Hard News by Russell Brown

12

The long road to "Yes"

One day in 1985, I came down from the loft where I was working as deputy editor of Rip It Up magazine, looking for lunch, and walked into a scene. There, on the corner of Queen and Darby Streets, a man was in the process of getting two kids to sign a petition against homosexual law reform.

I was incensed. I knew all about the petition, which had been founded by two Labour and two National MPs, taken up by the Salvation Army and then by the Coalition of Concerned Citizens, a conservative lobby group that also railed against biculturalism and the alleged communist threat to New Zealand. (As a measure of quite how bigoted this organisation was, it might help to know that its more moderate, left-leaning members eventually split away and formed the Christian Heritage Party.)

I knew about  the way the petition had been brought into workplaces, where men signed it to avoid losing face. And here, in front of me, was someone gathering fraudulent signatures from children.

I strode up and told the man with the petition to stop. He smirked and the two boys he was soliciting indicated they were up for signing. A police officer walked past and I called him over, urgently. Here, I told the policeman, was someone gathering illegal signatures, and he needed to do something. He looked bemused. Eventually, our odd little cluster broke up without the signatures being secured. Many months later, after the Coalition had presented its 800,000-strong petition to Parliament, it was determined that a great many of the signatures it bore were invalid.

It would be another 16 years before the Salvation Army reflected on its role in this unethical enterprise – and on its appalling submission on Fran Wilde's Homosexual Law Reform Bill – via a paper by Ian Hutson. Whether or not you think Hutson's paper was the mea culpa it needed to be, it's a worthwhile read.

Hutson places homosexual law reform in the context of social turmoil. The 1981 Springbok tour had torn the country apart and now the fourth Labour government was turning it upside down. After a vicious battle in the 1970s, access to abortion had been made possible, if not exactly legalised. The Treaty of Waitangi Amendment Act passed in 1985. And now, this drive to legalise homosexuality. The world of conservative Christians, including those in a growing evangelical movement, had come unmoored and it was time to make a stand against all this change.

In 2020, we again find ourselves in interesting times. Nature and its pandemic have forced change on us, made us anxious and sometimes angry. We've worked out that anxiety and anger in different ways and some of us have embraced conspiracy theories and bizarre beliefs. American evangelicism has been a noxious influence, again. A government led by a woman finally legalised women's fertilty choices – and it seemed so inevitable a step that the opponents of change looked right through it and focused instead on another change: legalising and regulating cannabis.

Three years ago, in the closing panel of an Orcon IRL event looking back at 2017, I asked National MP Chris Bishop what he thought about the just-announced cannabis referendum – putting it to him that he was a law reformer and wondering how many of his caucus would be with him if actually passing the law came down to a conscience vote.

He said he hoped it would be a conscience vote (as we now know, things didn't work that way for National MPs) and then he said something very interesting.

I'm a bit worried about the referendum proposal. You know, be careful what you wish for. I'm not sure a referendum is the right place to conduct a sensible, evidence-based, informed debate about drug law. Because I'm telling you now, there are a lot of people out there whose last wish is an evidence-based, informed debate about drug law reform. And they will have voices and they will spend a lot of money and they will ... not monopolise, but they will put their view into the public domain and they will toxify the debate.

And actually, I may be wrong, but i think we will come to regret the referendum proposal. It seems elegant and it seems clever, but actually referenda are the wrong place to decide finely-grained public policy questions like drug reform. Particularly a debate where there's so many different elements and people will impute their own interpretation about what each word means.

So the debate around decriminalisation versus legalisation – there's a lot in that, like a lot, and even finding the wording of the referendum question is going to be massively politically contentious. You know, it sounds good, but be careful what you wish for if you're a drug law reformer.

Since then, many others have echoed Chris's thoughts on the desirability of a referendum. I'm more philosophical about that. A referendum is what was politically possible at the time – and referenda, in the form of the ballot initiatves in American states, are main reason we're even able to talk confidently about legalisation as a policy initiative, after decades of political roadblock.

But the parts about voices, money and "fine-grained policy"? Yes. It feels like one side in this referendum has been trying to talk about policy points and the other wants a culture war.

That's why I was interested three months ago when Cleve Cameron bought me a beer and asked if I'd be interested in getting involved with an idea he had for a campaign focused on normalising a "Yes" vote. It wasn't my usual style – which is basically shouting nerd facts at people – but the "No" campaigners had focused on making an evidence-based choice for "Yes" look deviant. That needed addressing. We needed to say that this was something that good people could support. The campaign would be called "We Do".

