Hard News by Russell Brown

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Hard News: Genter's Bill: Starting at last on medical cannabis

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  • Shane Le Brun,

    I've never heard of a Private Members bill getting plucked so quick. Its been what, a month since it was put in the ballot, time for Labour and Maori Parties to man up on the issue and have a policy outside of saying nice things.

    Since Mar 2015 • 41 posts Report Reply

  • Sacha,

    RNZ's coverage.

    Ak • Since May 2008 • 19413 posts Report Reply

  • Craig Young,

    Russell, you may want to get in touch with disability rights campaigner Dr Huhana Hickey on this issue, as she is a strong and articulate supporter of medicinal cannabis as a palliative and analgesic care option in this context.

    Wellington • Since Nov 2006 • 456 posts Report Reply

  • Russell Brown,

    Paula Bennett does her Westie-girl schtick and says she "wouldn't mind" legalised medpot.

    Massively missing the point of course – it's not about being a stoner, pretend or otherwise – but on the heels of English's "I'll discuss it with caucus" response (after flatly ruling out voting for Seymour's bill) it's pretty interesting.

    Auckland • Since Nov 2006 • 22227 posts Report Reply

  • Russell Brown, in reply to Craig Young,

    Russell, you may want to get in touch with disability rights campaigner Dr Huhana Hickey on this issue

    Oh, I already know the mighty Huhana :-)

    Auckland • Since Nov 2006 • 22227 posts Report Reply

  • BenWilson,

    Curious whether "Registered Medical Practitioner" is limited to doctors, or includes, say, chiropractors. Since back pain would appear to be something that might qualify for treatment.

    I'm very, very curious how "non-psychoactive cannabis plants" is something that can possibly be controlled in the wild, since the people cultivating it are going to be pretty much anyone. Does it require some kind of mandatory testing and quality control regime?

    I wonder also whether eczema counts as a severe chronic disorder of the immune system. That is literally what it is, although I've never heard of cannabis being a useful treatment. Perhaps as a sleeping aid to someone with maddening itches?

    Auckland • Since Nov 2006 • 10488 posts Report Reply

  • Russell Brown, in reply to BenWilson,

    Curious whether “Registered Medical Practitioner” is limited to doctors, or includes, say, chiropractors. Since back pain would appear to be something that might qualify for treatment.

    Hmmm ... I can't see that getting through.

    I’m very, very curious how “non-psychoactive cannabis plants” is something that can possibly be controlled in the wild, since the people cultivating it are going to be pretty much anyone. Does it require some kind of mandatory testing and quality control regime?

    It is happening already in NZ with hemp, but I'm not sure exactly how it's regulated, whether there are inspections or what.

    I wonder also whether eczema counts as a severe chronic disorder of the immune system. That is literally what it is, although I’ve never heard of cannabis being a useful treatment. Perhaps as a sleeping aid to someone with maddening itches?

    There actually seems to be some promise in CBD as an eczema treatment!

    Auckland • Since Nov 2006 • 22227 posts Report Reply

  • BenWilson, in reply to Russell Brown,

    There actually seems to be some promise in CBD as an eczema treatment!

    Reduced inflammation through topical treatment sounds interesting, and comparatively easy to make oneself, if allowed to grow sufficient amounts of the plant material.

    Auckland • Since Nov 2006 • 10488 posts Report Reply

  • Craig Young, in reply to Russell Brown,

    A regular wahine toa, that one! And much loved within the disability rights movement.

    Wellington • Since Nov 2006 • 456 posts Report Reply

  • Russell Brown,

    After all the headlines about Dunne slamming Genter's bill I thought I'd been severely embarrassed in my predictions.

    But a look at what he actually said on The Nation suggests it was more about voting maths.

    I suspect he's still wrong, at least on the calculation of the public mood. But it does seem the case that if it progresses to law, Genter's bill will look quite different to what it does now.

    Auckland • Since Nov 2006 • 22227 posts Report Reply

  • Craig Young,

    We need to get out there and make this an election issue.

    Wellington • Since Nov 2006 • 456 posts Report Reply

  • Bart Janssen,

    I can't see this flying in any way.

    If you want Doctors to prescribe a drug, even a natural product drug, then you need to control production, establish quality and safety standards, set up a regulatory authority to manage testing and all the bureaucracy that goes with any other drug. And frankly burning it and inhaling vapors is just not going to fly for anything other than a terminal illness.

    But basically the bill wants to make it OK for anyone to grow and self treat. Which no doctor is going to want to be responsible for because how the hell is the doctor going to be sure they aren't "doing harm".

    Either you go for a genuinely medicinal bill and do it properly, or you legalise, but trying to do both in one amendment, yeah nah.

