"Helen Kelly is fighting for the rights of others to the very end," reads a comment under Life and Death and Cannabis, the trade union leader's new post at The Standard. And yes, she really is.
Kelly is taking cannabis oil to help manage the pain associated with terminal cancer. She knows she is in breach of the criminal law – and she knows she is not alone. She also knows she has the ability to speak frankly about it where others may not:
Since I have been public about it I have received so many very very sad emails from families also wanting access. Children with brain tumours, partners in their last stages of life zonked out on morphine and wanting something less brain numbing, people with elderly parents who are suffering from terrible arthritis and can’t cope with opiates so are basically in pain constantly and unable to move etc. It really has been incredible and quite heart breaking.
There's a reason that "Name Witheld" is the most popular byline on accounts like the letter to The Listener here:
I’ve never been interested in recreational drugs but tried cannabis as a last resort. I am now pain-free for most of the time, have been able to return to work and am again fully enjoying my life.
I would like to be able to share my experience with others who suffer from the same condition, but feel unable to for fear of prosecution, and for fear of jeopardising those who have helped me access cannabis.
This situation needs urgent redress. Although more evidence is urgently needed, those of us who have to rely on cannabis for our survival cannot wait for trials to take place. I know it works for me and has saved my life. I have conducted my own trials, carefully documenting the effects of every medication I have tried. Although I’m overjoyed to have my life back, it appals me to have to live in such a complicated and clandestine way.
And this Stuff column by a man who discovered that a very low level of cannabis use eased his inflammatory and arthritic symptoms and allowed him to return to work. It also helped moderate the effects of the prescription drugs he must take to treat his arthritic symptoms. Those drugs will eventually cause his liver and kidneys to fail. In that light, forbidding him to use cannabis because it might be bad for his health seems like a sick joke. He writes:
So although I have stepped out of the shadows to share my story, I am stopping short of telling you who I am. I would lose my job and my livelihood, I would lose everything I have worked so hard to create from the nothing when I was on the disability benefit.
My sense is that these stories are more common than is generally acknowledged. In the past, I've given a friend a pointer on where to access marijuana for a dying father, who had never used it before.
I also know of someone using cannabis oil (competently but illicitly prepared) in a bid to shrink tumours. This is not as far-fetched as it might sound: the evidence that cannabinoids can reverse fast-growing tumours is mounting. Researchers typically caution against self-medication with whole cannabis, but when self-medication is the only choice people have, such cautions may not carry a lot of weight.
Many are resorting to illegal supplies and this in itself is so far from satisfactory. They have no idea what the strength of the product is or what it even has in it some of the time. In countries which allow medical cannabis these things are sorted – Doctors are trained on its use and products are tailored to kids, elderly etc etc.
I'm not sure that even in more liberal regimes things are quite that "sorted" – this is new territory for everyone and it sometimes implies a departure from the precautionary principles of drug approval – but the lack of clarity on potency and cannabinoid ratios is a risk factor itself.
Which is why Helen Kelly – who you would think hardly needs the damn grief – has embarked on the process of seeking consent to import and use a cannabis-based product under the Medicines Act. You'll need to read her post to appreciate the full drama that involves, but it culminates in the required consent of the Associate Minister of Health, Peter Dunne.
Dunne is habitually, and often unfairly, pilloried in these matters. Yet in delivering the new National Drug Policy last year, he had to carefully navigate the National government's cynical and entirely political stance on drug law reform to become the first minister to acknowledge that a significant portion of the harm from illicit drugs lies in the laws that make them illicit.
Dunne is also constrained by the official advice he receives. Even when, as was the case in November when Pharmac's Pharmacology Therapeutics Advisory Committee advised against extending the subsidy for Sativex, the advice is frankly misguided. The committee advised against the funding in part because of the risk of "diversion" of Sativex for recreational use. Sativex is an oral spray containing a 50-50 ratio of the two main cannabinoids, THC and CBD – and is thus a poor candidate for getting high. The idea that criminals might seek to misuse it when actual cannabis (which will get you high) is widely available is simply ludicrous. But that's the nature of the environment we're in.
In speaking out, Kelly also has the advantage – if it can be called that – of being terminally ill. The ethical case for denying cannabis for palliative care evaporates on examination, like a raindrop on a hotplate. If a dying person derives a subjective improvement in quality of life through the use of cannabis, there isn't really a moral argument for denying it. And there is a strong moral argument for alleviating the legal peril that use involves. At the least, no sane person is going to call for her prosecution.
Making this application will generate headlines. It will engender public sympathy. And perhaps this case – or the next one or the one after that – will transport the issue from being a moral one to a political one, thus bringing it within the ken of the present government. This is why it's worth trying.
I'm sure Helen Kelly understands this very well. She's smart as well as brave. But she could have simply kept her head down and got on with her own business. That she has not and that she has chosen to fight on a principle that will help others speaks volumes for the person she is.
Kia kaha, Helen Kelly. And thank you.
UPDATE: There has been some useful discussion in the comments below about the hoops Helen Kelly must jump through to gain ministerial approval to use a medicinal cannabis product under sections 20-22 of the Medicines Act 1981. The requirements are not part of the Act and were only recently published, in the wake of the Alex Renton case. Elements of them seem, frankly, unreasonable. The most obvious being the requirement that "patient hospitalised when treatment is initiated". The risk-benefit requirements are also irrelevant and unreasonable in the context of palliative care at least. I would hope there is scope for discussion of these requirements – a discussion that actually involves patients and their families.