TUREI PUSHING MEDICINAL USE OF CANNABIS

In the movies, the condemned man is never denied a final
smoke.

The health risks of that last gasp pale into insignificance when
compared with the threat posed by the firing squad.

In a real-life replay of the silver screen scene, Dunedin-based Green
MP Metiria Turei is asking the community to look at the big picture
and offer the sick and dying the chance to consider cannabis.

A private Member's Bill sponsored by Ms Turei is due to go before
Parliament soon, possibly this month, proposing that doctors be
permitted to prescribe cannabis where it could do some good.

In an interview, Ms Turei said she expected some to oppose the move
but asked them to set aside prejudice and look at the evidence.

"I am asking people to set aside that prejudice because for the sick,
it is actually really important that they access the medicine," Ms
Turei said.

"It is enormously and fundamentally cruel for them to be denied a
potentially useful medicine because of the prejudice that some people
hold."

The Misuse of Drugs (Medicinal Cannabis) Amendment Bill, due to be
debated on November 22, would allow doctors to prescribe the drug for
specific serious medical conditions.

Conditions identified in a schedule to the Bill include Alzheimer's
disease, arthritis, multiple sclerosis and the nausea associated with
cancer chemotherapy.

Proponents say cannabis is useful in countering nausea and as an
antiemetic (which prevents vomiting) in the treatment of pain and
muscle spasms, and as an appetite stimulant for people suffering from
wasting conditions.

Under the Bill's provisions, those prescribed medicinal cannabis would
have to be registered and would be issued with an identity card.

"It will not work for everyone, which is why my Bill makes it a
decision for the doctor," Ms Turei said.

There is a limited facility for sick New Zealanders to access cannabis
now, but each case has to be considered by the Minister of Health.

The process is onerous and no approvals have been given.

"It does not happen with any other kind of drug in this country. It is
just ridiculous," Ms Turei said of the process.

The Bill proposes allowing people to grow-their-own, or have it grown
for them. Ms Turei said she expected some to object to the smoking of
cannabis and was open to discussion about the best way to deliver the
drug.

The debate is not new and both the research and the incidence of
people self-prescribing cannabis is well-known to those in the medical
profession.

Dunedin oncologist Associate Prof David Perez said he had encountered
a small number of patients who benefited from smoking cannabis, having
tried everything else.

"People access it for themselves, obviously, and they use it and they
report to us that they find it quite useful," Prof Perez said when
approached for comment.

"We are limited in that we can not go out and positively recommend
it."

However, if cannabis-related treatments were to become available,
"cannabinoid" drugs were preferable, he said.

"There is a medication which is produced pharmaceutically, which is a
derivative of cannabis, that is provided in the UK as a prescription
medication. I think we would prefer to have that kind of option
available to us."

Cannabis on its own was regarded as mildly or moderately effective as
an anti-nausea treatment, and selective in terms of whom it helped.

Other drugs were considerably more effective and avoided the
"mind-disturbing" side effects of cannabis some people found
uncomfortable, Prof Perez said.

Cannabis expert Prof Paul Smith, of the University of Otago's
department of pharmacology and toxicology, said the first question
when considering medicinal uses for cannabis was whether it was to be
smoked.

If so, the benefits had to be weighed against the risk of lung
damage.

Drugs derived from cannabis, cannabinoids, were the
alternative.

"Most of the evidence suggests that cannabinoids . . . are useful for
stimulating appetite in conditions like cancer or Aids where there is
wasting," Prof Smith said.

There was also good evidence cannabinoids were effective in treating
nausea and vomiting.

A drug available in the United States, called dronabinol, a synthetic
THC (the active ingredient in cannabis), was used for that purpose.

A drug developed in the United Kingdom, Sativex, was a mix of THC and
another chemical from cannabis delivered as a spray under the tongue.

"There's a good blood supply under the tongue so the drug is absorbed
very quickly into the blood."

There was some evidence cannabinoids could be useful in treating
glaucoma as well as chronic pain and spasticity, in disorders such as
multiple sclerosis (MS).

Claims for efficacy in the case of other conditions listed at the back
of Ms Turei's Bill were more questionable, Prof Smith said.

The Bill lists schizophrenia, brain injury and epilepsy as areas were
cannabis could help, but Prof Smith said such claims were poorly
supported by research.

New Zealand Drug Foundation executive director Ross Bell said they had
extensively researched the topic and supported the Bill going to a
select committee.

However, their own contact with MPs indicated it was unlikely to find
majority support in Parliament.

One problem might be that it provided for the smoking of cannabis
which was not to say that did not work for some people.

"It appears that the benefits slightly outweigh the risks just because
of the way people smoke cannabis medicinally," Mr Bell said.

It could be problematic for the Bill that it had attracted the support
of pro-legalisation lobby Norml, he said.

"It is the kiss of death."

New Zealand Aids Foundation executive director Rachael Le Mesurier
said the foundation would be quite happy for the Bill to go to a
select committee.

Anecdotal evidence indicated cannabis had helped some New Zealand HIV
sufferers with the nausea caused by antiretroviral medication.

"We are very aware that worldwide, in Canada, the United Kingdom and
America, people are making significant decisions around trying to
increase research and information around this so we can all work from
an evidence based position, rather than an emotive one."

University of Otago researcher Geoff Noller said it was his view that
the medicinal use of cannabis was unlikely to be seen as opening the
door to recreational use.

Where surveys had shown support for medicinal use, the same
populations continued to support prohibition for any other use, he
said.

There was evidence quite large numbers of people could be helped by
medicinal cannabis.

An Australian study showed 19,000 people in New South Wales had
conditions where cannabis could play a role in their treatment.

On that basis, more than 11,000 people in New Zealand could be in the
same situation, Mr Noller, a PhD student in the department of
psychological medicine, said.

Health Minister Pete Hodgson has acknowledged the potential for
cannabis to do good, but indicated he was not looking at relaxing the
laws.

"I consider the existing exemptions under the Misuse of Drugs Act 1975
allow for a medical practitioner to be given approval to prescribe an
appropriate cannabis-related product for a patient under their care,"
he said in a statement.

Mr Hodgson said he had asked the Ministry of Health to review the
latest research before he considered whether to support the Bill.