Hard News by Russell Brown

5

A big week for medical cannabis

I noted on Friday that the week marked by the presentation of Rose Renton's medical cannabis petition to Parliament and the passing of Helen Kelly, the woman who changed the debate, would be capped with an small, significant announcement about a medical cannabis product. That happened.

Q+A's Ryan Boswell got the exclusive. Or, rather, was supposed to: the Herald on Sunday ran the story early. You can can see it in the third part of today's show.

What has happened is that a cannabis tincture from the Canadian company Tilray (not a pill, as stated on Q+A) has been approved under section 3 of the Ministry of Health guidelines for approving cannabis-based products. That is, as a non-pharmaceutical grade product. That's the category under which the Bloom Farms product for which Helen Kelly's doctor sought approval but was denied. [Note: The minister's office takes issue with the word "declined". See the update at the end of this post.]

This is a different kind of product made by a different kind of company. Tilray operates under Canadian laws, rather than the loosey-goosey Calfornian medical marijuana system. It was able to meet the basic test of a product assay.

Indeed, the people at Medical Cannabis Awareness NZ, who helped with the application, applied under the second section of the guidelines, for "pharmaceutical grade cannabis-based products that do not have consent for distribution in New Zealand". I gather it came fairly close to meeting that standard. (You can read the join MCANZ-Tilray press release here.)

But the thing is, it's been approved. If the next application is in order, that should be approved too. Should.

There's another difference. The other two ministerial approvals for non-pharma grade products have been one for Alex Renton, Rose's son, who suffered with and eventually died of a condition of constant seizures, and one for a young man with Tourettes, for whom Aseco calm spray was approved. The young man in the second case would have qualified for Sativex, the only approved pharma grade product in New Zealand, but the Acesco product was relatively easy to approve, because it contained only neglible levels of THC and was therefore less psychoactive. (On the letter of the law, a CBD-only preparation might even have been able to be sold off the shelf, as it is in the UK – although that status will be ended by the UK regulator's recent acceptance of CDB as a viable medicine.)

The situation with the Tilray product is that it's functionally equivalent to Sativex, in that it contains equal quantities of THC and CBD – it's just way cheaper. Until such time as Pharmac funds a cannabis-based medicine, that means a hell of a lot to Huhana Hickey, the multiple sclerosis patient in whose name the application was made. I know Huhana and I'm very happy for her.

As she explains in the Q+A story, Huhana wasn't willing to freestyle it and just source some pot for her needs. Partly because she didn't want to break the law to have a medicine, but also because she wants to be assured of what she's taking, which is important when you have multiple health issues related to your primary illness. Retail cannabis doesn't have a warranted 50-50 ratio of THC and CBD, the two main cannabinoids – it has several (or many) times more of the former than the latter.

That might actually be an advantage if you wanted cannabis for, say, palliative care, but a high CBD content seems to be important for nerve pain. There's a pretty strong case for being able to say what a medicine contains, basically. That why you'll find many doctors who do not want to be put in the position of prescribing whole cannabis.

And yet, I've spoken to people who do experience symptom relief from raw cannabis – in one case, after trying every approved treatment for complex regional pain syndrome and becoming near-suicidal with it. They should be able to talk to their doctors about it – and they should not have to fear prosecution (neither should people who produce or prepare cannabis for them). The best thing that could happen for medical cannabis in this sense is for the law on cannabis itself to change. That would solve most of the problems.

But the present government has closed its ears to any talk of law reform – and, to be honest, the major party of Opposition isn't exactly champing at the bit either. So progress for now is likely to be a matter of finding paths within the law. In this context, both Rose Renton's petition and MCANZ's incremental win inside the system matter a lot.

Update: I received the follow message from Mr Dunne's media advisor, Rob Eaddy:

Kelly’s doctor was not “denied”, rather the opposite occurred - Mr Dunne asked the Ministry to actively follow up with him to obtain additional information on his somewhat loose application.

He subsequently decided to withdraw the application for Bloom Farms  and instead proposed to prescribe Sativex when the product was brought to his attention.  

Ms Kelly subsequently decided not to accept her oncologist’s recommendation for Sativex.

It is misleading and a little inflammatory to suggest, particularly given the recent death of Ms Kelly, that she was denied access by the Minister.

I'm not sure there is really a significant practical difference between "not granted pending further information to satisfy the guidelines for ministerial approval" and "declined under the guidelines", but yes, this was the sequence of events and the application was not formally declined. Perhaps we could say the application "failed". In my view, the Bloom Farms product was unlikely to ever be approved if the manufacturers did not supply sufficient information. But as I explained at the time, Dr Falkov's application also fell short of other guidelines (including that the patient be hospitalised when treatment was initiated) that were not reasonable or appropriate.

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