A Case For Cannabis

cutting medicinal marijuna

Despite now being legal, medicinal cannabis users say there is still a stigma attached to using it, despite it helping with chronic pain. Judene Edgar speaks with Nelsonians who say it’s been a life-changer for them.  This article was published in the Nelson Magazine (January 2023).

Growing up in a staunch catholic family in a small town just outside of Nelson, Anna (44) was “completely and utterly brainwashed into thinking that drugs are bad”. But seven years ago she started taking drugs – a lot of drugs – docetaxel, paclitaxel, tamoxifen, exemestane, zoladex, ibrance and more – and with them came the side effects, everything from bloody stools to burning hands, blisters, hot flushes, nausea, aching joints, osteoporosis, trouble sleeping, hair loss, mouth sores, diarrhoea and fatigue. Seven years ago Anna was first diagnosed with breast cancer, and despite all of the drugs, the surgeries, and the side effects, other than the briefest of remission windows, she now has stage 4 cancer – breast cancer that has metastasised to her pelvis and bones – terminal cancer. “The drugs are all pretty horrible and can do so much damage to your system,” she laments. “All of the opioids and barbituates I used could have been replaced by something natural.”

Following chemotherapy, Anna developed an autoimmune disorder and was unable to use any opioids to relieve pain, so her rheumatologist suggested CBD oil. “I had to wrap my head around it,” she says. “Despite having no THC in it, I had to give myself permission to use it, because I’d grown up believing that drugs are bad.”

Tetrahydrocannabinol (THC) is the principal psychoactive constituent of cannabis. THC binds with endocannabinoid receptors – mostly in the brain – that control pain, mood, and other feelings. That’s why THC can make you feel euphoric and give you a “high”. Cannabidiol (CBD) is the other most common cannabinoid in cannabis, however it doesn’t cause a high. Instead, CBD works on two main cannabinoid receptors – CB1 and CB2 – which help regulate a range of body functions including the gastrointestinal, musculoskeletal, immune, reproductive and central nervous systems. And not only is CBD not addictive, but it is actually used in some cases to treat addiction.

So when you hear people with a wide variety of health issues extoling the virtues of CBD, this isn’t exaggeration for effect or because they consider it to be a miracle drug, rather, it has the potential to help a wide range of conditions – but like all drugs, it depends on the person. Most commonly, CBD is used to treat seizures, anxiety, pain, depression and sleep disorders, but the World Health Organisation suggests that it could also be used to treat arthritis, Alzheimer’s disease, cardiovascular disease, and diabetes.

For Anna, after two years of not being able to sleep properly, she tried CBD to help her sleep. “For a couple of years it was the only way I could sleep, but it was a secret because it was illegal.” When she first tried CBD, Anna had to use the black market to access medicinal cannabis because it wasn’t legal. “I’m a middle-aged suburban mum, I couldn’t believe that it had come to this, yet you can go to the supermarket to get alcohol.”

The Medicinal Cannabis Scheme came into effect on 1 April 2020 with the commencement of the Misuse of Drugs (Medicinal Cannabis) Regulations 2019. The 1 April introduction came and went with little to no fanfare as New Zealand had gone into its first Covid lockdown just one week earlier. But how so many of us missed the introduction of the 2019 regulations is anyone’s guess.

But despite now being legal, according to the NZ Drug Foundation, Anna joins an estimated 249,999 other Kiwis still using the black market to access medicinal cannabis due to cost prohibitions. “It’s so stupid that it makes you a criminal. All the research is there,” she says. However, medicinal cannabis is classified as an ‘unapproved medicine’. Section 29 of The Medicines Act 1981 allows the sale or supply of unapproved medicines to registered medical practitioners only, with the requirement that the supplier notify information about the supply to the director-general of health (via Medsafe).

“Very strict rules apply to the information made available to the public and the medical profession. Unlike a regular pharmaceutical company who promotes approved medicines, we are not allowed to send in representatives to proactively talk about specific products and educate healthcare professionals,” says Julie Curphey, chief commercial officer of Helius Technologies.

Helius was founded in 2018 with the key aim of manufacturing high quality cannabis-based medicines, and was the first company in New Zealand to attain Good Manufacturing Practise certification. In October 2021 they then became the first New Zealand company to produce medicinal cannabis in line with the rules set out in the Medicinal Cannabis Scheme regulated by the Medicinal Cannabis Agency, a part of the Ministry of Health.

But despite all the regulation and red tape, which also means a lot of growers have to send their product overseas for manufacturing, Julie says that a lack of education, mis-information in the public arena and price are the biggest barriers. “It is not a subsidised medicine and there is a wide range of prices between products and between pharmacies.”

Catherine (not her real name) was prescribed medicinal cannabis as she was reluctant to use lorazepam for anxiety and insomnia. “Lorazepam is so much cheaper than weed, but way more addictive and has some really bad side effects,” she says. The side effects include auditory and visual hallucinations, suicidal ideation, thoughts of harming others, and “the risk of serious or life-threatening breathing problems, sedation, or coma if used along with certain medications”. It also warns that it “may be habit forming … and cause a physical dependence”.

