Hard News by Russell Brown

Last week, The Lancet Public Health journal published the conclusions of a significant four-year cohort study into the use of cannabis by people suffering chronic pain. The results were, on the whole, highly unfavourable: participants who used cannabis tended to suffer more severe pain and to have pain interfere with their daily lives. They were more likely to suffer from anxiety disorders and using cannabis didn't diminish their use of opioid painkillers.

The findings were widely reported under headlines like Cannabis shows no benefit for chronic pain, major study shows. And in the context of the study, that was true. But ...

You'd need to actually read the Lancet article to discover some significant caveats about its findings. The participants were originally recruited for an observational study called Pain and Opioids IN Treatment, which followed a group of Australians with chronic non-cancer pain who have been prescribed opioids by their doctors.

So the researchers knew a lot about what opioids their subjects were using and in what dosage. By contrast, they didn't know what cannabis products their subjects were using, where they got them, how they were using them or in what dosage. The most fine-grained the study gets is "daily or near-daily" use of (necessarily) illicit cannabis. That's it.

The researchers, who were specialists in addiction studies rather than in pain medicine, never met their subjects – they gathered their responses from self-completed questionaires and phone interviews. The non-cannabis users were not met face-to-face either, but presumably had personal contact with their prescribing doctors.

What can be said of the results is that unmanaged use of unknown quantities of unqualified street weed did not seem very effective in managing pain, and was possibly even counterproductive. But it's also worth noting that this was an unhappy, troubled cohort with comorbidities. Half had screened positive for current moderate-to-severe depression and one in five had attempted suicide. It's a group which should be very cautious about using high-THC street weed, with its known anxiogenic effects.

But there weren't actually many cannabis users in the context of the wider group: by the time of the final four-year follow-up only 16 per cent of the overall cohort of 1200 participants had used cannabis in the past year and only six per cent were in the "daily or near-daily" group. It's not really possible to assess the value of a controlled medicinal cannabis treatment programme in such a context.

There's a further wrinkle: while the cannabis users didn't outperform non-users on pain and life impairment scores, they tended to report a perception that their cannabis use was helping. And the proportion of those who felt cannabis was helping increased over time, even if their scores said otherwise. The authors speculate it might simply be to do with getting a good night's sleep. There might also be something else going on.

It's important to note that the authors have not misrepresented their results, and have acknowledged most of what I've said above (although there's no real acknowledgement of the probable difference in composition of street and prescribed cannabis products, which is significant).

It's no surprise that the study has been controversial. It contradicts other recent studies like this one – which did not use a control group, but did actually study the effects of cannabis administered in a formal treatment context, and found very different results to the Australian study. So the most useful thing this new study may show is that an unregulated black market is not an effective model for the medicinal use of cannabis.

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The Lancet study came up in this RNZ Sunday Morning interview with Tanya Black, a reporter for for the disability programme Attitude, who has made a two-part film called In Pot Pursuit, which follows her attempts to be prescribed an approved medicinal cannabis product. She suffered a spinal fracture 10 years ago and lives life pretty well with a wheelchair – except for persistent and painful spasms in her legs, for which she currently takes some pretty heavy drugs, including fentanyl. One pharmaceutical cannabis product, Sativex, is specifically approved for spasticity in MS patients, so it's not unreasonable to want to try it, or the functionally equivalent Tilray.

The interview also featured Rick Acland, a Christchurch-based pain specialist who appears in the film. He was actually more cautious in the interview than he is in the film, but it's no small matter for a pain specialist to break ranks with the current orthodoxy. One anaesthetist, Graham Sharp, sent a blazing message in to the programme during the interview slating medicinal cannabis as "a scientitifc fraud" with "a basis in naturopathy" supported only by "pressure groups". (This isn't actually true, but it's an indication of the extreme strength of feeling among many doctors.)

Anyway, despite its slightly cringey title, In Pot Pursuit is well-made and worth watching. You can see the first part on Attitude at 11am on TVNZ 1.

(Disclosure: I've just started doing a few casual days as a producer at RNZ and this story happened to fall to me to put together last week.)

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One more thing. This Transform article on cannabis social clubs in Spain popped up in my Twitter today and it's worth reading, because CSCs could be New Zealand's response to a positive vote in the forthcoming cannabis referendum – especially if restraining runaway commerce is deemed a priority.