Cleve had been offered a three-week nationwide billposter campaign by Phantom Billstickers, who have a history of helping out on these issues. My friends, graphic designer Roxanne Hawthorne (the one who originally pointed Cleve my way) and festival production maestro Fred Kublikowski came aboard too. Kieran Scott agreed to photograph our volunteers for the posters. About an hour after I announced our plans on Twitter, my old friend Tim Wood came through with $5000 donation that all but covered our main initial cost – the printing of the posters themselves.

A PledgeMe campaign brought in another $5000-odd, which meant we could also do a campaign with A3 "retail" posters to go in cafes, bars, bakeries and the odd church. That cost money to execute because Phantom contracts out that part of its business, but Stuart Shepherd and Fred Soar at Soar Print did the posters for free for us.

Part of their decision, I'm sure, came down to a shared memory of our dear, lost friend Grant Fell, who I was able to help through his last, precious days with a green fairy oil. My feelings about Grant – and my strong sense of offence that the people who helped me help him were classed as criminals – has a lot to do with why I've been doing this too.

Later in the piece, we were offered digital billboard inventory by MBM, Lumo, Locky Docks and Go! Media and, with multiple national outdoor campaigns, we've wound up looking quite a lot bigger than the four or five munters trying to keep up with their day jobs that we actually are.

The campaign evolved as we rolled it out. The plan to generate most of our campaign material in a single day – by photographing our 60-odd volunteers and asking most of them of why they were voting "Yes" – turned out to be a good one. Our volunteers, a really lovely and diverse bunch, from students to seniors, gave us a lot to work with. And it was work: Roxanne in particular has done an unbelievable amount, not only in generating the visual collateral but guiding what we'd do next.

Most of the words have been me. People wanted more detail, so I wrote up more detail for our website. We also did something I hadn't initially anticipated: we started telling people who the other side was. It turned out that in 2020, people aren't very good at parsing information and where it comes from. So I wrote a page with some background on SAM-NZ, Say Nope to Dope and Family First. It covered the involvement of Scientology front organisations in SAM-NZ and the fringe religious conservatism of its principals.

We didn't really want to get involved in a culture war, but that's what happened. Since I wrote that page, other parts of the picture have emerged.

New Zealand-born researcher Brent Allpress spoke last week to Kathryn Ryan on Nine to Noon. Allpress did some of the key research for the new documentary People You May Know, which exposes a network based around what he characterised as "oil interests, large extractive industries and evangelical activists and dominionists who seek to end the separation of Church and State". Part of the network is a software company called Gloo, which uses masses of personal data to help evangelical churches target vulnerable people for conversion, an activity which is at least unethical and possibly illegal.

He also thought he'd identified a link between this network and our referendum campaign. Gloo also works for the US opioid rehab industry, which makes many millions from the country's opioid addiction crisis, and has helped with campaigns against cannabis legalisation in various US jurisdictions. Gloo's recovery services director, Steve Millette, is on the board of Smart Approaches to Marijuana (SAM), which this year bestowed its name on SAM-NZ, bringing together Family First and its offshoot Say Nope to Dope, the Scientologists and others.

Allpress says there is a lot of "dark money" flowing through this network, which already has a presence in Australia. Is that what we're seeing here? We can't really tell. The fact that Family First's income from donations has doubled in the past two years, and is triple what it was four years ago, may be material.

This isn't a quarrel with faith: I am friends with many believers and I respect, even envy, what they have in their communities. But it feels unnerving. Our campaign hasn't really had much grief (there's a silly ASA complaint waiting on publication of a decision) but I know the New Zealand Drug Foundation has been harassed and that the Make It Legal campaign had to roster moderators for 18 hours a day on its Facebook page in the face of a tide of aggressive commentary, much of it from American evangelicals. Everyone's pretty exhausted.

Will the referendum pass? I don't know. But there has been a mood shift in the past two or three weeks. It would have helped if the Public Health Association and the public health experts who published their emphatic call for a "Yes" vote in the New Zealand Medical Journal had come along sooner. It would have helped if the whole thing hadn't become a matter of partisan politics and MPs like Chris Bishop had been allowed to speak honestly. It would have helped if the chair of the NZMA had displayed even a minimal sense of responsibility, instead of creating this debacle. It would have helped if the popular Prime Minister had expressed a view – although in a year when protesters have carried signs likening her to Hitler, there could also have been undesirable impacts. But, again, there has been a shift and I'm a lot more optimisic than I was even three weeks ago.

The Ministry of Justice team which has done most of the work on the Cannabis Legalisation and Controll draft bill has done a remarkable job – this is thoughtful, careful legislation that takes on board the lessons of other jurisdictions and places public health and harm reduction at its centre.

