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The cannabis referendum – a doctor's perspective

by Dr Graham Gulbransen

Cannabis is part of our culture: 80% of adults have tried it sometime. Intuition tells us that legalising cannabis will increase use – science suggests that is not likely. Our Dunedin and Christchurch studies show that cannabis use peaks in our 20s. Older people are less frequent users whether it is illegal or controlled. Those using cannabis now would be the same ones shopping at government regulated stores.

Legalising and controlling cannabis will make it safer for both medicinal and recreational users. Cannabis is widely used as a medicine. Medicinal substances are taken to heal. When I purchase paracetamol from a supermarket and take it for pain, it is medicinal use.

Medicines don’t always come from doctors. Most medicinal cannabis users rely on illegal cannabis rather than prescription cannabis from a doctor. Once it is legalised, many people will purchase cannabis for medicinal use just as they procure illegal cannabis for medicinal use now. Legalised cannabis will be safer because it will be tested, labelled and restricted to those 20 and over.

My interest as a GP and Cannabis Consultant comes from 40 years of questioning patients who tell me that illegal cannabis helps their pain, anxiety and insomnia. They use it medicinally. Cannabis has been used for more than 10,000 years as a healing herb, as noted in ancient texts. Medicinal benefits are confirmed scientifically. My own audit of over 1000 patients found that about 40% reported benefit when treated with prescription CBD, better than many standard medicines.

Of my last 200 prescription cannabis patients, 57 or 29% reported current use of illegal cannabis as medicine at first appointment. Recreational use when younger was reported by 104 or 52% of my patients. Surveys in this country have found that about 10% of adults have used cannabis (illegal) in the past year with 5% of adults stating their use was medicinal.

So why do people choose illegal cannabis when prescription cannabis has been available for five years? Cost and access are barriers. Prescription cannabis is imported as oils or sprays. Patients pay about $250 for a month’s supply of prescription CBD oil, close to $10 per day. There is no subsidy at the pharmacy. Winz provides very limited funding. About 20 Aotearoa NZ companies are licenced to grow and produce medicinal cannabis but the final products are still some time off. We are told they will be cheaper than imported medicinal cannabis. However, patients tell me that it is cheaper to purchase or grow their own for their medicinal purposes. 

Any doctor may prescribe CBD to any patient but most doctors lack knowledge and experience and wont prescribe. GPs are the specialists most likely to support our patients and prescribe. Others, like pain specialists, rheumatologists and psychiatrists, usually say no to patients.

While THC is the euphoriant that gets users high, blending it with CBD eliminates that intoxication. Street cannabis contains  very little CBD. Stronger prescription cannabis containing THC is cheaper and more effective for many conditions but is restricted to non-GP specialists. Specialist GPs like myself would be better placed to prescribe for their patients but this is blocked by the Ministry of Health. If patients cannot get these from GPs, some tell me they will continue to use illegal cannabis.

Patients have been waiting six months for the Medicinal Cannabis Scheme at the Ministry of Health to assess and notify the availability of various blends of THC and CBD that any doctor may prescribe. Patients continue to use illegal cannabis while we all wait.

How does legalising cannabis make it safer?

Cannabis use has a long history and people will continue to use it. As with other consumables, testing for pesticides, heavy metals, fungi etc and standardising for strength and constituents is what we expect. This cannot happen under prohibition.

Prosecuting cannabis users is a failure because many will continue to use it. And they carry the additional stigma of prosecution with subsequent work and travel consequences. Especially for Māori. Most cannabis consumers do so for relaxation and enjoyment, without harm to themselves or others. Some of us chill with a beer or wine, while others safely vape or smoke cannabis – same deal really. As with alcohol, heavy use can be problematic. This is best managed by health services, not by arrest and prosecution. The $200 million spent each year in policing cannabis prohibition could better be spent on treating problem use. Taxes from legal sales would help.

Youth use of cannabis has been decreasing here and in countries where cannabis has been legalised. Do drug dealers check the customer’s age? Government controlled stores would be strictly R20. Mental health risks are greatest for those under 18 with genetic predisposition to psychosis. Those over 20 using cannabis for symptoms of mental illness would be better served at stores where labelling would allow them to choose CBD-dominant cannabis, not available under prohibition.

Cannabis has a long history of use medicinal and recreational use. Prohibition has not worked. It is time to treat cannabis as a health issue and stop pointless and damaging prosecutions.

Vote "No" if you prefer cannabis sales from dealers and gangs with no regard to quality, contamination or customer age. Vote "Yes" if you agree that prohibition is not working and that legalisation will allow control over cannabis sales, whether it be for medicinal or recreational use.


In 2018 Dr Graham Gulbransen opened the first medical cannabis service in Aotearoa NZ. Cannabis Care Clinic is in Henderson, Auckland, providing specialist consultations for legal medicinal cannabis prescriptions. Problems addressed include chronic pain, cancer symptoms, anxiety, chronic insomnia and neurological conditions. Most patients have experienced little benefit or adverse effects from conventional treatment or have been told there are no further treatments. Many report that medicinal cannabis offers symptom relief, improved quality of life and most importantly, restores hope. He has prescribed CBD to 1400 patients with very good outcomes. An audit of his first 400 CBD patients showed benefit for chronic pain and/or emotional distress: British Journal of General Practice Open, 5/2/20.

His part time general practice experience dates from 1983. Much of this work involves assessing and managing addictions and/or chronic pain. He is a FRNZCGP.  Graham completed his Fellowship of the Australasian Chapter of Addiction Medicine (FAChAM) in 2008. As an Addiction Specialist he manages problems such as alcohol and drug withdrawal, opioid substitution treatment, medication for chronic pain and he writes addiction assessments.

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