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Sections in this issue outline (in order):
1. What they said. 2 The issue at a glance. 3 Background. 4 Internet information links. 5 and 6 Arguments for / against. 7 Further implications on this issue. 8 Newspaper items used in the compilation of the outline.
2003/11: Should the New South Wales Government conduct a four-year trial of cannabis as a medical treatment?
What they said ...
'No decent government can stand by while fellow Australians suffer like that, while ordinary people feel like criminals for simply medicating themselves' Mr Bob Carr, Premier of New South Wales
'While I understand the compassionate reasons for such a trial proposal, I am also mindful of possible legal and safety issues that need further consideration' Senator Kay Patterson, federal Health Minister
The issue at a glance
On May 20 2003 the New South Wales Government announced that by the end of the year a trial would have begun of cannabis as a medicinal drug.
Under the four year plan the New South Wales Government will establish a new Office of Medicinal Cannabis within the Health Department to oversee this trial.
It is currently unclear whether the primary focus of the trial is to remove the fear of prosecution from those who are currently self-medicating with marijuana (or would like to do so) or whether it is a scientific trial, designed to test the efficacy of cannabis as a medical treatment and to determine the manner in which it works best for this purpose.
The New South Wales Premier, Bob Carr, has been at pains to stress that this is a 'compassionate' measure, targeting those in significant distress from debilitating diseases and that his Government does not support the decriminalisation of marijuana for recreational use.
Despite the New South Wales Government's obvious attempt to remove the controversy from this issue, it has generated significant debate.
Background
(Most of the following background information is taken from the Australian Drug Foundation's information on cannabis. The Foundation's full discussion of the drug can be found at http://www.adf.org.au/drughit/facts/hdayca.html#what)
a) What is cannabis?
Cannabis is a drug that comes from the cannabis sativa plant. The active chemical in cannabis is THC (Delta-9 tetrahydrocannabinol).
Cannabis is a depressant drug. Depressant drugs do not necessarily make you feel depressed. Rather, they slow down the central nervous system. They slow down the messages going to and from the brain to the body. Cannabis can also have mild hallucinogenic effects.
There are three main forms of cannabis: marijuana, hashish and hash oil.
b) Forms of cannabis
Marijuana is the most common and least powerful form of cannabis. It is the dried leaves and flowers of the plant. It looks like chopped grass and ranges in colour from grey-green to greenish-brown. Its texture can be fine or coarse. It can contain seeds and twigs from the plant. The flowers or "heads" are the most potent part of the plant and so the potency of marijuana will depend upon the amount of leaf and heads it contains. Marijuana is smoked in hand-rolled cigarettes (joints) or in a pipe (a bong).
Hashish (hash) is small blocks of dried cannabis resin. Blocks range in colour from light brown to nearly black. The concentration of THC in hashish is higher than marijuana, producing stronger effects. Hash is added to tobacco and smoked, or baked and eaten in foods such as "hash cookies".
Hash oil is a thick oily liquid, golden-brown to black, that can be extracted from hashish. It is usually spread on the tip or paper of cigarettes and then smoked. Hash oil is more powerful than the other forms of cannabis. A very small amount can have a strong effect. This form is rarely used in Australia.
c) THC
THC (Delta-9 tetrahydrocannabinol) is the chemical in marijuana that makes you feel "high". This means you experience a change in mood and may see or feel things in a different way. Some parts of the plant contain a higher level of THC. For example, the flowers or heads have more THC than the stems or leaves.
THC is absorbed into the bloodstream through the walls of the lungs (if cannabis is smoked), or through the walls of the stomach and intestines (if eaten). The bloodstream carries the THC to the brain, producing the 'high' effects. Drugs inhaled get into the bloodstream quicker than those eaten. This means that the effects of cannabis when smoked (inhaled) happens more rapidly.
d) Cannabis use in Australia
According to recent research:
Cannabis is the most widely used illegal drug in Australia.
In 1998, 39% of the Australian population (44% male and 35% female) reported having ever used cannabis; and 18% had used in the last 12 months.
The average age of first time use of cannabis was 18.7 in 1998.
Of the recent users in 1998, the highest user group at 37% was the 20-29 year age group.
Cannabis was the most commonly used illicit substance among secondary students with 36% of all secondary students aged between 12 and 17 years reporting the use of cannabis at some time in their life.
Cannabis use (taken at sometime in their life) increased with age, increasing from 13% of 12-year-olds to 55% of 17-year-olds.
Weekly use also increased with age, from 3% of 12-year-olds to 16% of 17-year-olds.