After an extensive online consultation with Green Doctors in Auckland, a few days later her prescription arrived in Nelson via courier. Despite having a prescription, Catherine, a single parent in her 30s who works for the public sector, is highly aware of the stigma and misinformation associated with it. “It feels very white collar crime, yet it’s not a crime,” she says. “But I feel judged so I’m too scared to say I use it.” She also says that she “hates the inequity” and recognises the privilege she has being able to afford to pay for a prescription when it’s generally more expensive than buying it off the streets. “But it’s also about what it’s cut with or what’s in it. It seems really unfair that due to cost, being able to buy a safe product is out of reach of so many people.”

As a Nelson pharmacy technician, Alannah Sutherland sees a lot of that inequity every day with prescriptions ranging from $80 to as much as $400. For Alannah, “it’s medicine like anything else [and] like all meds it’s very individual and personal as to what works and what doesn’t.” She also recognises the irony of concerns about “taking drugs”, yet people are taking opioids and other medications that are less natural. “It’s more about what you’re told is okay, and what isn’t. The risks of abuse, side effects, addiction, are there on so many common medications that people are prescribed, so it’s really important to reduce stigma and get the facts out there,” she says.

She is pleased that some of the costs have come down and that doctors are becoming better informed about the benefits and prescribing regime; however, with a 3-month supply of anti-depressants costing $5 and CBD oil prescribed for the same condition approximately $100 per month, she says that there’s still a long way to go. “It’s been proven worldwide to be helpful for a range of issues, but like all meds it works for some and not for others.”

Dr Tom Mulholland, an emergency department doctor and GP for over 30 years, founder of Doctor Global (the world’s first online medical practice), and Clinical Advisor of The Pain Clinic which sees online patients and recently opened a clinic on Bridge Street in Nelson, is also keen to help reduce stigma and increase awareness. Tom says that he was “initially sceptical” about the benefits of medicinal cannabis, but has been “blown away by the effects of it”. A survey of 70 patients that he conducted last year found that 100% of patients reported reduced pain; 100% had enhanced quality of life; 85% had increased mobility; and 84% had improved sleep.

While Tom is a strong proponent of CBD, he still has a healthy “clinical caution” about THC and says that he prescribes it in certain conditions where people find it useful and it’s safe. “I don’t prescribe it if people are driving or in a safety critical role at work. We are involved in a major clinical trial on pain, sleep and quality of life because people are telling us it works and we want to prove it.” While Tom has undertaken training to get up-to-speed on the uses, clinical benefits and research relating to medicinal cannabis, he understands the position that other doctors find themselves in. “With a busy, over-worked workforce, it’s hard to keep up-to-date with everything.” But he says that “while it’s new here in a medicinal sense, people have been using it for thousands of years. It’s a legitimate medicine that’s pretty safe; people shouldn’t judge it.”

Ironically, Tom couldn’t get his own doctor to prescribe medicinal cannabis for him when he had an accident, so understands the predicament many people find themselves in. “I’d like to see it become a lot more accessible and affordable. It has a lot less side effects than other medications and has been used overseas for a long time.” By speaking at conferences and undertaking clinical trials, he’s hoping to add to the factual information and reduce the disinformation out there.

Johny O’Donnell (28) is also joining the small number of people prepared to speak out about the benefits of medicinal cannabis. “People who have the privilege of accessing these products need to do their part in reducing the stigma,” he says, “and ultimately advocating for improved access.” Johny suffers from Crohn’s disease, a type of inflammatory bowel disease that has resulted in three major stints in Nelson hospital, two surgeries, numerous bouts of excruciating pain, and copious quantities of opioids.

Three years ago he was introduced to medicinal cannabis through the green fairy (black market) network. He took CBD oil for a while, but says that he never really got any benefit. However, THC has been a life-changer for him. Every time he got sick he would end up bedridden for days, which impacted on family life and work, and until THC, he says that he’d never found an effective intervention. “The THC drops immediately create a different psychological response,” he says. “With opioids I’d end up like a zombie with brain fog, but with THC it completely changes my ability to respond. And if I use it early enough, I can avoid blockages altogether as it relaxes my muscles.”

He’s delighted that he can now use THC legally but acknowledges that he had kept his prior use as a secret, even from his closest friends. “THC grown on the black market is designed to get you high, but you don’t get that high from medicinal THC. What I take is a mix of THC and CBD which balances out the psychoactive component.” While he admits he’s only a few weeks in, he says that he’s needed no other pain killers in that time and that his pain has been a lot better. “I didn’t like the long-term effects of opioids. We’re so far behind the rest of the world when it comes to medicinal cannabis. There’s been so much harm done because of the approach that we’ve had. It’s against all the evidence.”

But he also laments that the cost prohibition and stigma is forcing people into purchasing black market products that don’t have the quality assurance of clinically produced products and the criminal risk that accompanies it, as well as the cost this has on society as a whole.

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