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Why National’s ‘pharmaceutical cannabis’ approach is dangerous and misguided

Image: Marijuana Info IL

Why National’s ‘pharmaceutical cannabis’ approach is dangerous and misguided

With three different medical cannabis bills submitted to parliament in 2018 (National released their draft Bill yesterday), the punter could be forgiven for not knowing exactly what is going on here. The reality is, it is all pretty confusing. It certainly doesn’t help that our Parliamentary system is so adversarial that the parties can’t just work together rather than draft Bills at cross purposes in some sort of ‘mine is better than yours’ game. There are good and bad elements of all three of these bills. There are also very dangerous and unjust intentions behind National’s new Bill, as I will explain. Spoiler alert: it involves neoliberal capitalism and the ‘big pharma’ industry. What is clear is that the public and patients in need are fed up with the bickering and self-serving politics. What we want is a progressive, patient and human rights centred cannabis policy, and we want it yesterday.

So, after hearing from hundreds of patients and caregivers, as well as medical groups and patient advocates, the Health Select Committee reported back yesterday on possible changes to the Misuse of Drugs (Medicinal Cannabis) Amendment Bill. The full report is available on Scoop here. Unsurprisingly, the overwhelming majority of submitters were in favour of the Bill, however most expressed concern at its limited scope.

With impeccable timing, a Curia poll released this week by the New Zealand Drug Foundation found 89 per cent support for allowing medicinal cannabis for terminally ill patients, and 87 per cent support for chronic pain relief. However the Bill as tabled by Labour de-schedules CBD and only creates a compassionate exception for terminally ill patients to possess cannabis (not chronically ill patients). The Bill is very light on actual substance as to how patients will access said medicine, leaving this to a regulatory framework to be determined by the Ministry of Health (MOH).

In fact, the select committee framing was so narrow that these details were not even considered, leading one to question why the process took so many months. This vagueness has created an opening to National MP Shane Reti drafting his own law and submitting it under the ballot system. You know something is wrong when National comes up with what is possibly a more comprehensive cannabis law than this supposedly ‘progressive’ Labour Government.

However, National certainly did not do so for the good of patients as they claim. No, if you read the fine print, this Bill is actually a cynical attempt to railroad the medical cannabis regime into the big-pharma focused direction that National would prefer to see it head. It is also a cheap shot and attempts at political point scoring and cynical politics.

A spoonful of compassion helps the legislation go down

Just what exactly David Clark and this select Committee have been doing on Cannabis is unclear, but in substance it amounts to next to nothing right now.

The Select Committee report recommends in favour of a ‘compassionate exclusion’ from the MOD Act for terminally ill patients to possess cannabis. It also recommends removing CBD products from the Act, a good step but hardly radical – CBD has no psychoactive compounds and never should have been included in the Act.

However, despite overwhelming support from the public submitters, the committee refused to extend the ‘compassionate’ (spew!) provision to people in chronic pain or with chronic illness and chronic pain. Clearly their ‘compassion’ quota for the year ran dry. Can’t use it all at once.

Kicking the can-nabis down the road…again

This weak attempt at legislation by Labour will do next to nothing for true medical access to cannabis products in the immediate term. It is essentially kicking the can down the road again to the Ministry to come up with a regime around medical cannabis with zero public scrutiny. Why the details of this regime were not included in the original Bill or the select committee terms of reference that have wasted months to achieve very little is unfathomable. Anyone would think they didn’t want public input into the process. Instead the task has been passed on to MOH by the Bill proposing to:

“provide a regulation-making power to enable the setting of standards that products manufactured, imported, or supplied under licence must meet. The creation of a regulation-making power would facilitate the development of a Medicinal Cannabis Scheme. The scheme’s aim would be to provide a greater supply of quality medicinal cannabis products by enabling domestic cultivation and manufacture.”

On the Regulation of medicinal cannabis products the report states: “The setting of quality standards will be led by the Ministry of Health, and will be informed by approaches taken in other jurisdictions, expert technical advice, and stakeholders.”

Remember that this is the same Ministry of Health that Helen Clark has accused of burying the Woodbridge report it commissioned which made positive statements on the benefits of medical cannabis back in 2008. How can the public have trust that they are going to create standards that take interests of patients into account this time around? How long will we wait for this new regime? No clear timeframe has been given and consultation has not yet begun. Labour claims this is in order to give greater flexibility to the Ministry to adapt to a changing environment. As Health Minister David Clark said yesterday:

“It may well put restrictions around the regulatory body and compromise their ability to do their job in a fast moving, fast changing market — I wouldn’t want to compromise the regulator.”

However, to date the Ministry has not proven its ability to keep pace with a snail on this issue, and as a result is way behind most other Western countries on medical cannabis. We are still stuck with hugely expensive products after years of supposedly legal medical cannabis on the books. As Tadhg Stopford, Foundation Leader of the Hemp Foundation says:

“Here in NZ the Ministry of Health is also insisting that we run an ‘evidence based system’ for which it provides the evidence, which is a worry. Because they’ve been suppressing evidence and misleading government for at least ten years.”

