A NSW Parliamentary Committee has recommended legalising the use of medical use of marijuana for people with terminal conditions. This is an approach that should be embraced nationally.
For some years now, people seeking cannabis for medicinal purposes have contacted me every few months asking for help.
Usually the person has cancer or some other terminal illness. Their conditions have included cancer of the breast, large bowel, pancreas and a young man with a malignant brain tumour. One person had advanced AIDS and a cancer. And a senior politician once told me that cannabis was the only thing that comforted his father as he was dying from lung cancer.
So it’s difficult for me to understand why, in 2013, a civilised and compassionate country such as Australia still doesn’t allow people with distressing symptoms from a terminal condition to obtain some relief from medicinal use of cannabis.
The NSW committee’s report, The use of cannabis for medical purposes was tabled yesterday, following months of hearings.
Comprising of members of the coalition, Labor, the Greens and the Shooters and Fishers party, the committee unanimously recommended the medical use of cannabis for people with terminal illnesses and AIDS. The NSW government will now have to consider its recommendations.
But we have been here before. In 2000, the then-NSW premier Bob Carr commissioned a report on medicinal cannabis from a distinguished committee. The committee strongly recommended the state government allow cannabis use for medicinal purposes.
Still, it will be difficult for the government to ignore the unanimous recommendations of this multi-party committee while also knowing that 69% of the community support allowing cannabis to be used as medicine.
And even beyond multi-party agreement and widespread community support, the committee’s recommendations are a victory for common sense, evidence and compassion.
In preparation for this committee, my colleagues and I reviewed the literature on this subject. Although I have followed research in this area for a number of years, I was astonished at the quantity and quality of rigorous evidence which now exists for the medical use of cannabis.
Cannabis is not a “first-line medicine” (the first medication to be prescribed when a patient is diagnosed with a particular condition). But, for a number of conditions, it is a very useful second or third-line medicine, especially when the more conventional drugs have proven ineffective or produced severe and unacceptable side effects.
Cannabis is also considerably less expensive than many conventional medicines. And it allows some ill people to stay at home rather than remain in an expensive hospital bed.
So let’s hope the commonwealth and other states and territories also promptly consider the committee’s recommendations. Cannabis should be a medical option throughout Australia. It’s now used medically in almost a dozen countries. In the United States, it’s used medically in 18 states and the District of Columbia.
There are a few ways to legislate for the medicinal use of cannabis. It could be made available by allowing people with certain conditions to be granted exemption from prosecution for cultivating or purchasing it. But if this is the only available option, then some elderly people who are financially limited after years of severe illness will be forced to purchase it from the black market or cultivate it.
The former has obvious inherent dangers relating to variability in quality, consumer protection and cost. And it seems unnecessarily harsh or cruel to expect a 75-year-old grandmother dying of cancer to start cultivating cannabis plants. Even more so because it would require her pain relief to be on hold until the plants are mature enough to be cured and then cured enough to be consumed. So this approach will not meet the needs of many people who need help most.
A second option is to allow the use of a pharmaceutical product called Sativex, which is the brand name for a pain-relief drug derived from the cannabis plant. This can cost as much as A$500 a month and will be too expensive for many elderly people with depleted savings after several years with an advanced terminal condition.
A third option is to allow the use of leaf cannabis. The Netherlands now purchases meticulously produced pharmaceutical-grade leaf cannabis from a commercial contractor, and makes it available through pharmacies to approved patients.
Cannabis can now be taken by inhaling its vapour rather than breathing in cannabis smoke. No doctor likes the idea of a patient inhaling their medicine dissolved in smoke, which contains a lot of particulate matter although this can be overlooked in patients with a short-life expectancy. Cannabis vapour has minimal quantities of particulate matter and vaporisers have been available in Australia for some years now.
The advantage of cannabis leaf over Sativex is the former’s better representation of the complex combination of active ingredients. The pharmacology of cannabis is complex as the leaf contains over 60 psychoactive ingredients. It seems that cannabis' benefits may be enhanced and some of the side effects reduced when there is greater representation of these ingredients.
The NSW Legislative Council committee’s recommendation that medicinal cannabis should only be permitted for selected people with terminal conditions, can be justified at the start. But the arrangements should be flexible enough to be reviewed in a couple of years and, if need be, allow for some modification or relaxation of the initial stringent conditions.
The regulation of medicinal cannabis is a very different issue from the prohibition of the drug’s recreational use. Doctors in Australia prescribe morphine, cocaine and amphetamine for medicinal purposes even though the recreational use of the same drugs is banned.
It’s time to treat the issue of medicinal cannabis on its merits. It is not a panacea but it is a useful drug. We should not allow our obsession with the prohibition of recreational use of the drug to get in the way of allowing compassionate use of cannabis to reduce suffering for people with serious medical conditions.