Pubdate: Sat, 24 Mar 2001
Source: Listener, The (New Zealand)
Copyright: 2001 The Listener
Website: http://www.listener.co.nz/FrontPage.asp
Contact:  The Editor, Listener, PO Box 90119, Auckland Mail Centre
Forum: 
http://www.listener.co.nz/NewsGroup/FrameMain.asp?GroupID=1&PM=DisplayTopicList
Author: Matt Philp

THE STASH THAT HEALS

A Select Committee Will Investigate Marijuana Decriminalisation, But The 
Herb's Therapeutic Potential Isn't On The Agenda

Life comes in pills. Greg Soar swallows 98 each week, a powdery, 
foul-tasting cocktail that represents his best hope of slowing the virus 
that is replicating inside him and staving off the onset of full-blown 
Aids, perhaps for several more years. Unfortunately for Soar, the pills 
produce extremely unpleasant side-effects. Worse still, the one substance 
that offers some relief - easily administered, effective relief - could put 
him behind bars.

Those pills. "They make me sick with severe nausea; I can't sleep, I get 
uptight, anxious; I can't eat and so I get diarrhoea from taking the pills 
on an empty stomach." He was offered heavy tranquilisers - more pills - he 
was given anti-nausea medication. Been there, got addicted. Not so with 
cannabis. "Two puffs on a joint or a couple of tokes on a vapouriser and 
it's instant nausea relief. It's gone."

Soar's GP is happy to oversee his use of the herb. "We've nothing better to 
offer him," concedes Dr Arvind Ranvhhod. "It's a shame that Greg has to 
break the law to help himself and it's a shame that he has to pay an 
artificially inflated price for it. Because of his limited means he's not 
guaranteed a regular supply of the medication."

Soar's friends help out; he buys as often as he can afford to. If worse 
comes to worse, he could always risk prosecution and grow his own. But 
there is a better option. Under the Misuse of Drugs Act, Soar can apply to 
the Minister of Health, Annette King, for an exemption. Twice he has 
written, backed up by a second GP and a specialist in infectious diseases, 
asking the government to supply him with what he considers to his "best 
medicine", or failing that for permission to grow six female marijuana 
plants, or at least for the threat of arrest and imprisonment to be lifted. 
Two replies from King, same response: in the absence of clinical evidence 
that cannabis is safe and effective, she will not be granting any dispensation.

King says she has received four applications to use marijuana 
therapeutically, all declined. One of those is from tetraplegic Danuiel 
Clark, jailed for 21 days in 1999 for cannabis cultivation, and this month 
facing a charge of possession for personal use. Soar, who is likely to 
protest with a group of supporters at Clark's trial, asks the obvious: 
what's the point of a power to exempt if it's never exercised? "The fact 
that we're not allowed to use cannabis when everyone is using it for social 
reasons is completely obscene to me. Prohibition is causing more harms than 
people realise."

An empty gesture? King defines her powers narrowly: she is able to approve 
a doctor to prescribe a drug from the category to which cannabis belongs. 
She argues that none of the applications she has received, including 
Soar's, has met the necessary "clinical criteria" - although she is unable 
to define those particular hurdles. Her strongest objection is apparently 
reserved for the likely form of delivery. "People have asked me to [let 
them] smoke cannabis. One of the problems with smoking is that you don't 
know what your dosage is. It's also bad for your health."

The line leaves NORML's Chris Fowlie aghast. "For someone to say we can't 
have a medicine that involves smoking, and that that outweighs your quality 
of life is pretty narrow-minded." Fowlie argues that in the absence of a 
non-smoking device that would deliver cannabinoids to the lungs - far more 
efficient at metabolising THC than the stomach - smoking is actually the 
best way of regulating a dose, better, for example, than Marinol, a pill 
form of THC available overseas.

King's attention is on the bigger policy picture, and particularly a couple 
of overseas clinical trials into the possible therapeutic uses of cannabis 
derivatives - "that's of more interest to me than some exemptions." 
Possible scenarios? "If you're talking about marijuana being used for 
medicinal purposes, then you're talking about it being put in the same 
regime as morphine, or whatever: registered, prescribed and managed by 
people trained in these matters. It would be done in the same way that we'd 
register any medicine in New Zealand."

In other words, we're talking tinctures, capsules, pills - the 
pharmaceutical route. In essence, then, Soar and others are left waiting on 
those overseas clinical trials and on a kindling of interest among drug 
companies, traditionally wary of cannabis's illegal status and the fact 
that the raw product itself can't be patented. Most likely, they are 
waiting on researchers to find a means to separate the buzz from the source 
of the therapeutic effect - to remove the stoner's high from the argument.

Green Party MP Nandor Tanczos believes King is "hiding behind" the 
wait-and-see argument. "We don't need to synthesise a pill and buy it off 
some pharmaceutical company for millions of dollars and then have a doctor 
prescribe it. We just really need some recognition that these people 
shouldn't be arrested for growing their own medicine and using it."

