Do We Really Need “Pharma Grade” Medical Cannabis?
Part one of a series of opinion pieces by Shane Le Brun, Coordinator, Medical Cannabis Awareness New Zealand
There is strong public support for significant reform of Medical Cannabis (MC) regulation. The system currently in place, which focuses wholly on pharmaceutically trialed cannabis-based medicines, removes patient and prescriber choice, and costs are prohibitive. New Zealand may have the highest priced MC in the western world – a side-effect of our remote location and small market.
Most other western countries are looking to grow and make their own products to expand treatment options while reducing costs. Australia in particular, with its solid experience in poppy cultivation, is looking to create an export market and has at least a dozen companies exploring the pharmaceutical route, pouring 10s of millions of dollars into trials for a product that they will likely have trouble holding patents on.
We have already proved with one patient, Dr Huhana Hickey, that a comparatively simple standardised extract made in grapeseed oil, can do a better job than the registered pharmaceutical alternative. This is compared to the ‘pharmaceutical grade’ product Sativex, which is essentially “2 strains of hash oil in a spraycan”. The alternative is available from Canada for a much lower cost. Imagine the cost reduction if such products could be produced in New Zealand with our proven scientific capabilities. Our issue with cost can be resolved without granting patients the individual freedom to grow their own.
At MCANZ we have introduced a small handful of products from 2 companies in Canada. These products are not Pharmaceutical grade, but are close to it, yet they cost 30-60% less than Sativex to the patient. I refer to these products as “near pharmaceutical” the quality is good, the product is clean. We have never had a request to prescribe one of these products declined by the MOH and we need to differentiate them from the negative connotations of “non pharmaceutical” in the applications scheme.
These products are not dirty hash oils made in a Californian garage by a “Ganjapreneur”, but are developed under a regime regulated and monitored by the Canadian MOH equivalent, “Health Canada”. For these products, the MOH has said nothing but yes (the trick is convincing New Zealand doctors to apply). These products have been safely prescribed to thousands of Canadian patients already, so why shouldn’t we also use these products?
The cost savings per patient can be immense for customers. However, this also matters for public expenditure as currently, WINZ, ACC and DHBs are funding Sativex on rare occasions. I estimate there are tens of thousands of dollars to be saved per annum by ditching the pharmaceutical only mindset. Naturally, starting from such a low number, the projections will only increase going forward as the evidence of cannabis’ effectiveness for conditions such as chronic pain shores up. (It is trending towards conclusive in general terms.) This has massive ramifications for the potential financial vulnerability/liability for the likes of ACC if they are increasingly asked to pay up for Sativex or other Pharmaceutical grade products in the future. It also matters for patients if they refuse access due to this cost burden.
After our next product roll out, we will reach a point where the only way to get products cheaper will be to make them ourselves in New Zealand. Canada’s system of licensed manufacturers would be ideal for New Zealand. It delivers relatively standardised and safe, sterilised products 80% cheaper than Sativex (the only relevant product preapproved by MedSafe for use in New Zealand) for similar-strength products. Products can double in price when getting shipped internationally, if we allow “near pharmaceutical” products to be made in New Zealand without trials, then we could make these products available as unregistered medicines. Trials cost big money, a cost that is then forwarded on to the patients. With plenty of generalised evidence emerging, there is no need to reinvent the wheel and prove that a balanced cannabis product that is in essence similar to Sativex does the same job.
Instead, lets make the products locally, and make them available to GPs and specialists, and let the medical professionals use their own common sense about when to prescribe. Additionally, by forgoing the insistence on trials, we can race ahead of Australia in getting the potential industry to the export stage, with cost advantages to boot. We snoozed and loosed with Opium production in the 60s, and now Tasmania leads the world in that multibillion-dollar industry, lets not make the same mistakes with Cannabis just because a few conservative MPs can’t differentiate between a medicinal crop and the cash crop down at their local tinny house.
To have your say on Scoop's HiveMind conversation on Medical Cannabis go to the conversation page and vote on various statements on the issue in order to help co-create a policy for Aotearoa.
Part 2 of this series of opinion pieces will be published next week and will cover the finer points on the workability of policy allowing patients to grow cannabis at home.