If "Yes" prevails and it goes to select committee, I wouldn't want to make it any more onerous to provide and purchase cannabis legally: it's extremely tight as it is. But I'd get behind working on the already world-leading market allocation and licensing provisions to make it even harder for "Big Cannabis" to appear. I've thought all along that these are the most important parts of the the bill.

A few weeks ago, I took part in a respectful and useful debate on the referendum. Our opponents were good people, but they barely engaged with a policy point and leaned far too heavily on the idea that it's fine to carry on with the "soft decriminalisation" of the past decade.

But if it's no longer acceptable to prohibit, to prosecute and punish thousands of people over cannabis – and, in truth, I think even most "No" voters accept that – then the solution is not to keep on selectively applying the law. It's wrong and unfair and it produces racist and harmful outcomes. Let's do this honestly and properly.

A "No" vote in this referendum would be a vote for no solution in an environment where the need for sensible, honest law is becoming more acute. The cannabis market isn't standing still and voting to just keep doing what we're doing won't stop or change anything about it. It is, in the end, just a vote against change.

To return to where we started, there was a famously noisy debate on homosexual law reform in 1985. It wasn't the only such event around that time. The year before saw The Great Marijuana Debate, which was chaired by the late Peter Williams QC. The two events even had an antagonist in common – Invercargill MP Norman Jones, who predicted that homosexual law reform would make New Zealand "the sodomy capital of the South Pacific".

One law reform soon found its way to success; the other has drifted for decades since. I'm hopeful that on Saturday we will finally signal we're ready to deal with that unfinished business.

Please vote "Yes" to say you do support the Cannabis Legalisation and Control draft buill and, if you feel able, talk to friends and family about it. If you need more to read on why, visit the We Do website.

8

Cannabis: legalisation versus decriminalisation

One thing I've been hearing fairly regularly, usually from more conservative voters, is that they're wary of voting "yes" for legalisation and regulation of cannabis, but that they'd definitely get behind decriminalisation if that was on offer.

I think most of them are sincere in saying so, and I understand the appeal of decriminalisation: it seems like a nice middle ground, easing the harm of criminalisation without going all the way. But I also think that it's clearly  an inferior option that comes with its own risks.

So I was pleased to hear John Hudak, Deputy Director of the Center for Effective Public Management at the Brookings Institution, address the choice during last week's Helen Clark Foundation webinar on the cannabis referendum, in response to a viewer question. He had this to say:

The United States definitely debated those topics. In fact, in the 1970s a lot of states decriminalised cannabis, starting with Oregon in 1972 or 1974, and including a lot of liberal and a lot of conservative states – north, south, west.

For your viewers who are unfamiliar with the distinction, legalisation is an outright legal system with some sort of method of supply and then the ability to have some sort of transaction, whether it's a monetary transaction or a gifting transaction, to meet demand.

Decriminalisation does not remove all legal barriers against cannabis. But in the United States, what it does is it turns a minor crime into the equivalent of a speeding ticket or a traffic ticket. That is certainly a much smaller punishment for possessing cannabis or using it in the wrong places, but it is still a drug offence in the United States.

And what we found is, in states that have decriminalised, those racial biases do not change. In fact, in some places they get worse. And so police are still able to use the existing law enforcement apparatus to really disproportionately impact certain communities.

And so decriminalisation is simply driving the market into the shadows, and making sure that the government is halfway okay with something, but not okay enough to regulate its safety, and to regulate whether children are going to get access to it or to regulate the manner in which businesses operate or where they operate. They're comfortable with people using it for a small fine and also using it from illegal operators who are producing it and selling it.

To me, that's just a screwed up system. Either keep it illegal, because you think it should be illegal, or legalise it and regulate it and tax it, and make it more responsive. The decriminalisation middle-ground just, like I said, is the sort of policy upside-down for me. It's continued costs and very few benefits.

The report of the Chief Science Advisor's expert panel also addressed the issue in its Prohibition vs legalisation section. The panel said that in New Zealand "over the past decade the regulation has morphed into a ‘soft decriminalisation’ approach" and observed that the government tried to emphasise health-based rather criminal justice responses in last year's Misuse of Drugs Act amendment guiding police discretion. But:

It is too early to have solid evidence for the difference this approach has made to cannabis use, enforcement and harm. However, early signs, supported by a wealth of related evidence here and overseas, suggests that such discretion may not be applied equally. Discriminatory policing and justice outcomes result from the uneven application of cannabis laws, especially for Māori.

Derek Cheng in the Herald last week did a very good job of confirming those discriminatory outcomes in an analysis last week. Working with police data since the amendment came into force last August, he found that Police did start directing more cannabis possession cases away from court. For Māori, that lasted a month – then it was back to being disproportionately criminalised.