This non transparent approach taken by labour to developing a regime is now leaving an opening for National to claim the moral high ground and play political games by claiming their Bill is superior. Spoiler alert, it is not. However, already the confusion is damaging public and political support for Labour’s approach.

Progress on non-pharmaceutical medical cannabis at last?

Although the Bill and the report have precious little detail on the regime to be introduced for medical cannabis, there are positive signs in the report that a more sensible approach to regulation of cannabis outside of the pharmaceutical system may finally be taken by MOH. In the ‘Labour Party View’ section of the report it states as follows:

“Allowing the Government to make regulations to set quality standards for medicinal cannabis products.

The majority of products likely to be available as part of a medicinal cannabis scheme will be unconsented. We want to ensure that products on the market are made to a standard that allows them to be prescribed and consumed with confidence….The overall standard for medicinal cannabis products is not expected to match that of pharmaceutical grade products, e.g. manufacturers will not be required to provide clinical trial data. Standards will however cover the manufacturing process and end product quality, and will apply to all products manufactured domestically and imported. The setting of quality standards will be led by the Ministry of Health, and will be informed by approaches taken in other jurisdictions, expert technical advice, and stakeholders.”

Now, this highlighted sentence part buried deep in the report is actually one of the most important points to come out of the report, as at long last it is recognition by the Government of the fact that the standards around medical cannabis do not need to meet a pharmaceutical standard. This is the crux of the difference between the National Party approach as unveiled yesterday, and exactly why National’s Bill is a dangerous and predictable response from a neoliberal party with the hands of the big-pharma industry in its pockets.

National Bill, Nice try but no thanks

Shane Le Brun of MCANZ believes the National Bill is a big step forward for them, and has a lot more detail than the labour Bill:

“The size and scope of the bill reflects a significant amount of time, hundreds of hours, and international expertise being pulled in to `Do it once, do it right`, as opposed to David Clark’s hands off, 0 detail approach which has suffocated on a lack of resources”

Le Brun also points out that MOH is already falling behind on their self imposed deadlines and no consultation is yet in play on the to be drafted regulations.

However, Le Brun also raises concerns over the National Bill’s treatment of the back end of cultivation and production, stating:

“it doesn’t address import or exports, onboarding local illicit cannabis into the legal supply chain, and the bill is vague about the single most deciding factor, of standards versus product costs.”

Le Brun also states that the most disappointing aspect of the National Bill is “the scrapping of any form of compassionate clause, for the tens of thousands of ill people who don’t deserve to be criminalized.”

Why I still supporting Labour’s Bill – even though it is inadequate

The Labour Bill, although vague on detail at this stage at least indicates that near pharmaceutical products such as those allowed in Canada will be part of the new MOH medical cannabis regime once it is drafted. This is very important as Le Brun states:

“MCANZ has a strong preference for Canada’s “Near pharmaceutical” standards of “GPP”. MCANZ has had 4 separate products approved for individual patients made to that standard, and deemed acceptable by Medsafe”.

It is just a shame Labour did not have the confidence to actually put a provision in the Bill stating that a non-pharmaceutical standard would be followed. This approach essentially opens up the possibility of future Governments changing the regulations to require a pharmaceutical standard.

Importance of avoiding a big pharma approach

Why is National so interested all of a sudden after doing nothing during their decade of rule?

Apart from the political expediency of supporting something that nearly 90% of New Zealanders want, essentially, it is money. The National Party Bill predictably continues their neoliberal and paternalistic stance of regulation through the corrupt pharmaceutical regime that has gotten us into this mess. It is clear to anyone following the issue of the past decade that the National Party has deep ties to the big pharma industry, the biggest industry and most voracious lobby group in the world. This group, and hence national stands to lose a lot of money from true cannabis reform as it will reduce profits from expensive opioid pain killers and many other medications. Evidence from overseas markets has already borne out this prediction. As Tadgh Stopford wrote today: "in the legal US states, doctors are prescribing, on average, 4500 less prescriptions a year, most of them for pain. That’s about a billion NZ dollars in savings." It seems the last desperate grasp at profits of this industry has been a power play to at least control the cannabis industry by requiring stringent pharmaceutical standards.

Any law stating that cannabis medicines must meet pharmaceutical guidelines is ridiculously counter-factual, outdated and counterproductive. In fact amounts to not legalising cannabis at all for the majority of patients in need because it means medication costs patients $30,000 per year. This is because getting such pharmaceutical certification is expensive… really f***ing expensive.

