Turei pushing medicinal use of cannabis
11-04-06 l The Otago Daily Times l Tom McKinlayIn the movies, the condemned man is never denied a final smoke.The health risks of that last gasp pale into insignificance when compared with the threat posed by the firing squad.
In a real-life replay of the silver screen scene, Dunedin based Green MP Metiria Turei is asking the community to look at the big picture and offer the sick and dying the chance to consider cannabis.A private Member’s Bill sponsored by Ms Turei is due to go before Parliament soon, possibly this month, proposing that doctors be permitted to prescribe cannabis where it could do some good.In an interview, Ms Turei said she expected some to oppose the move but asked them to set aside prejudice and look at the evidence.“I am asking people to set aside that prejudice because for the sick, it is actually really important that they access the medicine,” Ms Turei said.“It is enormously and fundamentally cruel for them to be denied a potentially useful medicine because of the prejudice that some people hold.”The Misuse of Drugs (Medicinal Cannabis) Amendment Bill, due to be debated on November 22, would allow doctors to prescribe the drug for specific serious medical conditions.Conditions identified in a schedule to the Bill include Alzheimer’s disease, arthritis, multiple sclerosis and the nausea associated with cancer chemotherapy.Proponents say cannabis is useful in countering nausea and as an antiemetic (which prevents vomiting) in the treatment of pain and muscle spasms, and as an appetite stimulant for people suffering from wasting conditions.Under the Bill’s provisions, those prescribed medicinal cannabis would have to be registered and would be issued with an identity card.“It will not work for everyone, which is why my Bill makes it a decision for the doctor,” Ms Turei said.There is a limited facility for sick New Zealanders to access cannabis now, but each case has to be considered by the Minister of Health.The process is onerous and no approvals have been given.“It does not happen with any other kind of drug in this country. It is just ridiculous,” Ms Turei said of the process.The Bill proposes allowing people to grow-their-own, or have it grown for them. Ms Turei said she expected some to object to the smoking of cannabis and was open to discussion about the best way to deliver the drug.The debate is not new and both the research and the incidence of people self-prescribing cannabis is well-known to those in the medical profession.Dunedin oncologist Associate Prof David Perez said he had encountered a small number of patients who benefited from smoking cannabis, having tried everything else.“People access it for themselves, obviously, and they use it and they report to us that they find it quite useful,” Prof Perez said when approached for comment.“We are limited in that we can not go out and positively recommend it.”However, if cannabis-related treatments were to become available, “cannabinoid” drugs were preferable, he said.“There is a medication which is produced pharmaceutically, which is a derivative of cannabis, that is provided in the UK as a prescription medication. I think we would prefer to have that kind of option available to us.”Cannabis on its own was regarded as mildly or moderately effective as an anti-nausea treatment, and selective in terms of whom it helped.Other drugs were considerably more effective and avoided the “mind-disturbing” side effects of cannabis some people found uncomfortable, Prof Perez said.Cannabis expert Prof Paul Smith, of the University of Otago’s department of pharmacology and toxicology, said the first question when considering medicinal uses for cannabis was whether it was to be smoked.If so, the benefits had to be weighed against the risk of lung damage.Drugs derived from cannabis, cannabinoids, were the alternative.“Most of the evidence suggests that cannabinoids . . . are useful for stimulating appetite in conditions like cancer or Aids where there is wasting,” Prof Smith said.There was also good evidence cannabinoids were effective in treating nausea and vomiting.A drug available in the United States, called dronabinol, a synthetic THC (the active ingredient in cannabis), was used for that purpose.A drug developed in the United Kingdom, Sativex, was a mix of THC and another chemical from cannabis delivered as a spray under the tongue.“There’s a good blood supply under the tongue so the drug is absorbed very quickly into the blood.”There was some evidence cannabinoids could be useful in treating glaucoma as well as chronic pain and spasticity, in disorders such as multiple sclerosis (MS).Claims for efficacy in the case of other conditions listed at the back of Ms Turei’s Bill were more questionable, Prof Smith said.The Bill lists schizophrenia, brain injury and epilepsy as areas were cannabis could help, but Prof Smith said such claims were poorly supported by research.New Zealand Drug Foundation executive director Ross Bell said they had extensively researched the topic and supported the Bill going to a select committee.However, their own contact with MPs indicated it was unlikely to find majority support in Parliament.One problem might be that it provided for the smoking of cannabis which was not to say that did not work for some people.“It appears that the benefits slightly outweigh the risks just because of the way people smoke cannabis medicinally,” Mr Bell said.It could be problematic for the Bill that it had attracted the support of pro-legalisation lobby Norml, he said.“It is the kiss of death.”New Zealand Aids Foundation executive director Rachael Le Mesurier said the foundation would be quite happy for the Bill to go to a select committee.Anecdotal evidence indicated cannabis had helped some New Zealand HIV sufferers with the nausea caused by antiretroviral medication.“We are very aware that worldwide, in Canada, the United Kingdom and America, people are making significant decisions around trying to increase research and information around this so we can all work from an evidence based position, rather than an emotive one.”University of Otago researcher Geoff Noller said it was his view that the medicinal use of cannabis was unlikely to be seen as opening the door to recreational use.Where surveys had shown support for medicinal use, the same populations continued to support prohibition for any other use, he said.There was evidence quite large numbers of people could be helped by medicinal cannabis.An Australian study showed 19,000 people in New South Wales had conditions where cannabis could play a role in their treatment.On that basis, more than 11,000 people in New Zealand could be in the same situation, Mr Noller, a PhD student in the department of psychological medicine, said.Health Minister Pete Hodgson has acknowledged the potential for cannabis to do good, but indicated he was not looking at relaxing the laws.“I consider the existing exemptions under the Misuse of Drugs Act 1975 allow for a medical practitioner to be given approval to prescribe an appropriate cannabis-related product for a patient under their care,” he said in a statement.Mr Hodgson said he had asked the Ministry of Health to review the latest research before he considered whether to support the Bill.
Blair Anderson
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