This also came up in a debate I took part in last week, where one speaker insisted that cannabis wasn't criminalised any more. Helen Clark observed that between 2000 and 3000 New Zealanders a year are still very much criminalised for cannabis offences. That number has come down quite a lot over the past decade. But the idea that selective application of the criminal law – which is what our "soft decriminalisation" actually is – is a long-term solution is hard to defend in the face of clear evidence of continued racial baias.

I honestly worry about us drifting into a messy, unregulated de facto decriminalised space if "No" prevails. That's what happened in Canada, where dab bars operated and youth use actually went up – until legalisation reversed the trend.

Even if you formally decriminalise use and possession – and choose a flavour of decriminalisation where it is not an offence at all to use or possess cannabis, but producing or supplying it can only be done by criminals – you're missing out on a lot of benefits. No standards, no age limits, no  potency labelling, no separation from the sale of other substances, no public revenue.

Frankly, let's just regulate carefully and do it properly.

________________________

PS: Here's that webinar in full. The foundation have kindly sent me a transcript, so I'll probably dip into that again this week.

7

ASA: Let's not talk about this

Last week, major newspapers carried a full-page ad as part of the campaign for a "No" vote to the referendum question about supporting the Cannabis Legalisation and Control Bill. The ad was authorised by the SAM NZ Coalition, which takes its name from a controversial American anti-cannabis group and includes members of two Scientology front organisations.

I took a photo of the ad in the Herald that morning.

It would be fair to say I was furious about it – my immediate reaction on social media included the words "lying liars". I wasn't alone.

The most obviously misleading elements of the ad are:

- The signs. These would never be permitted under Section 157 of the Cannabis Legalisaton and Control Bill, which prohibits advertising both generally and specifically, including any notice or sign "outside of the place of business of a person who offers cannabis products for sale". A retailer who breached the advertising ban would be fined up to $240,000. The advertising ban has been fundamental to the proposed reform since the original Cabinet paper.

– Under Section 159, a licence-holder would be allowed to display the name of the business outside, but not "any word or expression signifying that any cannabis product is available in that place for purchase" or "the trade mark of a cannabis product or the company name of a cannabis product processor". The name of the retail business itself would also be subject to regulations on "unsuitable names".

– Licensed cannabis retail outlets would not be "everywhere, like dairies". The bill requires the new Cannabis Regulatory Authority to take into account the proximity of "kindergartens, early childhood centres, schools, tertiary institutions, places of worship, parks, sports facilities, swimming pools, playgrounds, and other community facilities" in drawing up local licensing plans, and to further consult with local residents and businesses and consider "whether the amenity and good order of the territory would be likely to be reduced" by the presence of a licensed premises. Practically speaking, there would not be licensed premises with open doors raced past by kids on bikes and scooters.

– The more-than-400 cannabis outlets comes from an estimate by the economic consultancy BERL in its speculation of a likely regulated market, and relates to the least restricted licensing option – albeit the one BERL favoured as offering the best prospect of supplanting the existing criminal market. (The actual figure is 420, so someone was perhaps having a quiet joke.) But there are ten times that many dairies and convenience stores, so licensed outlets will not be "everywhere like dairies" in that respect either. Or, for that matter, like liquor outlets– there are at least 14,000 of those.

So the depiction of a dairy – which is a manipulated image of a real-life dairy whose local customers aren't happpy about its use – is wholly misleading. But there are other, more subtly misleading elements to the ad. The claim about "drug usage increasing by almost 30%"  relates to the other BERL paper, which does not predict a sustained increase in cannabis consumption. The figure equates to BERL's guess of an initial "short-term spike" as people try out the novel experience of buying cannabis legally, and what effect that might have on the Regulatory Authority's cap on annual cannabis production:

While consumption will drop back down to a long-term average, the legal cannabis market will need to be able to supply this short-term spike, or risk allowing the illegal cannabis market to maintain a sizable share of the market.

But that could be argued, and the 30-odd complainants to the Advertising Standards Authority regarding the ad presumably looked forward to just such an argument. As it turns out, the argument will not be had.

In an extraordinary decision, ASA chair Raewyn Anderson has blocked the complaints from reaching the ASA's Complaints Board, on the basis that there are "no grounds to proceed". It appears the advertiser was not asked to respond to any of the complaints, so that response will not be relayed to complainants, as might usualy happen. Instead, Anderson has chosen to devise a defence on her own (it's a more able one than the Say Nope to Dope spokesman was able to summon himself when challenged).

The defence on the signage issue effectively amounts to "what do words mean anyway?".

