Hard News by Russell Brown


Who are the medicinal cannabis users?

At almost every level, the problem with medicinal cannabis is a lack of good information. In the US, FDA regulations make it hard to research. Most doctors aren't familiar with what research there is and most patients don't know either. And on a policy level, no one really knows much about who in New Zealand is already using cannabis for medicinally or exactly why or how. The same scant data points get recycled over and over.

Given that we're midway through the drafting of regulations to be attached to the Medicinal Cannabis Amendment Act, that's a problem. And it's a problem Medical Cannabis Awareness New Zealand set out to address at the beginning of May when it launched this country's first dedicated survey of medicinal cannabis use.

The anonymous survey, designed and presented in partnership with Dr Geoff Noller of the University of Otago, is intended to inform policy-makers and regulators, and has approval from the national Health and Disabilities Ethics Committee. It is open until July 31, but Dr Noller and MCANZ have kindly let me see some progress results. And they're very interesting.

The first notable result is that the population professing to use cannabis medicinally does not look much at all like what we know about adult users in general.

"Unlike typical illicit drug-using populations which are dominated by males, almost 54% of those answering the questionnaire to date are female, with participants’ average age being 36, and with almost half the sample earning more than the median wage," Dr Noller told me.

The proportion of Māori participants, 18% (only slightly higher than the proportion identifying Māori in the general population) further suggests that this is a different group to general cannabis users.

This is a self-selecting survey, so we should be cautious about those results. But it does look like it's a fairly well-informed group. Fully 98% of respeondents know what CBD (cannabidiol) is, and nearly 70% have sought out either balanced strains (that is, with a roughly equal ratio of CBD to THC) or high-CBD strains.

CBD is not itself psychoactive, but does appear to mitigate some of the effects of THC (and last year, the World Health Organisation reported that CBD poses no public health risk and has demonstrated benefits in treating epilepsy and possibly a range of other conditions, from Alzheimer's to Parkinson's disease and some cancers). In standard black-market weed, the ratio of CBD to THC is tiny verging on insignificant, bred out over decades of prohibition.

The interaction between THC and CBD may be complicated – and this fascinating 2018 Nature article by Israeli researchers both validates the idea that there is an "entourage effect" involving the many dozens of different cannabnoids in whole flower, while making it look even more complicated – but the short version here is that these not just people looking to get high.

So what are they doing with their cannabis? Only 2.5% of participants so far have been issued with a certificate confirming they are in palliative care, and thus immune to prosecution for the possession or use of cannabis. From there, a wide range of conditions are cited, from chronic back pain (which nearly 40% of participants had sought to treat with cannabis), to inflammatory bowel disease, persistent nausea and forms of arthritis. But by far the most common condition, perhaps surprisingly, is depression and anxiety, which nearly two thirds of participants had sought to address with cannabis.

Notably, many said they had reduced or eliminated the use of prescribed medications in favour of cannabis. This isn't necessarily a good thing – people don't always do what's good for them – but the most common class of drugs that had been reduced or eliminated was pain medications. If people are coping with pain to the extent that they don't need conventional pain relief, especially opioids, that might be a very good thing.

The survey participants are very largely not dispensing with medical advice. Eighty seven per cent have a regular doctor and nearly half see a medical specialist at least twice a year. Around half don't tell their doctors about their cannabis use, but 26% reported that their medical professionals were either "supportive" or "very supportive" of what they were doing. Only 5% reported seeing medical professionals who were "completely against" medicinal cannabis use. GPs were the most supportive, but only 9% of respondents reported being helped to get a medicinal cannabis prescription. (Which perhaps isn't surprising, given how scarce and expensive approved cannabis products currently are, and the process involved in being prescribed one of the two products containing THC.)

The survey also suggests people aren't necessarily using cannabis by the healthiest means. Two thirds said their usual means of administration was smoking, about a quarter each either through a bong or rolled joints and another 15% through a dry pipe. Only 10% usually used a vapouriser, although around half had tried one. But decent vapourisers cost $300 and upwards, and 90% said they would use one if "given a high-quality vapouriser for medicinal use through your GP or pharmacy". 

But that can't happen while vapourisers are illegal. (Yes, you can buy them in shops, but officially only for use with other herbs.) Happily, it appears the survey's authors have already had a win there. Dr Noller and MCANZ coordinator Shane Le Brun recently met with Ministry of Health officials to discuss progress results and were told that the ministry has already drafted a gazette notice allowing the use of vapourisers with cannabis, and it only needs ministerial sign-off.

They've had further good news in the form of discussions with the authors of the equivalent survey in Australia about working together to combine and compare results.

The MCANZ survey has, proportionally, achieved a very good response rate  compared to the Australians. They're looking for 2000 valid responses and I gather they've already exceeded the 2000 mark in raw terms, but probably need another 500 once invalid and incomplete responses are stripped out.

If any of the above is relevant to you, now is the time to complete this survey. There is no risk in doing so and the results will matter.

>>>>>The survey is here<<<<<


This possibly won't be the only cannabis post from me this week. The draft regulations under the new Act are to be released for comment any day now – the regulations governing production have been signalled to prospective producers and seem pretty sound, but this will be the first time anyone gets a good idea of the likely rules around prescribing.

Further, it appears that there will be a significant appointment announced soon by the Ministry of Justice, which is responsible for next year's cannabis referendum.

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