UPDATED: Change to approval for medicinal cannabis – Expert Reaction

UPDATED with new comments. Patients seeking medicinal cannabis will no longer need the approval of a minister, but instead will go to the Ministry of Health.

Associate Health Minister Peter Dunne announced the change this morning, saying he was confident the ministry could take over now that firmer guidelines are in place for making decisions on the contentious issue.

The Science Media Centre asked experts for their reaction to the announcement. Feel free to use the comments below in your reports.

Dr Giles Newton-Howes, senior lecturer, University of Otago, comments:

“It is with some interest to see the Honorable Peter Dunn delegate the decision on the use of cannabis-based products, presumably to ease the use of such product in the New Zealand medical sphere. This appears to be part of the process of ‘medicalising’ cannabis-based products that has been occurring internationally.

I have written recently encouraging doctors to be engaged in the debate surrounding the use of cannabis-based products and this is an example of the need for physicians to engage, as they will be the prescribers of such ‘medicine’.

“As the honorable Mr. Dunn notes there are now guidelines for the use of pharmaceutical grade cannabis and these are encouraging, requiring informed consent and a clear treatment paradigm. This ensures the patient will be aware of the limited nature of the literature, albeit there is a risk that patients in considerable suffering will try anything, regardless of the sparse evidence for it. There is a similar concern that medical professionals may be distressed by the suffering of their patients and consider this ‘worth a try’.

“The capacity for doctors to apply to prescribe ‘non-pharmacological grade’ cannabis is considerably more worrying. These doctors will not have any idea of what they are giving to their patients and on some level, this makes the process of consenting them near impossible. Further, we know in New Zealand there is an overlap between recreational and self-identified ‘medical’ users of cannabis and this requires careful attention, as is given to other psychoactive medicine.

“Somewhat more worrying are the comments Associate Health Minister Dunn made related to this delegation. This suggests Minister Dunn would like to see cannabis used more, although the evidence base remains weak and relatively small for benefit but clear, larger and relevant to New Zealand in respect of the harms [e.g. Fergusson et al. 2008  and Fergusson et al. 2005] particularly in those with developing brains.

“Doctors use their clinical judgment and medical science to work for the best outcomes for their patients, as identified by their patients. Although this delegation will, ideally, improve access for those where there is an unmet clinical need and an evidence base for effectiveness in the real world, we need to be clear that for cannabis-based products to be labeled as a medicine, they should fulfill the requirement of any medicine in New Zealand.”

Professor Paul Smith, professor of neuropharmacology, University of Otago, comments:

“Overall, I think it is a positive step that brings New Zealand into line with many other countries such as the USA.

“However, it is important to be clear about what ‘Cannabis-based medicine’ (CBM) actually is. Cannabis the plant contains hundreds of chemicals and about 66 that are unique to the Cannabis plant.

“Therefore, CBM can potentially mean many things. Sativex [one of two pharmaceutical-grade cannabis-based products available here] contains equal concentrations of delta-9-THC, the main psychoactive ingredient of Cannabis, and cannabidiol (CBD), but other CBMs may contain different ratios or just CBD.

“Whatever the case, CBMs are not ‘magic bullets’. The evidence that they work for some conditions like neuropathic pain is not entirely consistent or convincing, but they do appear to help some people. So, it is a question of benefit versus burden for a particular condition.

“In the case of terminal illness, there is not much reason to have concerns because the harm will be minimal and the patient may benefit.

“For non-terminal illness, one issue is the way it is taken. For example, Sativex is used as an oromucosal or oropharyngeal spray and this avoids the potential harm of smoking Cannabis, which is associated with damage to the lungs even if only Cannabis is used in the cigarettes (a point often overlooked in the medicinal Cannabis debate).

“According to current evidence, there are few long term risks from using drugs like Sativex. The doses of delta-THC are low and long-term studies indicate that it is well tolerated.”

No conflict of interest declared.