significant capital in Australia in coming years. We intend to break ground on an Australian facility in the next 12 months.”

The parallels with this research and Dan Haslam’s story are clear: cannabis eased his nausea and vomiting, which led to the Baird State Government contributing AU$9 million to three clinical trials in 2014. But the biggest donation in this field has come from a couple of grandparents, Barry and Joy Lambert, who in June 2015 announced their decision to donate AU$33.7 million to medical cannabis research. Their story, too, is rooted in compassion, after they saw the difference cannabis oil made to the life of their granddaughter, three-year-old Katelyn, who has a rare and extreme form of epilepsy named Dravet syndrome. Their gift is believed to be the world’s largest single donation towards this type of research.

The Lambert Initiative, as it’s now known, is based at the University of Sydney. It’s an Australian first in the field of medical cannabinoid research, and its stated aim is to optimise and introduce safe and effective cannabinoid therapeutics into mainstream medicine in Australia and beyond. The Lamberts’ donation was followed by the NSW Government committing a further AU$12 million
to establish a Centre for Medicinal Cannabis Research and Innovation. Together, public and private funding have combined to position Australia alongside the likes of the Netherlands, the United States and Israel as world leaders in cannabinoid science. The avalanche rolls on.

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...with federal legislation allowing the cultivation of medical cannabis being passed in February and regulations governing production under licence now being drafted, the toughest roadblock – politics – has at last been cleared.

With the spectre of stigma fading
into the background, science comes to
the fore. All modern societies value knowledge and empirical data, and it is this desire that is driving investment in cannabis research. So it is for cannabis,
a drug long derided and misunderstood
in the public sphere by the masses – even though at least 1.9 million Australians privately use cannabis each year, according to the most recent data from the United Nations 2014 World Drug Report.

Scientific discoveries have shown us that the human brain and body is immersed in its own cannabinoids, which are known as endocannabinoids. Nor would we know that the cannabis plant contains more than 100 different cannabinoid substances but that only one is intoxicating. This is why we
do research: to better understand
the unknown.

“The [Lamberts’] gift will accelerate cannabinoids through the drug development pipeline to ultimately relieve the suffering of patients,” said Associate Professor and Lambert Initiative leader Jonathon Arnold in October.

“Without it, many important therapeutic applications would be left on the shelf, never to be realised.”

The Lambert Initiative won’t report its results for a few years, and before cannabis is approved for medical use across Australia, an application must be made to the Therapeutic Goods Administration (TGA), accompanied
by data to assess its quality, safety and efficacy. But with federal legislation allowing the cultivation of medical cannabis being passed in February and regulations governing production under licence now being drafted, the toughest roadblock – politics – has at last been cleared. Now, we wait for the science.

In the meantime, Australia’s states and territories are free to legalise the manufacture, supply and access to medical cannabis products within their jurisdiction, as Victoria did on 12 April 2016, becoming the first state to do so.

A white paper published by the University of Sydney Business School in March suggests tens of thousands of patients in Australia suffering medical conditions are expected to consume as much as 8,000 kilograms of cannabis
– worth AU$100 million – in the first year alone. With stigma largely vanquished and scientific inquiry taking its place, a veritable green avalanche is set to continue rolling down the hill in the years ahead.

NSW Terminal Illness Cannabis Scheme
– the details

Unique to NSW is its Terminal Illness Cannabis Scheme (TICS). Announced in December 2014 alongside the NSW Government’s AU$9 million trials of cannabis-derived medicines, TICS permits possession of certain amounts of leaf, oil and resin. Given that the scheme was developed to extend compassion to adults who are terminally ill, it is fitting that, in early February 2015, Dan Haslam became the second person in the state to receive a TICS licence.

At the time, Dan’s mother Lucy said the licence was both a symbolic and practical victory for the wider cause of nationwide access to medical cannabis.

“This was our first goal; this was the reason we were campaigning in the first place,” Mrs Haslam told The Northern Daily Leader.

Lucy Haslam, husband Lou and Dan’s wife Alyce also received licences, which protected them from repercussions for carrying cannabis for Dan.

Unfortunately, Dan Haslam died of bowel cancer within a month of receiving his TICS licence.

Under the scheme, licence holders are exempt from prosecution for possessing up to 15 grams of cannabis leaf, 2.5 grams of cannabis resin or 1 gram of cannabis oil. At the time Dan Haslam received the state’s second TICS licence, the Premier’s department said that only 11 applications had been received so far, though Lucy Haslam suggested this was due to a lack of promotion and public awareness.

Almost six months later, in August 2015, The Sydney Morning Herald reported that only about 40 people had signed up to TICS, drawing criticism from Greens MP John Kaye, who said the government had deliberately not publicised the scheme.

“[NSW Premier] Mike Baird is happy to reap the political rewards for moving on medicinal cannabis without delivering,” said Kaye, while a spokeswoman for the Premier said the government had promoted the scheme through cancer charities.

By the end of April 2016, there were 94 terminally ill people registered along with 180 carers.

Under the NSW TICS, applicants
require a medical practitioner, who is registered in Australia and involved in their ongoing care, to certify that the person has a terminal illness. Each eligible adult may nominate up to three carers who will be registered under the scheme. If requested by the NSW Police, registered adults and carers must produce their
TICS documentation.

There are limits for those registered under TICS, of course. Activities not covered by the scheme included supplying cannabis products to those not registered with TICS, cultivating cannabis, using the products in public or drug driving.

At the time of publication, no other state in Australia had established an equivalent scheme.

Andrew McMillen is a freelance journalist and writer based in Brisbane, Australia. Web: andrewmcmillen.com

Photo credits: flickr.com/photos/cwhitfield and Australian Broadcasting Corporation. Photographer: Time Lehā.