The Chair said the scenario depicted in the advertisement is a subjective interpretation of what a possible future could look like if the Cannabis Legalisation and Control Bill becomes law, and therefore comes under the category of opinion.

The Chair noted that while certain provisions are currently in the Bill, many changes could potentially be made during the Select Committee process, and it is not possible to predict with any accuracy what the final outcome might be. The Chair noted that while the signage on the shop in the advertisement might not comply with the provisions in the Bill, it assisted with conveying the Advertiser’s view of what cannabis retail outlets may look like and how the New Zealand way of life might change if the Bill is passed.

The bill might well be amended in the legislative process, although as constitutional law professor Andrew Geddis has observed, the moral imperative to pass it essentially as voted on would be considerable. But to declare that it is "not possible to predict with any accuracy" whether a central facet of the bill, the advertising ban, becomes law is a hell of a call to make.

And apart from anything else, this is the bill we're voting on. If we can't discuss its text as meaningful, to use it as a point of reference, what's the point of a discussion? By the logic of this decision, SAM NZ could depict 14 year-olds lining up to buy weed at the school tuck shop as its "interpretation" of what could happen if the "Yes" vote carried. 

On the "short-term spike" issue, Anderson acknowledges that the ad presents a 30% increase in consumption without noting that on the same basis as it expects the spike (the experience of other jurisdictions) and in the very next sentence, BERL expects a fall to the long-term average. But:

The Chair said while the Advertiser has chosen to refer to the first statement from this quote, and not the second, this is allowable in the context of advocacy advertising.

Hmmm. 

Anderson also addresses the presence of children in the ad, and observes that premises would be strictly R20:

The Chair said that if cannabis is available for purchase at shops children will be able to walk, scooter and bike past these shops, as shown in the advertisement, and this is not misleading.

There is at least a significant discussion to be had about whether these licensed outlets would actually even look like shops "as shown in the advertisement", given that shopfronts would be effectively banned.

Anderson responds to complaints that the ad was "scaremongering, sensationalist and exaggerated", by writing that:

... while the advertisement did have shock value, which is likely to have been deliberate, it did not reach the threshold to cause serious or widespread offence or cause fear without justification. The Advertiser is using provocative imagery to draw attention to the debate about an important social issue.

Is the advertiser really "drawing attention to the debate", or simply misrepresenting what's being debated? It seems notable that Anderson hasn't included even a cautionary word for referendum advertisers to be mindful of the facts. It's all just fine.

If the complaints board, with its representatives from the public and from the advertising industry, had been given the opportunity to discuss the complaints and declined to uphold them, that would have been something. Complainants and commentators would have grumbled and perhaps opted to take the decision to the review board. But there was no discussion permitted.

It's proper and a matter of practicality that the Chair should have the power to weed out complaints in this way – otherwise the board would be bogged down in trivia.

But this isn't trivia. Misinformation about cannabis reform is clearly as much part of the debate as the bill itself. Last November, Justice minister Andrew Little expressed concern about a likely barrage of misinformation about the referendum, appealed to the public to call it out and specifically underlined the role of the Advertising Standards Authority. The complaints board chair's decision that the board should not even discuss it seems extraordinary, the more so when you look at many of the complaints to board has been allowed to discuss.

In a way, this does speak to the different purposes and philosophies of the the "Yes" and "No" campaigns. The "Yes" people – and I am one – are generally, sometimes painfully, focused on making a good-faith evidential case for reform. Say Nope to Dope/SAM-NZ's role is to raise fear, uncertainty and doubt about that reform.

This isn't necessarily the end of the road – the ASA has a separately-constituted appeals board – but having been dismissed in this way, the complainants may simply lose faith in the authority. The advertisers in this case will doubtless be considerably emboldened.

44

An unhelpful column about cannabis

The bar to get a opinion published about legalising and regulating cannabis is, you'll know, not terribly high at the moment. Anyone can have a crack. But there's a column published on Stuff that I want to take a closer look at because it's by someone who should bring a degree of expertise.

It's by Dr Mark Hotu of Green Doctors in Ponsonby, which bills itself as "the ONLY [cannabis] clinic that has actual medical specialists". I presume that doesn't mean the only one with medical doctors, but with a specialist on staff. 

Acccording to the Green Doctors website, Dr Hotu himself himself has been prescribing cannabis products for "over a year" and visited a cannabis clinic in Canada last year. His colleague Dr Anne Craig joined the practice last year. They both have have backgrounds in treating pain and Dr Craig is a pain specialist. Like all New Zealand doctors, their history of prescribing cannabis is a very short one.

UPDATE: In the comments below, Dr Waseem Alzaher of Cannabis Clinic says Dr Craig "works solely for Cannabis Clinic and not Green Doctors. She has requested her name be removed for 2 months now."