Weekly use was more common among boys than girls.
e) Medical uses
Cannabis has been used medicinally for many centuries. There is evidence to suggest it is useful in providing relief to cancer patients from nausea and vomiting caused by chemotherapy. Researchers now believe cannabis is worthy of further investigation in the treatment of glaucoma, nausea, multiple sclerosis, anorexia nervosa, epilepsy and asthma.
There is as yet no consensus on the best mode of administering cannabis for therapeutic or medicinal purposes. Tablets, inhalants and sprays have all been considered as ways of controlling the dosage. There is also, as yet, no consensus on strength of dosage re THC content and also whether other active constituents in cannabis should be included in medicinal treatments.
Currently Canada, the United States and The Netherlands are all experimenting with cannabis for therapeutic purposes.
f) Cannabis and driving
It is illegal to drive a motor vehicle while under the influence of any drug (including cannabis). Breaking this law carries heavy penalties, disqualification from driving, fines, and even imprisonment.
Cannabis, particularly in combination with alcohol, will greatly increase the risk of having an accident. Cannabis and alcohol can significantly reduce the ability to drive safely. Effects, such as reduced coordination, slow reaction time, blurred vision and drowsiness, impact on driving ability. These effects can last several hours and appear to vary according to quantity, quality and content. Research on the effects of cannabis on driving is currently being undertaken.
g) Cannabis and the law
Cannabis is illegal. Federal and State laws provide penalties for possessing, using, making or selling cannabis. Drug laws in Australia distinguish between those who use drugs and those who supply or traffic drugs.
For example, in Victoria penalties range from fines of $2,000 and/or one year in prison for cultivation (not related to trafficking) to fines of up to $250,000 and/or 25 years in prison for commercial trafficking.
The laws in Australia vary from state to state in relation to the possession and use of cannabis.
In Victoria, the police and courts have recently introduced a number of new schemes in relation to drug offences. Some of these aim to divert people from the criminal justice system; others involve referring people with a drug problem to treatment programs.
For example, first time cannabis users will usually be formally cautioned at a police station and then referred to drug treatment service. Failure to attend treatment may result in charges being laid.
Internet information
On July 3 2003 the ABC's science program Catalyst included a substantial discussion of the Carr Government's proposed trial of cannabis for therapeutic purposes. The full text of this program can be found at http://www.abc.net.au/catalyst/stories/s888110.htm#transcript
On February 20 2003 the ABC's science program Catalyst considered recent research apparently linking marijuana use with the development of schizophrenia.
A full transcript of this program can be found at http://www.abc.net.au/catalyst/stories/s777336.htm#transcript
On May 15 2001 the ABC's PM program presented an interview with Dr David Taylor, senior lecturer in pharmacology with Monash University, giving his views on the therapeutic use of cannabis. A transcript of this interview can be found at http://www.abc.net.au/pm/s297270.htm
On August 13 2001 the ABC's Health Minutes program reported on a recent British review of a range of studies on the therapeutic benefits of cannabis. The review suggests that as a pain treatment cannabis is no more effective than alternatives, but that it seems to work more effectively to reduce nausea. It recommends research to develop 'more specific derivatives of cannabis ... which have fewer side effects.'
The text of the report can be found at http://www.abc.net.au/health/minutes/stories/s345228.htm
On September 5 2001 the ABC's News in Science program presented a report titled 'Cannabis eases chronic pain, study finds'. The full text of this report can be found at http://www.abc.net.au/science/news/stories/s358716.htm
On November 4 2000 the ABC's Science Show presented a report on the possible efficacy of cannabis as a treatment for multiple sclerosis. The report was precipitated by the New South Wales Government's original decision to investigate the therapeutic uses of cannabis.
The text of this report can be found at http://www.abc.net.au/rn/science/ss/stories/s206397.htm
On June 21 2000 CNN presented a report indicating that the University of California
Los Angeles had just completed research suggesting that 'THC can promote tumour growth in mice by impairing the body's anti-tumour immunity system.'
The report can be found at http://www.cnn.com/2000/HEALTH/cancer/06/21/marijuana.lung.cancer/
The International Association for Cannabis as Medicine has a section of its site that details the supposed therapeutic uses of cannabis. This can be found at http://www.cannabis-med.org/english/patients-use.htm
'Legislative Options for Cannabis Use in Australia: Cannabis in Context'. The Australian Institute of Criminology was commissioned by the National Task Force on Cannabis to prepare this paper addressing the legislative options available for cannabis use in Australia. The paper was published in April 2003. One of the appendices to the paper gives an informative overview of the therapeutic uses of cannabis in Australia and the United States.
