Hard News by Russell Brown

61

A dramatic and unremarkable decision

The remarkable thing about minister Peter Dunne's welcome decision to approve the import of Elixinol, a cannabis-based oil, to treat the refractory status epilepticus being suffered by 19 year-old Alex Renton, is how unremarkable it should have been.

Status epilepticus, a state of epileptic seizures so frequent there is no opportunity for the patient to recover between them, is not only a terrible condition, it is deadly. Alex's doctors have tried more than 40 treatments to halt the condition, many of them more onerous and risky than cannabis itself.

Except Elixinol isn't cannabis. It's an oil manufactured from industrial hemp, in which the concentration of THC, the main cannabinoid that produces a high, is negligible. The primary ingredient (at around 18-19%) is CBD, a cannabinoid that mitigates some of the effects of THC and has developing applications in treating a variety of conditions, including anxiety disorders – and some forms of epilepsy.

The Science Media Centre has helpfully sought expert commentary on the issue. Including this, from Associate Prof Michelle Glass, head of the Department of Pharmacology at the University of Auckland:

The compound that has been approved for Alex Renton is not Epidiolex which is a pure 98% CBD oil – but Elixinol, this is reported on the manufacturers web site to be 18% CBD hemp oil, which to the best of my knowledge has never been tested in clinical trials - however, there are some anecdotal reports of similar products proving useful in seizure disorders.  There is even a suggestion from animal studies that less pure products with a range of plant based cannabinoids in them might be preferable to a highly pure product.

My lay understanding is along similar lines: that medical applications may not all be found in isolating CBD or any other single compound in cannabis plants, but in combinations of cannabinoids – and even of aromatic terpenes, which also appear to have a modifying influence on the high that smokers enjoy from any particular strain of marijuana.

But, as both the SMC's experts say, it's very early days and trials in the area area still in progress. Yes, trials of a plant that has been used for medical and recreational purposes for thousands of years have only relatively recently got underway. Because Prohibition. (Prohibition is also the reason that, if you're older, today's pot seems a bit full-on and makes your heart race – in the past 20 years, the natural ratio of THC and CBD has been bred out in pursuit of maximum bang for buck.)

The answer isn't necessarily breeding out THC in favour of CBD, as the Israelis have already done. A paper published last year found  "dramatic reductions" in the size of glioma brain tumours when an equal (and low-dose) mix of THC and CBD was used in conjunction with radiotherapy – greater than for radiotherapy alone, and for radiotherapy with either THC or CBD alone. There have been promising results in treating leukaemia with a mix of half a dozen cannabinoids.

Except in its use for analgesia – if it helps your subjective pain, it helps your subjective pain – I've been a sceptic on medical marijuana. But in the past couple of years, the whole area has been, if you'll excuse the pun, lighting up. And New Zealand should be there. We are world leaders in plant breeding, and the space for selective breeding of cannabis is wide open.

It's also material that the cost of Sativex, a spray containing a 50-50 ratio of THC and CBD, the sole cannabis-based product approved for use in New Zealand, is obscene. It is approved for the treatment of multiple sclerosis symptoms, but its use is severely limited by the $20,000 annual cost of buying it without subsidy. Very few people on a supported living payment can afford that. It is literally a rort on the part of the companies that manufacture and distribute it. It seems that Novartis, the licensed distributor for this part of the world, would rather tout its own multiple sclerosis drug. It's a ghastly and wholly unjustifiable situation.

None of this has anything to do with recreational cannabis, except as it relates to cynical, risk-averse politicians. Politicians like Prime Minister John Key, who this week said medical marijuana was a topic we should not be debating.

That was the atmosphere in which Peter Dunne, as Associate Minister of Health, made his "one-off" decision to grant permission for the import of the Elixinol. He deserves real credit for doing so.

It's important to recognise that this drug may not be a cure for poor young Alex Renton. Indeed, the chances are, it won't. The point is that it should not have been such a political challenge to approve a drug which is much better tolerated than some of the treatments he's already undergone.

Let's grow up about this. And when we've grown up, perhaps we can talk like grown-ups about recreational cannabis use.

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