Dr Hotu says this in his column:

As a GP I feel a duty to help ensure the public is properly informed when they cast their vote, they should know about the existing availability of medicinal cannabis and the potential risks of self-prescribing cannabis for health reasons.

I’m concerned that many voters have been led to believe a cannabis referendum ‘Yes vote’ equals a ‘Yes’ for medicinal cannabis. This is not the case; patients already have access to medicinal cannabis. It’s legal under the Medicinal Cannabis Scheme and currently available via prescription from doctors who can identify any potential drug interactions and adverse effects that may affect a patient.

At present, that means that they prescribe a lot of CBD, which they've been allowed to do since September 2017. Green Doctors bills itself as offering "the cheapest CBD products in the country". There are nine of them listed on its website, but the Ministry of Health's regulations are such that no one's allowed to tell you what they are.

Currently, doctors can readily prescribe exactly one product containing THC: Sativex, which was approved in 2010. Sativex is approved by MedSafe for treating the symptoms of multiple sclerosis, but since April 1 this year, doctors have been allowed to use their clinical judgement prescribe it off-label, for pain and other conditions. It's not funded by Pharmac and costs around $900 + GST a month, although for some patients it's considerably more.

Another, functionally similar, product, Tilray 10:10, is often cheaper, but it's unapproved, which means a specialist must write the prescription, which has to be approved on a case-by-case basis by the Ministry of Health. (Having a pain specialist like Dr Craig on staff is an obvious advantage.)

The situation will gradually improve as products are approved under the April 1 regulations, but no product has been submitted for approval yet.

Moving on ...

Admissions to psychiatric hospitals for marijuana induced psychosis will go through the roof. Over the last few years we’ve put millions of dollars into the prevention and treatment of mental illness. Speak to any health professional that works in this field and they’ll tell you the impact that marijuana has on psychosis. Increasing access will undoubtedly result in a surge in mental health admissions. 

"Through the roof" and "undoubtedly result in a surge" are big claims – and they're not supported by evidence. If they were, you couldn't imagine the directors of our two most important public health research projects, the Dunedin and Christchurch longitudinal studies, being supportive of  careful legalisation. Or for frontline mental health staff consulted for the 2018 Report of the Government Inquiry into Mental Health and Addiction to repeatedly emphasise the way crimianlisation makes ther work more difficult.

The rate of Cannabis Use Disorder, which is assessed with a DSM checklist asking about tolerance, dependence and various social impairments, is a good thing to look at here, because it can lead to more serious mental health problems.

One study last year showed small but significant increases in CUD in legal US states among past-year users in 2008-2016 – effectively covering the first two years of legal availability in Colorado and Washington state – but the researchers speculated that the teen rate was influenced by unmeasured confounders.

Another, published at the same time but using the same dataset over a longer period and a slightly different case definition (frequent users, rather than past year users), found a substantial fall in CUD incidence among young people and the authors speculated that "as the cannabis market becomes increasingly regulated, better information about cannabis use risks may be available." In other words, bringing cannabis out into the light may be facilitating better choices.

A new study, published last week and using 2008-2017 data, found the same nationwide decline in adolescent CUD - and that "compared to other states, the rate of admission declined more rapidly among adolescents in Colorado and Washington following the legalization of cannabis."

We may not yet be at the stage of conclusive evidence, but claiming as a fact that legalisation would send psychiatric admissions "through the roof" seems pretty reckless for a doctor.

Dr Hotu continues:

Last year I was in Montreal at a medicinal cannabis summit and spoke to one of the clinical directors of Spectrum Therapeutics, the medical arm of Canada’s largest medicinal cannabis company. Prior to 2019, they increased production of their oral oils and capsules in preparation for the recreational market. When cannabis was finally legalised they ended up having to dump all those products because no one wanted them. Why? Because all people wanted to do was smoke. 

Such is the transition from a permissive medical regime to one in which people have access to regulated retail. Spectrum is a medicinal brand launched last year by Canopy Growth – which is increasingly viewed as the Big Cannabis example regulators should do anything possible to avoid.

Although Canopy began in Canada's medicinal regime, its primary shareholder now is Constellation Brands, a booze company. What actually happened last year is that Canopy completely misread the market for cannabis oils, medicinal or otherwise. Now, despite a staggering $4 billion investment from Constellation, Canopy is floundering because the booze barons wanted to focus on cannabis beverages – and it's really only its medical divisions that are making any money.

 So Dr Hotu's pretty off-beam there.