This appendix can be found at http://www.health.gov.au/pubs/drug/cannabis/can_app1.htm
On July 4, 2003, the UK Cannabis Internet Activists published a report on the plight of Mrs Biz Ivol, a British woman suffering multiple sclerosis who is facing prosecution for her therapeutic use of cannabis and her distribution of the drug to other sufferers.
This report can be found at http://www.ukcia.org/middleframe.html
The Cannabis Campaigners' Guide has a section of its Internet site arguing that there is no effective difference between using marijuana therapeutically and using it recreational use. The piece argues that all supposedly recreational users are in fact self-medicating. This argument can be found at http://www.ccguide.org.uk/recvmed.html
Arguments against trialling cannabis for medicinal purposes
1. There are more effective and safer medicinal alternatives to cannabis
Mr David Perrin, executive officer of the Drug Advisory Council of Australia, has claimed, 'There are effective alternative treatments to the problems of illnesses that may be considered.' For example, Melbourne University's Dr Julien Rait has claimed that new drugs, in particular Lumigan, are more effective in treating glaucoma and do so without cannabis' side-effects.
David Perrin has further claimed, 'There are well-tried drugs - for example, anti-emetics for nausea and vomiting associated with cancer chemotherapy - that have been through rigorous clinical trials before being offered for use in humans. Why not just use these drugs for medical relief?'
A review of the effectiveness of cannabinoids in controlling pain and nausea published in the British Medical Journal in 2001 claimed that existing studies indicated 'Cannabinoids were no more effective than codeine in controlling acute and chronic pain and they had undesirable effects in depressing the central nervous system.
The same review then claimed that the effectiveness of codeine as a pain control treatment, in combination with other drugs, had been further increased since the original studies that had indicated its superiority to cannabis. The review states, 'These studies are mostly from the 1970s. Since then we have learnt to use non-steroidal anti-inflammatory analgesics alone and in combination with opioids in both cancer related and postoperative pain. There is thus no need for cannabinoids for these indications.' This review concluded, 'The currently available cannabinoids clearly loose the battle in both efficacy and safety with the competitors of today ... the current information is that the adverse effects of cannabinoids outweigh their effectiveness.'
2. It is inappropriate to conduct initial testing of the therapeutic utility of cannabis on human subjects
Mr David Perrin, executive officer of the Drug Advisory Council of Australia, has claimed, 'In the past, Australia has had vigorous medical testing of drugs before they are used on humans. There is no reason why we should now allow politicians to determine the drugs that are used in medicine.'
According to this line of argument, it is premature to proceed straight to trialling the therapeutic potential of cannabis using human subjects. Trials would normally first be conducted using animal subjects and perhaps tissue cultures before then undertaking human trials. It is suggested that bypassing this preliminary testing places human subjects at unnecessary risk. It has also been suggested that it is not appropriate that politicians, in this instance, primarily the Premier of New South Wales, should be setting the agenda for doctors researching treatment options for a variety of illnesses.
3. The known toxic effects of THC, a primary component of cannabis, is likely to preclude its medicinal use
Mr David Perrin, executive officer of the Drug Advisory Council of Australia, has claimed, 'Cannabis is highly unlikely to be used in medicine because of the known toxic effects of the THC in the drug.'
The April 1998 edition of Pharmacy Connects stated, 'Several medical uses of THC and marijuana have been studied, including nausea and vomiting associated with cancer chemotherapy, cachexia in cancer and AIDS patients, multiple sclerosis, and glaucoma.
By far, most of the medical research on the uses of oral THC and smoked marijuana has focused on the control of nausea associated with cancer chemotherapy. Oral THC has generally been found as effective or more effective for nausea than oral prochlorperazine or oral metoclopramide.
The toxicity profile of oral THC, however, has been less than favourable in many studies. In two studies, adverse effects occurred in 81 per cent of patients. Nine per cent of these patients experienced hallucinosis, distortion of reality, and/or mental depression. The effectiveness of THC was usually correlated to the onset of a "high" or intoxicated feeling. In another study, the toxic effects of THC were so profound that most patients preferred nausea to THC therapy.'
4. Cannabis use has been linked to a variety of cancers
Mr David Perrin, executive officer of the Drug Advisory Council of Australia, has asked, 'Why would a doctor give cannabis to a cancer patient when the medical research has proven cannabis causes cancer of the upper airways, tongue, lungs, head, neck, mouth, larynx, upper jaw and respiratory tract?'