    Auckland • Since Nov 2006 • 4354 posts Report Reply

  • Sacha, in reply to Bart Janssen,

    how the hell is the doctor going to be sure they aren't "doing harm"

    The harm-benefit equation needs to be properly weighed up against other common options like opiods. In terminal conditions, withholding treatment because of potential long-term harms does not make sense.

    But yes, the lack of dose consistency and quality control will worry many practitioners, especially if they're treating something like say chronic epilepsy rather than cancer pain. Many may opt to avoid it.

    Ak • Since May 2008 • 19413 posts Report Reply

  • Bart Janssen, in reply to Sacha,

    In terminal conditions, withholding treatment because of potential long-term harms does not make sense.

    Yeah no question about that and I don't think you'd see any issue from doctors.

    if they're treating something like say chronic epilepsy rather than cancer pain. Many may opt to avoid it.

    The way it reads any chronic pain would qualify, at that point it becomes much more problematic to prescribe something that doesn't have pretty rigorous definitions and quality control.

    To be clear, personally I'm all in favour of getting rid of prohibition. I can't see any real difference between alcohol and smoking and marijuana use. Removing prohibition would allow real clinical trials to be undertaken for the medical uses, something sadly absent for most of the claims of medical value.

    I just think this amendment is too mixed up to make any progress.

    Auckland • Since Nov 2006 • 4354 posts Report Reply

  • BenWilson, in reply to Bart Janssen,

    how the hell is the doctor going to be sure they aren’t “doing harm”.

    If they're convinced the underlying treatment doesn't really have much notable harm, and they believe there is a case for it in pain treatment. They can recommend a delivery method that is not smoking it, and owning a vaporizer that has been used would no longer be illegal, so it would be quite compelling, not to mention that eating it would be the most sensible for medicinal purposes anyway, and not outrageously expensive if you are able to cultivate your own.

    But more to the point, why do we really care whether some doctors might not be on board with it? Some would be. If most doctors say they would not prescribe it, then surely that's a sign of a functional system, they're using their doctorly discretion how its meant to be used. They may wish to wait until evidence accrues. But we don't have to wait for that for some people to genuinely receive treatment legally in the cases that pass the sensible threshold of a doctor's opinion.

    Either you go for a genuinely medicinal bill and do it properly, or you legalise, but trying to do both in one amendment, yeah nah.

    I would certainly vote for it. I believe in both medicinal cannabis AND legalisation. They're not mutually exclusive, nor does one have to wait for the other by any kind of logic beyond the art of the possible. Maybe it's not possible, maybe it's opposed by a majority in the population and in Parliament. Maybe not.

    This bill isn't really legalization in this form, though, because the cannabis they're talking about is not the recreational kind. I don't fully grasp how self-growing could be controlled to ensure this, but presumably the idea is just to make it illegal to grow the other kind and let the chips fall where they may. That's the current status quo anyway, the only difference is that there would be a lot of cannabis plants around, and enforcement would need to be able to spot the more recreational kinds, and have tests be able to prove it. I'm pretty sure they can and do already.

    So why let people grow their own medicinal cannabis? Pretty much for the same reason we let them grow their own tomatoes. Because why not? Because it normalizes a ridiculously demonized plant? Because it might save the people using it heaps of money? Because it's not really a big problem, most people would buy it anyway, as they do with tomatoes? Because it might not be financially viable for a big operator to do it initially? Because it might be difficult to buy it in some places? Because you're a farmer with a dicky back, and it helps, and you can supply your dying mum with endless relief at almost no cost?

    Auckland • Since Nov 2006 • 10488 posts Report Reply

  • Bart Janssen, in reply to BenWilson,

    So why let people grow their own medicinal cannabis?

    Again - personally I'd just legalise it.

    But here's the thing for me, at the moment the evidence for medical benefits from cannabinoids is mostly shite. What is being proposed is functionally legalising based on dubious medicinal claims and putting doctors at the pointy end of legitimising it.

    I get it. The Greens and a whole lot of New Zealanders (a significant minority if not a majority) want to legalise marijuana. This amendment acts to do that without actually doing the hard thing and saying prohibition is stupid and hasn't worked.

    Nobody claims tomatoes are for medicinal purposes, nobody is asking doctors to put their integrity and credibility on the line to prescribe tomatoes. But you're happy to risk the credibility of doctors to achieve functional legalisation? I'm not.

    Oh and BTW doctors belong to a real professional society (unlike real estate agents), there are pretty serious restrictions to that. Prescribing is not done casually.

    Auckland • Since Nov 2006 • 4354 posts Report Reply

  • BenWilson,

    I mean, lets face it, cannabis use is very widespread. There are a lot of doctors who have direct personal experience of it, and continue in their high functioning jobs in perfectly good health. I expect these ones would be less inclined to dismiss the enormous plethora of existing evidence already in place for medicinal cannabis, and would know from personal experience that it's pretty difficult to stuff up the production of a plant you grow in your garden, and literally impossible to overdose on it. Maybe they have concerns about recreational cannabis on mental health, but they're not prescribing that, and they're certainly not accountable for what illegal activities patients get into.