CSCs not only make cannabis available without commercialisation (CSCs are forbidden to make a profit), but allow for the production and sale of specific strains,  with particular attributes and cannabinoid ratios. There is an underground in New Zealand producing such strains, including for medicinal use, but the people in it are in constant danger of arrest and prosecution.

The news that Canada's Cannabis Act, which legalises and regulates the sale of cannabis, and its use and possession by adults, had passed its final legislative hurdle, was somewhat overwhelmed by the day-to-day madness of global news in 2018. But you will hear a lot more about it as New Zealand edges towards its promised cannabis referendum.

It was evident as soon as the Trudeau government won election with legalisation on its manifesto that the experience there might prove to be a vital case study for other liberal democracies. And that it is even more true now. Canada has done a lot of the thinking for the rest of us.

I have an impending Matters of Substance feature on the cannabis referendum promised in Labour's support agreement with the Green Party. It wasn't something any of the governing parties campaigned on, but because New Zealand First has long (ostensibly anyway) favoured a referendum on the issue, it happened to be the point where all three could agree.

So the government is coming to this historic vote from a standing start. But this much we know: the referendum will be held in either 2019 (possibly in conjunction with local body elections and/or a voluntary euthanasia referendum) or 2020 (at the same time as the general election). The minister responsible is Andrew Little. Andrew Little told me that it was unlikely that there would be a fully worked-up law for the people to vote on, and that his sense is that the referendum will not be binding.

The first part there is problematic: "legalising cannabis" is an almost meaningless proposition. It might involve anything from removing penalties for use and possession (yes, I know, that's decriminalisation) to weed supermarkets on the high street. People need to know what they're voting for. That's why the full text of California's successful Proposition 64 in 2016 ran to more than 100,000 words of legal and technical definitions. Almost no voters actually read it, but they wanted it to be there. New Zealand voters will feel the same.

So how much of our homework has Canada done for us? Parts of its law do not apply to us: principally, the decision to devolve some of the regulation to its provinces. But even that offers us options to look at. In Alberta, about 200 regulated private retailers will be allowed to sell cannabis – while Ontario will only allow 40 state-run weed stores. (I'm told by an Ontario friend that the provincial government's decision is not popular with voters, and the rules there might loosen with the next election.)

This Guardian explainer usefully rattles through other key issues: product labelling, public possession limits, a new, stricter drug-driving law (it's still an incredibly fraught area and will be until there's an efficient, reliable impairment test), limits for home-growing (four plants up to a metre high, except in Quebec or Manitoba, where it will remain illegal), edibles (can't be sold until the government works out some specific regulation some time next year) and the rights of landlords and employers to restrict consumption.

The provisions come come from A Framework for the Legalisation and Regulation of Cannabis in Canada, which is the final report of the taskforce appointed by the goverment to travel around the country and consult. There are many other recommendations in the report, including strong restrictions on advertising and higher taxes on higher-THC products.

It also proposed an age for legal adult use: 18.

The choice of 18 as a threshold has been controversial in Canada. We know that while heavy use is less risky at age 18 than it is at age 15, risk is lower still at 25, when brain development has stabilised and neuroplasticity is much less of an issue. In choosing the lower age, the task force concluded that:

... persons under the age of 25 represent the segment of the population most likely to consume cannabis and to be charged with a cannabis possession offence, and in view of the Government's intention to move away from a system that criminalizes the use of cannabis, it is important in setting a minimum age that we do not disadvantage this population.

Anne McLellan, the former Canadian deputy Prime Minister who led the task force defended the choice of 18 in similar terms when she visited New Zealand last year: yes, you could minimise risk by opting for 25, but that would marginalise the very group of users you’re trying to engage and educate. She made the point that Canada was reforming precisely because the rate of youth use had remained worryingly and persistently high under prohibition.

It's worth noting that New Zealand doesn't currently have a minimum age for cannabis use. It also doesn't have any official guidelines for lowering the risk of cannabis use. Canada does, having adopted this 2017 expert literature literature review. It offers 10 key points:

For most recommendations, there was at least “substantial” (i.e., good-quality) evidence. We developed 10 major recommendations for lower-risk use: (1) the most effective way to avoid cannabis use–related health risks is abstinence, (2) avoid early age initiation of cannabis use (i.e., definitively before the age of 16 years), (3) choose low-potency tetrahydrocannabinol (THC) or balanced THC-to-cannabidiol (CBD)–ratio cannabis products, (4) abstain from using synthetic cannabinoids, (5) avoid combusted cannabis inhalation and give preference to nonsmoking use methods, (6) avoid deep or other risky inhalation practices, (7) avoid high-frequency (e.g., daily or near-daily) cannabis use, (8) abstain from cannabis-impaired driving, (9) populations at higher risk for cannabis use–related health problems should avoid use altogether, and (10) avoid combining previously mentioned risk behaviors (e.g., early initiation and high-frequency use).