Mr Perron has further claimed, 'The British Lung Foundation recently confirmed the cancer causing effects of cannabis, claiming cannabis cigarettes contain 50 percent more cancer causing agents than tobacco cigarettes.'
A study conducted by the University of California at Los Angeles suggests that smoking marijuana may be a greater cancer danger than smoking tobacco.
The research, conducted on mice, was published in the July 2000 issue of the Journal of Immunology. The researchers studied the effect of tetrahydrocannabinol, or THC, the major euphoriant in marijuana.
The UCLA scientists found that the tar in marijuana smoke contains higher concentrations of substances called hydrocarbons than tar from tobacco smoke does. These hydrocarbons are a key factor in promoting human lung cancer.
Because marijuana smoke deposits four times as much tar in the respiratory tract as a comparable amount of tobacco, the exposure to carcinogens is increased, the researchers observed.
5. THC causes the suppression of the human immune system
The Berkman Center for Internet and Society at Harvard Law School has a section of its site dealing with the medical danger of marijuana use. It claims that smoking marijuana regularly (a joint a day) can damage the cells in the bronchial passages that protect the body against inhaled microorganisms and decrease the ability of the immune cells in the lungs to fight off fungi, bacteria, and tumour cells. For patients with already weakened immune systems, this means an increase in the possibility of dangerous pulmonary infections, including pneumonia, which often proves fatal in AIDS patients.
Studies further suggest that marijuana is a general "immunosuppressant" whose degenerative influence extends beyond the respiratory system. Regular smoking has been shown to affect the ability of the smoker's body to defend itself against infection by weakening various natural immune mechanisms, including macrophages and T-cells. This suggests the conclusion that the use of marijuana as a medical therapy can and does have a very serious negative effect on patients with pre-existing immune deficits resulting from AIDS, organ transplantation, or cancer chemotherapy, the very conditions for which marijuana has most often been suggested as a treatment. It has also been shown that marijuana use can accelerate the progression of HIV to full-blown AIDS and increase the occurrence of infections and Kaposi's sarcoma.
6. The chemical composition of cannabis varies too greatly to make clinical trials reliable
Many critics of New South Wales' proposed trials, including Victoria's Health Minister, Bronwyn Pike, have made this point. Ms Pike has stated, 'Smoking dope's not OK at all. I'm very, very concerned at the strength and intensity of the marijuana that's available ...'
Mr David Perrin, executive officer of the Drug Advisory Council of Australia, has made a similar point. Mr Perrin has quoted the following findings, 'After an extensive study of cannabis as a medicine, the US Government concluded, "It is clear that cannabis cannot met the criteria for safety under medical supervision. The chemistry of cannabis is not known and reproducible.'
According to these critics, marijuana varies dramatically according to where and under what conditions it has been grown and from where on the plant the active components are harvested. Thus, it is claimed, its chemical properties are difficult to standardise. It has been claimed that this makes it unsuitable for medicinal use, as composition and consistency of dosage cannot be guaranteed. It has been claimed that regulating dosage is particularly difficult when marijuana is smoked or ingested. It has further been claimed that cannabis is an extremely complex substance and that isolating its active components and understanding how they interact is extremely difficult. This difficulty is increased, it is argued, by the variability of the substance.
7. The neurological effects of cannabis make it an undesirable drug to give, especially to patients who may then drive
Mr David Perrin, executive officer of the Drug Advisory Council of Australia, has claimed, 'Cannabis is an addictive drug that causes cognitive dysfunction affecting self-awareness, memory, concentration, skills, behaviour and personal relationships.' Mr Perron goes on to ask, 'Why then give cannabis to patients who are likely to drive on our roads or operate dangerous equipment?'
A 1993 review of the research literature on the effects of cannabis concluded, 'Acute cannabis intoxication includes not only the pleasant state of relaxation, euphoria, and sought-after sensory alterations, but also impairs judgments of distance and time, memory for recent events, ability to learn new information, and physical coordination. At slightly higher doses the acute intoxication includes tremor, transient muscular rigidity, or myoclonic muscle activity. The subjective feelings of muscular "weakness" or stiffness can be measured objectively. Low doses produce no changes in tendon reflexes, but high doses cause hyperexcitability of knee jerks with clonus. At even higher doses a full blown acute brain syndrome is possible.' At the time at which this review was made it was still disputed as to whether the use of cannabis might result in permanent brain damage.