King seems unlikely to allow a doctor to prescribe cannabis unless as part 
of a "properly conducted" trial. Okay, says Ranvhhod: "Greg would be more 
than happy to be a guinea pig if that's what they need!" But joking aside, 
his own expert opinion should be all the "clinical evidence" required. Of 
course, his patient is aware of the potential risks of smoking. "But he's 
looking at the quality of his life now, not some long-term future. It 
really shouldn't be such a hurdle if we think that it's his best treatment."

NORML would go a step further. "Self-medication has to be an interim step," 
says Fowlie. "Not everyone can grow their own, and those who do are at risk 
of being robbed for their medicine." The future of medicinal marijuana 
isn't in extraction or synthesis, but growing specific strains of the raw 
plant for specific ailments, he believes. "What we'd be after would be a 
proper supply of cannabis in the prescription system."

The mystery of physics: Ranvhhod hasn't a clue why cannabis seems to be the 
best answer to Soar's symptoms. "Greg and I are interested in the effect, 
rather than how or why it works," he says. But medical science is learning 
more about the therapeutic potential of THC and the various other 
cannabinoids (there are more than 60) found in the plant. Both the US 
National Institute of Health and the British Medical Association have 
reported that cannabinoids may be useful as analgesics, anti-emetics, 
anti-spasmodics and appetite stimulants.

Even deeper in the heart of the Establishment, a select committee of the 
House of Lords has itemised the conditions for which marijuana may hold 
therapeutic potential, namely: HIV-related and cancer-related wasting; pain 
unrelieved by conventional treatments; symptoms of neurological disorders 
such as MS; nausea and vomiting in cancer patients undergoing chemo. Of 
interest to Soar, a University of California study has found that patients 
on HIV medication who smoke cannabis do not have their immune systems 
suppressed and experience significant gains in calorie intake and weight.

There is some political movement, too. In the US, several states have 
allowed the medicinal use of marijuana (butting heads with federal 
authorities; at press-time the Supreme Court was to rule on the conflict). 
The Spanish Catalan parliament is to consider it; and in Canada, where the 
prosecution of medicinal users threatens to invalidate federal drugs laws, 
the Minister of Health has authorised a number of applicants to use the plant.

The Australian example is arguably most relevant. New South Wales 
authorities are considering how to implement a recommendation from the 
National Drug and Alcohol Research Centre (NDARC) that seriously ill 
patients be given exemption to smoke. NDARC's report recognises that the 
development of synthetic cannabinoids or approved alternative methods of 
delivery is at best several years away. In the meantime, it proposes, 
anyone who can provide medical certification that they suffer from certain 
conditions (those same illnesses recognised by the House of Lords 
committee) should be allowed to grow as many as five small plants.

"Cannabis is not a first line treatment," says Professor Wayne Hall, 
executive director of NDARC. "For most of these conditions there are other 
forms of treatment that are likely to be much more effective. But for some 
individuals who don't respond to conventional treatment it could be life 
saving."

He cites chemo patients whose side-effects can get so bad that they quit 
their treatment regimes. As things stand, many of these patients will be in 
their 60s and 70s and unable or unwilling to access cannabis through the 
black market. "I don't think any sensible, humanitarian-minded person would 
want to prevent people with those conditions having access to it."

Participants in the scheme will be monitored at six monthly intervals. The 
downsides? The potential harms of smoking is the only major one that he can 
see. "People talk about diversion, but that's not something that one would 
take seriously given how readily available the drug is now. I also think 
it's pretty unlikely that it'll do much to affect attitudes towards the 
recreational use of cannabis - it needn't if the government is very clear 
and explains what it is doing." "And", he adds, "given that people are 
likely to be doing it anyway, isn't it better that they should be doing 
this under medical supervision with the opportunity to pick up on any 
adverse effects?"

Yet, this side of the ditch, the Ministry continues to say no. Is this 
about sending a message?  Not at all, answers King. A Health select 
committee is to report later this year on decriminalisation, but the herb's 
therapeutic potential will not be on the agenda. "Personally, I don't want 
to see it mixed up in that wider debate about marijuana. I would have 
thought people who seriously consider it a good medicine wouldn't want it 
mixed up in there, either."

Fowlie doesn't see how the two can be divorced. "Admitting that cannabis 
has therapeutic effects [undermines] the whole justification for 
prohibition. They believe it will open the door and that's a valid fear, 
because it will. This is a prime example of prohibition causing a huge 
amount of unnecessary harm."

NORML is spoiling for a fight. To date, courts in New Zealand haven't 
accepted the defence of possession for medicinal purposes. But British 
juries have acquitted, and Canadian courts have ruled that prohibition, 
overly broad in its application, goes against the individual's right to the 
best possible medicine. Fowlie, who argues that New Zealand drugs law was 
only ever aimed at stamping out recreational abuse not medicinal use, 
believes that such a legal attack might be mounted here. "Human rights 
legislation guarantees access to the best possible treatment," he says.

Alternatively, the next time Soar is knocked back, someone with a flush 
wallet might want to fund a writ for judicial review. The next visiting 
cannabis-friendly billionaire, perhaps?
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