Some of these are difficult or impossible to apply in a prohibitive environment.

Canada has taken another important step: making clear that a past cannabis conviction will not be a barrier to joining the new, legal and regulated cannabis industry. I think this will be important to Māori communities who have suffered grossly disproportionate criminalisation for decades.

Canada has yet to decide whether it will follow California in expunging historic convictions for offences which no longer apply. Andrew Little was a little startled when I put it to him that it could be part of the package here, but our prosecution of cannabis laws has been as racially inequitable as California's has. This is a chance to redress enduring historic wrongs. It is also wholly in line with Little's own ideas about criminal justice reform.

So anyway, there is much to discuss and not much time to discuss it in – a public engagement programme can't even roll out until it receives funding in next year's Budget. And give that time is tight, we should be watching our Commonwealth cousins closely – and let Canada do our cannabis homework.

In recent weeks, it has been more difficult than ever to assess and comprehend all the stupid, awful deeds and words of President Donald Trump. The tantrum and chaos of the G7 meeting bleeds into his preposterous accounts of the North Korean summit bleeds into the 14 different stories his administration has offered on the immigrant child-snatching policy. He's tweeting more and, it appears, publicly lying at an even greater rate. Last week always seems a long, long time ago.

So perhaps it's worth pausing for breath and focusing on one story that's somewhat lost in the noise: the Trump administration's steady suffocation of the Appellate Body at the World Trade Organisation. The US government has blanket-banned approval of new appointments to what is essentially world trade's appeals court, and the point is approaching when that court will not be able to operate.

As this Reuters commentary observes:

... the Trump administration’s obstructionist approach to appointments is extremely dangerous. If the appeals court cannot function, all WTO member governments suffer, including the United States. When governments, including the United States, bring WTO complaints, they want them heard and resolved quickly. With the appeals process slowed by a lack of judges, the system will experience long delays (it was already taking much longer than expected, so anything more could be devastating), or even stop working altogether.

It's important to note that – as with the current immigration crackdown – there is a precedent in the Obama administration. Obama's government did ramp up deportations, mostly of undocumented immigrants with criminal records, and it did sometimes prosecute people who arrived at the border, which sometimes did mean removing children. (In 90% of those cases, the defendant had an existing criminal record. Under the Trump zero-tolerance policy, the ratio has turned around so that 90% of the asylum-seekers prosecuted do not have any criminal record.)

Similarly, it was Obama who started playing hardball with Appellate Body appointments, first in 2011 when his administration declined to reappoint its own judge and, more agressively, in 2016 when it vetoed the reappointment of a South Korean judge it didn't like.

But that's not the same thing as what happening now. And while it would be nice to think that Trump and his officials are acting to a strategy for reform of the rules, I don't think that's the case. When have these people ever had a day-after plan? 

Moreover, I don't think they want a rules-based world. You don't insult and provoke your economic allies, you don't start trade wars, if that's what you want. I think the bastards just want to blow the whole thing up.

I sometimes think back to secondary school History, and being taught the elements of the post-war consensus: Bretton Woods, GATT and what followed. One teacher also presented us with the United States system of government, with its three branches keeping each other in check, as the democratic ideal. That ideal was always flawed in reality. But seeing that system becoming completely dysfunctional and attempting to spread that chaos and dysfunction to the international community feels visceral. It feels very dangerous.

Watching this week's episode of TVNZ's new I Am strand, I Am Living With Aspergers, the story of David RS Greer and his family, pushed a lot of buttons for me.

To be clear, neither of our ASD sons has ever had contact with the police or the justice system, and certainly not in the way David did – although I know the statistics and that possibility is never lost on me.

But we, too, were forced to withdraw our younger son from school, and to find a way to keep clear of truancy services. We too were blamed as parents. We too had to repeatedly face down ignorant people in the system. We too sometimes cowered, awaiting the next violent, inexplicable meltdown. We too got through the tough times by being a loving family.

And we too came to understand that what our son did came down to a single fact: his experience of the world was profoundly different to ours.

