30 Oct 2020

Referendum rejection: Safe access to cannabis still needed - doctor

8:56 pm on 30 October 2020

By Dr Graham Gulbransen*

Opinion - New Zealanders have sadly chosen to continue cannabis supply from the black market rather than government regulated shops after the referendum results today, writes Dr Graham Gulbransen.

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Photo: 123rf

The public discussion of cannabis use and sales has been very welcome, but somewhat uninformed of best public health evidence. The government with Health Select Committee input would have made a better evidence-informed decision.

It is unfortunate the decision went to referendum. Of course the government may still decide that the merits of legalisation far outweigh the harms of prohibition and go ahead with the proposed law change. This would benefit those using cannabis for medicinal purposes and those using it for pleasure.

To quote Professor Michael Baker and others in the NZ Medical Journal (9 October 2020), 'The Cannabis Referendum is a once in a generation opportunity to place evidence-informed controls around a substance that is widely used and unregulated. A yes vote is not a vote in support of cannabis - it is a vote in support of placing public health controls around a substance that is currently left to the black market to manage'.

I supported the Cannabis Legalisation and Control Referendum because doctors have a duty to advocate for our patients, and while the preliminary result has gone against reform, I wish to acknowledge a somewhat invisible group of our patients for whom I ticked Yes.

About 5 percent of adults may be using illegal cannabis for medicinal or healing purposes, according to the Cannabis Use Survey 2012-13 commissioned by the Ministry of Health (MoH) and published in the NZ Medical Journal in 2015.

The Legalisation and Control Bill would have regulated use or consumption. It did not specify the word recreational and personal use included medicinal use.

The Cannabis Use survey used data extracted from the regular New Zealand Health Survey, a representative sampling of 13,000 kiwis. It found that 11 percent aged 15 and over had used cannabis in the past year. This equates to about 400,000 kiwis using illegal cannabis annually.

Forty-two percent - almost half of cannabis users - reported medicinal use to treat pain or another medical condition. Those over 55 reported higher rates of medicinal use.

So more than 150,000 people reported using cannabis for medicinal purposes in the past year.

For 40 years as a doctor I have been asking patients if they use alcohol, tobacco and other drugs. Patients tell me that cannabis is the only thing that relieves pain, anxiety and insomnia.

This is confirmed in the cannabis medical literature and in my experience as a cannabis prescriber for more than three years.

In my prescription cannabis practice 57 of my last 200 patients were using illegal cannabis as medicine - almost a third.

Why do they see me for prescription cannabis? Many live in constant fear of arrest, confiscation of their cannabis medicine, risk to education, jobs, travel.

Most are concerned that they don't know what is in their illicit medicinal cannabis. They ask how prescription cannabis compares with the oils or herbal cannabis they use. We just don't know because it is almost impossible to analyse illegal cannabis for its THC and CBD content.

The strength of cannabis varies and it is not tested for contaminants like pesticides, heavy metals, solvents, & fungi.

Illegal cannabis supplies may be erratic and can run out leaving sick people stranded.

So patients ask their GPs or me for prescription cannabis.

The barriers here relate to unwillingness of doctors to prescribe and MoH restrictions that block GP-specialists applying for the less expensive but more effective blends containing THC.

THC is medicinal, it is a partial agonist in the endocannabinoid systems of all animals, including us. This is a fundamental cellular signalling system of retrograde inhibition for immediate feedback, supporting homeostasis. Think pain, anxiety, seizures etc where signals are amplified and medicinal cannabis may bring them back to the normal zone.

Cost is the other barrier to prescription cannabis, about $10 per day.

So many start prescription cannabis but cannot afford it and revert to illegal cannabis.

As I have said, up to half of personal use is for pain, anxiety, sleep etc, often for conditions not responding to standard medical treatment.

There will always be patients with intractable conditions and many will find symptom relief with cannabis. They will keep using cannabis as medicinal regardless of its legal status.

What I want for my patients is safe access to cannabis when standard treatments fail.

Government controlled cannabis sales would have required products to be tested for contaminants and constituents and labelled just as with any consumable item sold.

I have no doubt that people will continue to use cannabis illegal or controlled. Cannabis has been with us for 10,000 years and is not going away. Prohibition has not stopped its use. Legalisation and control make it safer for both medicinal and recreational use.

In Canada at the time of legalisation, just 35 percent were in favour. After 18 months of legalised cannabis 70 percent support legalisation. It is a better option.

I ticked Yes at this referendum because I know that it would have been safer for more than 150,000 people who use cannabis as medicine.

*Dr Graham GulbransenI is a cannabis consultant, General Practitioner and addiction specialist.

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