He continues:

Home-grown cannabis is not medicinal grade, the THC and CBD levels are unknown making effects on users unpredictable. A patient of mine experienced unexpected and unwanted side-effects from cannabis oil obtained from a green fairy. They were informed the cannabis oil had a high-CBD, low-THC ratio but described effects suggesting it contained much higher amounts of THC.

Even if suppliers provide a cannabis plant’s likely pharmacological characteristics, how the seed is grown and refined into a consumable form can affect the final product. Whereas medical-grade cannabis products receive Medsafe approval following proper testing and certification showing analysis of the CBD and THC levels.

He's right to say (the occasional back-door test at ESR notwithstanding) that green fairy products aren't tested and that many may not be true to label. But the good green fairies would really, really like access to testing. It's actually dangerous that they are denied that access. As the Cannabis Legalisation and Control Bill stands, it would not legalise their products, but it would open the way to creating a safer niche for them – and the people they supply – to occupy. That's what we would do if we wanted to reduce harm. Perhaps the green fairies will gradually fade away as prescribable products appear in the system, but for now, there's a straightforward way to reduce the potential for harm for thousands of people.

Also, the referendum bill would require the THC and CBD content of dried cannabis flower to be listed at retail, and set quality standards. The medicinal regs go further by requiring GMP production standards – the same as other pharmaceutical drugs – which is expensive to do. But it's misleading to imply there would be a lack of information about the products themselves.

Then there's this:

Essentially we’re letting five million non-medically trained New Zealanders decide whether a controlled drug should be sold at the corner store.

Whoa there, doc. No one's going to be selling anything at "the corner store" and it's ridiculous to say so. Licensed cannabis retailers wouldn't even be able to have a storefront, let alone advertise.

It may not have been his intention, but this column does read as if Dr Hotu is rather clumsily trying to defend his market. It's not going to help with the frustrating problem of doctor distrust in the cannabis community and it ignores the public health problems related to criminalisation. Apart from anything else, Dr Hotu would benefit from a little humility. He could learn some things from the green fairies who have been dealing with cannabis patients for years, as much as they could learn from him.

Finally, he writes in conclusion:

Right now there’s a lot of smoke being blown about and as a GP and medicinal cannabis specialist I want to equip Kiwis with the facts.

Those facts need some work.

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More on the repurposed hepatitis C drugs and their potential as a Covid-19 treatment

Back in April, I wrote about trials in Iran of a fixed-dose combination of two existing anti-viral drugs used to treat hepatitis C – sofosbuvir and daclatasvir –  that could point to an effective treatment for Covid-19 symptoms.

At the time, data from those trials was not available outside the hospitals that conducted them and their identification was a matter of some detective work at a distance by the Australian doctor James Freeman.

Overnight, per the press release below in the names of doctors in Iran, Brazil and the UK, those results were formally presented to the International Covid-19 Conference.  It's important to note that the three trials were small – totalling only 176 patients – and open-label. They do not confirm that   "sof-dac" is an effective treatment. But, in the words of the doctors, patients given the combination showed "significantly faster rates of clinical recovery and improved survival for patients hospitalised with COVID-19 infection."

In particular, as a Financial Times story this morning notes, the death rate for patients given the drug combination was 5% versus 20% for those who were not. The FT also quotes Dr Anthony Fauci:

Anthony Fauci, the head of the US National Institute of Allergy and Infectious Diseases and a member of the coronavirus task force, told reporters the results were “really quite interesting and provocative and encouraging”.

“We desperately need antivirals that can be given early on in the course [of the disease] to prevent individuals from requiring hospitalisation,” he said. “I’d encourage that we do further studies to nail this down.”

That's happening. There are now five randomised trials involving 2000 patients in Iran, Brazil, Egypt and South Africa, which should by October give a better idea of the viability of the treatment. If the results are positive, it would be good news for the world. The two drugs are generically manufactured as Hep C treatments in several countries and, if shown to be effective, would represent a Covid treatment that could be provided cheaply ( $US7 per 14-day treatment) and at scale.

That remains to be seen. But how we got to this point is interesting. There is no pharmaceutical company money behind the new trials and the key one in Brazil, representing half the total patients, only got off the ground because Dr Freeman personally provided some funding. A further $500,000 from the NGO Unitaid let it go ahead.

By contrast, huge resources have gone into the global Solidarity clinical trial project overseen by the WHO, which last week announced that its trials of hydroxychloroquine and an HIV antiviral combination have been discontinued. Only Gilead's remdesivir antiviral remains in active trials under Solidarity.

That doesn't mean there are no other treamtent trials in progress – to take the most notable example, dexamethasone has emerged as an effective treatment in trials in the UK. But it does raise real questions about the allocation of the really major resources.