Like David, our son couldn't cope with the human noise of a crowded classroom. He was excused assembly because the singing was unbearable, and a couple of times he took steps to extend his blissful silence: the class would come back from assembly to discover that he'd locked them out and was smiling happily inside. From his point of view it was a rational, resourceful response. I rather admired him for it.

A psychologist in the progamme explained that David's childhood meltdowns seemed to appear so suddenly because they were always just below a threshold of constant stress and anxiety. I remember that: I'd touch my son's skin and it would be hot. Hour after hour, day after day, stimuli he couldn't cope with had him in constant fight or flight mode. Can you imagine living that way?

That seems a long time ago and things are better now. They do get better. And in large part, that was down to our son learning to manage himself and his immediate environment. He knows he'll have to engage more with the world eventually, although not quite how yet. We'll get there. But for now the child who could be so hard to live with is intelligent and courteous, and he has a rich life online.

We're both pleased at how well his new thing, collecting and precisely painting Warhammer figurines, is working out – especially that it's not screen-based. And his no-filter experience of the world always has its benefits. Could you play a video game on one monitor and watch a movie on the other, at the same time? He does it as a matter of course. (He's also very handy for telling us when our water filters need replacing and deciphering ambiguous sounds.)

So yes, I'd recommend watching  I Am Living With Aspergers. Its rendering of an autism family experience is authentic, and I appreciated the details, like explaining that although it's not wrong or offensive to say "Aspergers", these days we generally talk about Autism Spectrum Disorder. I could have done without the wibble at the end about how we're all on the spectrum. It's true to some extent, but saying someone has multiple "quirks" instead of the one or two most of us do doesn't get near the profoundness of difference involved.

I think it's important to note that David Greer, who is highly intelligent and has learned to adapt his behaviour to social expectations, still has trouble keeping a job, in part because of stigma about who he is. Our older son, I am happy to say, recently began a job that for the first time, at age 27, feels like a real one. The difference in him, in his confidence and sense of identity, has been remarkable.

There's still a way to go. It feels like we've been parents a long time, and there's a way to go yet. We do get weary, and I still worry about the future, or feel like we've failed sometimes. But things do get better.

You can watch I Am Living with Aspergers here on TVNZ On Demand.

In Lee Borrie's oral history of Radio With Pictures, the first part of which is published this week on Audioculture, Bruce Russell recalls a Sunday night student ritual: you'd watch Radio With Pictures, and then you'd watch what everyone referred to as "the Sunday horrors".

If there wasn’t a television in the flat, then on Sunday night you would go to somebody’s house who had a television and you would watch Radio With Pictures.

You didn't have to be a student. Back then, when we consumed popular culture through a thin straw, rather than being drenched in it by a digital firehose, it seemed like everyone watched it. There had been music shows on New Zealand television since the early 1960s and, like those elsewhere, they almost all presented live (or mimed) performances. Radio With Pictures was born out of the unprecedented availability of a new medium: the promotional music video.

Strictly speaking, music promo clips had also been around since the 1960s: we can still watch the films the Beatles, the Stones and The Doors made to accompany their songs. But they were being made in much greater numbers by the late 70s and, crucially, they were free content. The first iteration of RWP was incredibly cheap television: just a whole of clips provided by record companies and strung together, without even a presenter.

But, especially after the show got a face – radio DJ Barry "Dr Rock" Jenkin – those clips weren't just advertisements for records, they were communiques from the outside world. And more particularly, news from the revolution. New Zealand's embrace of punk and what followed had a lot to do with the likes of The Stranglers' 'Get a Grip on Yourself' – a performance-style clip of the band playing in some low-ceilinged club – being played on Sunday nights. (I'd embed the clip, but it only seems to be available now on a weird Russian website.)

Unless you could hear Barry's radio show, you couldn't get this stuff anywhere else. Barry didn't always get it right: I recall him once grousing about having to play a particular clip. It was, he grumbed, "the bootom of the barrel". It was Labelle's 'Lady Marmalade', and I will fight any man who doesn't recognise the genius of that tune. But his was a bracing, disruptive presence. He was actually only the host for three season (1977-79), before Karyn Hay took over – and she, in quite a different way, was also not of the standard order of TV presenters.

Gradually, there were also the first stirrings of what would later become a vast catalogue of New Zealand music videos. Toy Love can take a bow there.