    Auckland • Since Nov 2006 • 10488 posts Report Reply

  • BenWilson, in reply to Bart Janssen,

    But you’re happy to risk the credibility of doctors to achieve functional legalisation?

    I'm happy to give them the choice about it, yes. Very much so. They know a lot more about health than I do. The law would not force any doctor to prescribe it. But it would enable any to do so if they deemed it worthwhile, and I totally disagree that the evidence of the benefits in pain reduction are shite. There are millions of first hand testimonies to that effect. When it comes to pain relief, first hand testimony is the only direct evidence there is.

    Oh and BTW doctors belong to a real professional society (unlike real estate agents), there are pretty serious restrictions to that. Prescribing is not done casually.

    Yup, they can apply their appropriate level of seriousness on a case by case basis. The terminally ill cancer patient finding pain relief and nausea reduction from it is hardly a casual prescription, it's an act of mercy, potentially increasing the quality of life for a suffering human being tremendously. Quite a lot of doctors believe in that. I also believe in it.

    Auckland • Since Nov 2006 • 10488 posts Report Reply

  • BenWilson,

    I get it. The Greens and a whole lot of New Zealanders (a significant minority if not a majority) want to legalise marijuana. This amendment acts to do that without actually doing the hard thing and saying prohibition is stupid and hasn’t worked.

    Yes, it's incremental. It's a hard sell to me, too, but I would take a medical cannabis bill in the hand over 2 legalization bills in the bush, especially if it's one that doesn't insert big pharma business completely unnecessarily into the equation. Yes, it's not the bill I'd put forward, but it's also not a bill I'd oppose. It might help some people in pain, however much it doesn't get me any sticky icky.

    Auckland • Since Nov 2006 • 10488 posts Report Reply

  • BenWilson,

    Just to clarify, since obviously I've had harsh words for incrementalism over the years. My position is that I don't think incrementalism is in any way optimal, and can entrench suboptimality. But that does not mean that when an increment comes along I'd oppose it. That's just cutting off nose to spite face.

    There is at least some argument that the medicinal pathway eases legalization too. It could work backwards, but Jesus, I'd prefer it to complete stasis. Quite aside from any free-the-weed master plan, there's the rights of people in great pain to consider. I think some proportion of people against legalization can probably accept that, and there's a real human consequence if they do.

    Auckland • Since Nov 2006 • 10488 posts Report Reply

  • Bart Janssen, in reply to BenWilson,

    There is at least some argument that the medicinal pathway eases legalization too. It could work backwards, but Jesus, I'd prefer it to complete stasis. Quite aside from any free-the-weed master plan, there's the rights of people in great pain to consider.

    And I agree.

    I really think there are enough observations to argue there is some medical benefit. Unfortunately because it's been illegal there are very few good controlled trials. And you are wrong it is entirely possible to do controlled trials on the benefits of pain relief, some of the results are kinda fun. Swearing really does reduce pain perception. But because of our weird attitude to marijuana we can't do similar trials.

    I am totally happy with a proper medical marijuana bill as an increment. I'd be happy with regulated tested certified products that the medical profession could asses and prescribe with confidence. And that doesn't have to be big pharma, most of the US medical marijuana suppliers are not big pharma and their standards could be adopted here. We don't have to reinvent the wheel or even buy someone else's wheel.

    It's when the amendment steps into allowing anyone to produce the medical product that I think it fails. You wouldn't and shouldn't accept that for any other prescribed medication. We have enough of a problem with fake medicines as it is.

    So I'd happily vote for a medical marijuana bill.

    I'd also happily vote to allow people to grow their own.

    But jam the two together? Nope.

    Auckland • Since Nov 2006 • 4354 posts Report Reply

  • BenWilson, in reply to Bart Janssen,

    And you are wrong it is entirely possible to do controlled trials on the benefits of pain relief, some of the results are kinda fun.

    I never said any different. Just that considering the way controlled trials about pain relief work, by treating as the response the subjective evaluations of the pain levels reported by the subjects, I’d consider the centuries of people doing exactly that pretty damned compelling evidence that it’s worth a shot. We should also do more controlled trials, but I just don’t see the compelling reason to hold things up over them. We also don’t have to reinvent the wheel on this. There is an entire planet of evidence to look to.

    I’d be happy with regulated tested certified products that the medical profession could asses and prescribe with confidence.

    As would I. I’d just also be happy with them prescribing, in some circumstances, access to “experimental” stuff, by which I mean stuff that’s been consumed by millions of Americans, and derives from plants that have been consumed for thousands of years, with very little evidence of toxicity.