New Zealand Hep C activist Hazel Heal, a longtime collaborator with Dr Freeman, also brought in donations from her colleagues in the Edmund Hillary fellowship. She's strongly of the view that the international research effort into Covid treatments is broken – and focused too much on vaccine development and too little on treatment options.

"Treatments have been starved of research dollars and patients to try them on because all the eggs are in the vaccine basket, which is a long way off giving us a solution. There are 150 funded vaccine trials around the world at the moment – and for treatment, just Solidarity, which was for three drugs and is now only for one.

"Even if remdesivir is shown to be effective at ICU, the US has bought up all the global production for the next several months. So the world has given up its ICUs and its research dollars to research one drug that's not very good which will only be available to Americans."

Even after Brazilian researchers conducted in vitro research that showed that daclatasvir was active against the SARS-CoV-2 virus and published the results as a pre-print three weeks ago, efforts to have their work replicated in the US were stymied because all necessary resources were committed to vaccine development.

She says in the longer term, the sof-dac combination is probably "an answer, rather than the answer," comparing it to AZT in the early days of HIV treatments, but adds:

"Repurposing small-molecule drugs that come in tablets is the important work that shoud have been done methodically around the world– and it just hasn't been. It's a failure at the international organisational level."

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Hepatitis C Treatment shows promising efficacy against COVID-19 in first studies.

Definitive results expected in October

Results presented today at the International COVID-19 conference show significantly faster rates of clinical recovery and improved survival for patients hospitalised with COVID-19 infection given two Hepatitis C drugs - sofosbuvir plus daclatasvir.  These results are from three relatively small, open-label clinical trials in a total of 176 patients.  These trials were conducted in three cities in Iran (Abadan, Tehran and Sari), during their first wave of the COVID-19 epidemic.

After 14 days of treatment, 94% of patients taking sofosbuvir/daclatasvir showed clinical recovery versus 70% on control treatment.  The death rate for people taking sofosbuvir plus daclatasvir was 5%, versus 20% for people taking control treatment.  One of these trials was not properly randomised, but clinical recovery rates were still significantly higher for sofosbuvir/daclatasvir in the two randomised trials (96% versus 80%).  Small, open-label trials could be prone to biases, so these results need to be seen as preliminary, unless confirmed with larger double-blinded placebo controlled trials.  

“Laboratory studies have shown that daclatasvir has antiviral activity against SARS-CoV-2.  Daclatasvir also penetrates well into the lungs, where COVID-19 infection can be concentrated.  In laboratory studies, sofosbuvir has only marginal antiviral activity against SARS-CoV-2.  Sofosbuvir plus daclatasvir already has a well-established safety profile in the treatment of Hepatitis C.  Worldwide, millions of people have been cured of Hepatitis C using this treatment.”  Dr Thiago Souza, Laboratório de Imunofarmacologia, Rio de Janeiro, Brazil.

“This treatment is being developed with no support from the large pharmaceutical companies.  All our funding is from governments, Universities, or donor agencies such as Unitaid. If this treatment proves to be effective, it could be made available worldwide as a cheap generic treatment costing approximately $7 per 14-day treatment course.  Sofosbuvir plus daclatasvir is already available at these prices in India, Pakistan, Iran and Egypt.  There is already enough generic sofosbuvir and daclatasvir mass produced to treat millions of people if this drug proves effectiveness in large trials.  We want this treatment to be affordable for anyone with COVID-19 infection, in any country.”  Dr Andrew Hill, Liverpool University, UK. 

“In spite of the encouraging initial results, we believe it is too early to reach a verdict.  Larger, well-designed studies are required to confirm our results.  A network of 5 randomised clinical trials has been set up, to test sofosbuvir plus daclatasvir in over 2000 patients with COVID-19, in Iran, Brazil, Egypt and South Africa.  The largest of these trials is double-blinded and placebo controlled.  By October, we should know from the trial results if this treatment could be approved for worldwide use.  Conducting research amidst a pandemic with overwhelmed hospitals is a challenge and we cannot be sure of success.  Sometimes treatments look promising in early trials but then fail later on.  

In the future, we will also be evaluating daclatasvir at higher doses and as part of dual or triple combination treatments.”  Professor Shahin Merat, Tehran University of Medical Sciences, Iran. 

Dr Andrew Hill, Senior Visiting Research Fellow, Liverpool University

Dr Thiago Souza: Laboratório de Imunofarmacologia, Instituto Oswaldo Cruz (IOC), Fundação Oswaldo 10 Cruz (Fiocruz), Rio de Janeiro

Professor Shahin Merat: Digestive Disease Research Institute, Tehran University of medical sciences