The programme's success was also down to something that would be unthinkable on modern broadcast TV: a bunch of weirdos basically being left to get on with it, so long as "it" didn't cost too much. That kind of freedom really exists only outside broadcast now.

Borrie's interview subjects traverse an oft-told story – that while touring New Zealand, Michael Nesmith happened to catch an episode of RWP and was inspired to create a show format called PopClips, which Warner picked up and turned into MTV – without reaching a firm conclusion as to whether it's actually true.

There is certainly one verfiable MTV link. When the record labels decided that music videos weren't ads that they'd give away, but works that should attract a public performance fee, RWP went off air for some time. And during that time, the show's producer, Brent Hansen, took off on a sabbatical from which he would not return. I recall having a coffee with him in London, the pair of us freshly arrived in 1986. He was about to go and interview for a job at a new venture setting up in Camden: MTV Europe. 

But that will doubtless be covered in the next part of Borrie's oral history, which is drawn from interviews for a research project on New Zealand video production. For now, this first part is a great read about a time when things were different.

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Reading it did put me in mind of this: when I was interviewed on RWP in 1986 by my one-time flatmate Dick Driver (none of us, least of all Richard, could have expected that he'd become the TV production titan he is now). I seem sort of meek ...

And there is one other, less savoury memory: sitting down for the ritual every Sunday in our first-floor flat at the Ascot apartments on Newton Road, and, as the music gave way to some cheap horror flick, often hearing a scratching noise below the window. It was the sound of what we jokingly (if a little nervously) referred to as "the Phantom Sweeper" – who turned out to be Stewart Murray Wilson, so so-called "Beast of Blenheim". Shudder ...

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I've been revisiting one of the great albums, Talking Heads' Remain in Light, in recent months, so I was immediately interested when I saw that Beninese soul singer Angélique Kidjo had remade it.

I was not disappointed. Remain in Light came from Africa and Kidjo takes it back there. David Byrne was quite clear at the time the Talking Heads album came out that reviewers who wanted to understand it should consult the afrobeat grooves of Fela Kuti. Kidjo brought in Tony Allen, Fela's longtime drummer and musical director, to play on her record, and it's infused with the warm blood of afrobeat.

But she does more than funk it up. In her hands, some of the original songs take on new meaning. 'Born Under Punches', she has said, read to her as a song about government corruption. That's how it's illustrated in the video:

'Once in a Lifetime', envisioned by Byrne as the existential lament of man lost in the modern world, comes up joyous and liberated in Kidjo's reading:

And she somehow turns 'The Listening Wind' – a song about an African terrorist – into what it was meant to be:

Kidjo has reinterpreted the work of male composers before – Bob Marley's 'Redemption Song' and a fantastic version of Hendrix's 'Voodoo Chile' – but this feels prodigious; not only a musical work, but a sophisticated commentary. (Her nuanced take on "cultural appropriation" in this recent Pitchfork interview is further testament to her awareness and intelligence.)

This record makes me dance, and it gives me chills. And I'm waiting for an enterprising promoter to get Angélique Kidjo here to play in this country next summer. Because that would be amazing.

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And of course, David Byrne is touring this year. As is Suzanne Vega. I hear you can get their stuff on those new-fangled compact disc things.

Gareth Shute's adventures in Spotify data journalism continue with this look at lesser-known local artists who've cracked a million streams. You might be surprised – I certainly was.

The Guardian has the obituary of the the Fleetwood Mac guitarist we all forget – Danny Kirwan. It's a really sad story, and a reminder of how punishing the music business can be for the talented but vulnerable.

Janine – formerly Janine and the Mixtape – has rather dropped from view in New Zealand since she signed her deal with Atlantic Records and flew out to America, but it's been fascinating checking in on her. Her fanbase isn't star-level, but it's passionate, and she speaks really authentically to those fans. You can see that in the recap video of her North American tour that she posted this week:

Meanwhile, I checked in on the Twitter of another New Zealander making his way in America, Lontalius – and it wasn't there. Turns that after all that talk about his youthful precocity, it finally caught up on him now he's an adult. How utterly odd ...

He'll be wanting to get that fixed asap, given that he has his first new song in a year coming out soon.

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Tunes!

Fanau Spa are a kind of Auckland rap supergroup (you'll hear Coco Solid in there) and this new jam is tuff and ominous:

It comes only three weeks after their debut:

I've got no idea where all this is headed, but I'm here for it.

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