This pharmaceutical approach rules out the production of cheap ‘food grade’ products on the local market and destroys any chance of a local medical cannabis industry emerging as a competitor in the global market. The hypocrisy of the big pharma players now pushing for a law requiring such an approach is pointed out by Le Brun:

“Despite promises made by inexperienced speculative Cannabis producers during the select committee process, “Pharmaceutical grade” or “GMP” adds a significant cost burden, and foreign companies such as Bedrocan operated for many years before obtaining that standard. To demand it upfront would handicap patient access by adding costs and potentially an additional year of time before companies are productive.”

However, the reality is, there is very little (if any) difference in substance between the expensive big-pharma cannabis brands like Bedrocan and ‘near pharmaceutical grade’ products. Pharmaceutical cannabis products are no more ‘scientific’ or refined than any of the ‘food grade’ certified products allowed in countries such as Canada available for a fraction of the price.

Despite what National and Pharmaceutical lobbyists will tell you, there is no magic going on here other than the magic already present in the plant. As Tadhg Stopford, Foundation Leader of the Hemp Foundation points out in his open letter to Dr Stewart Jessamine, the raw cannabis plant without processing contains the cannabinoids that provide health benefits by interacting with our unique internal Human Endocannibanoid System:

“Our bodies use a 'wi-fi system' to maintain our health and protect us from injury. This ‘wi fi’ system connects all of our organ and tissue systems. These connections enable our health to be maintained through 'on demand' regulation. Obviously this wifi system doesn’t use radio, it uses fatty molecules called cannabinoids. That’s why it is called our cannabinoid system.”

The massive costs are all in the pharmaceutical grade testing and patenting process. These are then of course passed on to consumers. However this is not necessary. These drugs are just the raw cannabinoids CBD and THC in different ratios, no magic is required. The truth is people can make quality cannabis CBD or THC extractions in their own homes, and have been doing so for years. Sure quality and safety may vary, but a simple food grade certification would solve any safety issues on that front and ensure verification of CBD/THC ratios as labelled.

Please, let’s not fall again for the line National have trotted out for a decade now. It is misdirection plain and simple and excuse making to cover up their real motivations of maintaining pharmaceutical control over the budding industry (pun definitely intended.)

Cannabis lobby group, NORML also believe there are merits to National's proposed scheme, but state that regulating medicinal cannabis like pharmaceuticals could keep products unaffordable – forcing patients to continue turning to the black market. Spokesperson Chris Fowlie, who is also CEO of PharmaCann New Zealand Ltd stated: "National's proposals could allow local producers to overtake Australia, but their restrictions could also hobble our budding industry before it's even begun."

Phil Saxby, a former Registrar of the Medical Laboratory Science Board also stated: "As well as pharmaceutical products, we need cheaper, food-grade cannabis products to be available here, as they are in other countries."

Failure of a Bill or regime to provide this providion for ‘food grade’ products, would simply continue the status quo of holding New Zealand patients to ransom with the most expensive and inaccessible cannabis based medicine available anywhere in the world.

The path forward – Collaboration

There is no guarantee that the National bill will ever be heard by parliament, as it may never be drawn from the ballot. Meanwhile, the Labour Bill, as it is will not provide relief for patients in need in an expedient manner. The irony of all this is that the Greens Bill, already roundly dismissed by these Parties was in fact a superior Bill than both of these and far more comprehensive and compassionate. A mix of the three different approaches may well be what is required. The so-called coalition parties should now get together and hash out their differences and come to an understanding about a Bill that they (and NZ First) can support that incorporates elements of the Greens and National Bills and greatly expands the Labour Bill.

Thankfully the Green party seems to agree with this need for greater action and hopefully can sway the Government to be more open-minded and collaborative on this issue. Green Party Sensible Drug Law Reform spokesperson, Chlöe Swarbrick, said yesterday:

“With 87% of New Zealanders in support of cannabis liberalisation for pain relief, the Health Select Committee now has a mandate to broaden the Government’s Medicinal Cannabis Bill to help those living with pain, not just those with a terminal illness.”

NORML also issued a press statement today saying: “Changes to the Government's medicinal cannabis bill don't go far enough, while the National Party's proposed new bill could mean only expensive pharmaceutical-style products are available.

As Chris Fowlie stated yesterday: "It's great they're now competing to have the best law …But we need to keep the focus on patients, and that means no more delays.”

In similar vein Rebecca Reider, who has debilitating chronic pain and serves as a patient representative on NORML's board says: “We need the parties to work together now to fix the proposed legislation and give patients urgent protection…While they squabble patients are still getting busted, or dying without medicine."

The first 100 days is well and truly up, and it is time for real action now. People in pain and with treatable chronic illnesses are suffering and growing tired of the continued inaction and misinformation on this issue. If National’s Bill shows anything, it is that making legislation on this issue is really not as complicated as they have been making it. This hopefully serves as a motivation for the Government who have smugly been refusing to listen to the activists and campaigners calling for more action now. What we need is a patient centred and human rights centred approach to medical cannabis ensuring access for all chronic pain and illness sufferers at affordable prices. It needn’t be this complicated or politicised.

© Scoop Media

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