    You wouldn’t and shouldn’t accept that for any other prescribed medication.

    It isn’t how it’s usually done, sure. But we are talking about something that does not have an involved or difficult production process. The reason it’s “prescription” is to allow it at all, not to provide carefully measured doses of something that would otherwise be toxic, or might even be outright toxic if made wrong. The prescription will almost certainly “use as needed”, like it is for many prescription medications, like ventolin, or all the topical steroids I’ve been on for decades. They’d give guidelines of how to establish a reasonable dose, something that is not rocket science, since it’s to stop pain, so it’s “increase dose until pain improves”, and “watch for side effects”. Like it is for so many other drugs, the patient is experimented on in a somewhat systematic way. Doctors also do very frequently make health recommendations that are not via prescriptions, just advice and guidelines for managing health.

    And lets focus on what they’d probably do it for, if they thought their reputation was at risk – people who are dying in pain. People for whom there is an extremely good case for this even on the less than perfect information we already have. As the evidence begins to roll in on the effectiveness in pain relief and/or the general harmlessness otherwise, they can get wider. I think I’d rather doctors were making that choice than some politician, frankly.

    But jam the two together? Nope.

    I’m struggling to see the downside, and definitely struggling to see that downside trading off well against the upside. Your concern is for the public respect for the medical profession? Frankly, I neither see it as likely to be affected, nor as my responsibility to maintain. Or is it that you’re genuinely worried someone will get hurt by growing their own medical cannabis? If so, I’d like to see some evidence of that actually happening. I don’t see the onus being automatically on people seeking to free something like this to prove the lack of harm, but quite the other way around, given what the blanket ban costs people in unnecessary misery and suffering. I’m pretty sure you’ll find the evidence for that every bit as shaky as the evidence of the benefits, for all the same reasons.

    ETA: Forgot to add: Also, once again, it’s not legalization of recreational cannabis. It’s not the same thing at all. It’s legalization of the consumption and supply of medical cannabis. Yes, the idea of it being available for people to grow is strange. But how else is anyone going to make it? What amazing magic process are they going to use in some tightly controlled medical cannabis plantation? They’re going to take cuttings and plant them, then water them, fertilize them and sun them. Like what I do on a daily basis in my backyard, producing products every bit as good (I would actually maintain that they are in many ways better) as what is available in the shops, at a fraction of the cost (in some cases).

    Auckland • Since Nov 2006 • 10488 posts Report Reply

  • Russell Brown,

    Henry Cooke checks the health of Genter's bill.

    Situation: Labour, Act and the Maori Party on board for the first reading.

    NZ First likely to forbid a conscience vote (you can't NZF MPs being seen to think for themselves) and Dunne undecided.

    That leaves the votes of 12 National MPs required. Which won't be a stretch if National allows a conscience vote.

    That's what it comes down to.

    Auckland • Since Nov 2006 • 22227 posts Report Reply

  • Rich of Observationz,

    What amazing magic process are they going to use in some tightly controlled medical cannabis plantation?

    Well, if you wanted to do evidence-based medicine, you'd start by taking your crop, maybe making cannabis oil using the usual process, then assay it for active ingredients and then standardise it by dilution or concentration so you had a known dose.

    Then (assuming you'd pre-decided that the drug was generally safe and effective) you'd prescribe it to each patient, perhaps starting with a small dose and increasing to see the effect on their symptoms. You'd record this and report any adverse effects, as well as conducting formal follow up studies on safety and efficacy (informed by the way you are using a standardised product).

    If you don't do that, it isn't evidence based medicine and isn't what doctors are supposed to do.

    If people want to take weed, either because they consider it helps them medically or they just like being stoned, then to me, that's fine. The government should provide clear and accurate information on the health effects and leave them to make up their own mind.

    But trying to introduce into medicine the idea of "prescribing" random plant material is a big step backwards.

    Back in Wellington • Since Nov 2006 • 5528 posts Report Reply

  • Russell Brown, in reply to Rich of Observationz,

    report any adverse effects

    A Facebook friend was encouraged last week to take CBD oil for the pain from fibromyalgia and spinal arthritis. (I confess, I didn't exactly discourage her either.)

    She's in the UK so the oil was unregulated and fairly easy to to obtain. So she got some.

    She's into day three of what sounds like a hideous allergic reaction and still feeling very sick. It's unclear what product she used, let alone what caused the reaction, but it was a bit of a reality check.

    Was it a reaction to the CBD itself? (It can cause severe gastro symptoms.) The oil base? Remnant terpenes? Dose-related? This is the kind of thing doctors want to know before prescribing.

    Auckland • Since Nov 2006 • 22227 posts Report Reply

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