8. Cannabis can be a depressant and may principate mental health problems
Mr David Perrin, executive officer of the Drug Advisory Council of Australia, has claimed, 'Ingested or inhaled cannabis has all the brain altering and mood altering functions of smoked cannabis. A recent Western Australian study, for example, has linked cannabis with suicide because of the depressant effects of the toxins in the THC.'
Professor Sven Silburn, of the Western Australian Research Institute for Child Health and the National Advisory Council on Youth Suicide Prevention, found that smoking marijuana more than 50 times a year could double the chances of a youth committing suicide.
According to Professor Silburn's findings, cannabis was detected in 20 per cent of males and 11 per cent of females aged between 15 and 24 who committed suicide between 1986 and 1998. He also found strong suggestive evidence that regular cannabis use could trigger forms of psychosis latent in vulnerable individuals.
Further, a study by the Royal Children's Hospital in Melbourne released in February 2002 found that cannabis use was linked with depression and anxiety in youth.
Professor George Patton, Director of the Centre for Adolescent Health at the hospital, has said that this is the best evidence yet that cannabis is bad for mental health and causes higher rates of depression, anxiety and other mental health problems.
9. Legalising the medicinal use of cannabis may be seen as endorsing its recreational use in the community
There are those who fear that legalising cannabis for therapeutic uses might lead to softening in attitude toward cannabis as a recreational drug.
This view is supported by the statements of some of those groups that call for the legalisation of cannabis as a recreational drug.
A British group calling itself Cannabis Campaigners Guide has challenged the supposed distinction between the recreational use of cannabis and its therapeutic use. The group argues that all users of marijuana, including those who are currently classed as recreational users, are in fact self-medicating. It claims that they are 'instinctively' treating themselves with marijuana for either a physiological or psychological condition.
Opponents of the decriminalisation of cannabis argue that marijuana lobby groups could cynically exploit its therapeutic use as a lead in to the full legalisation of the drug.
Arguments in favour of trialling cannabis for medicinal purposes
1. People with a variety of medical conditions are already self-medicating with cannabis
Approximately 5 percent of multiple sclerosis suffers in Great Britain are believed to self-medicate using cannabis. It is suspected the figure would be similar in Australia. Anecdotal evidence suggests that the rate of self-medication using cannabis is higher among AIDS sufferers. A survey of HIV positive patients conducted in Australia in the mid 1990s found that one quarter were using cannabis therapeutically.
Dr Phillip Robson is a consultant psychiatrist and senior lecturer at the University of Oxford. He heads a drug dependency unit, and has acted as an adviser on medicinal cannabis to his country's Department of Health. He has said of AIDS sufferers who self-medicate with cannabis, 'They're long-term cannabis users and probably have been using cannabis long before they became infected with the HIV, but have found subsequently that smoking cannabis alleviates these symptoms, and interestingly, that's of course how most of the anecdotal information that we have on a variety of illnesses, have come about, that the children of the '60s who used cannabis recreationally and some of whom developed a range of diseases, found that it would alleviate their symptoms.'
In response to the growing awareness that marijuana may relieve the symptoms of a number of extremely debilitating conditions, there are now many self-help groups of disease sufferers growing marijuana for medicinal purposes and distributing it among others with the disease. Such groups are also pressuring governments in Australia, Britain, Canada and the United States to either decriminalise marijuana or conduct trials to establish its medical benefits.
2. Informal trials suggest cannabis has a variety of medical uses
There have been many anecdotal reports suggesting the effectiveness of marijuana for a variety of conditions including AIDS, reducing the side effects of chemotherapy, multiple sclerosis and glaucoma.
On the July 3 2003 edition of the ABC's science program Catalyst, an interview subject identified as 'Patsy' was introduced. She suffers with severe spasms, epilepsy and pain following a stroke. When conventional drugs failed, she finally tried cannabis cookies. The middle-aged woman claimed, 'I'd been bed-bound for about five days with intense pain on my right side. I was in terrible pain and couldn't move, so I took a little bit more than I usually would take. And that is still a very very small amount. And within half-an-hour I was feeling better and I was able to get out of bed and start acting normally again.'
The AIDS Council of Victoria has stated that the experience of people with HIV showed that marijuana was an effective way of dealing with pain without the side-effects associated with other pain relief. It has also been claimed that cannabis is an appetite stimulant which helps counter the debilitating weight loss that is a feature of AIDS and some forms of cancer.
Dr Christopher Vaughan, Senior Hospital Scientist, at the New South Wales Pain Management Research Centre has claimed of marijuana, 'This is up in a class of very strong analgesics like morphine and other drugs that are used during surgery.'
Marijuana is also believed to be beneficial in the treatment of the eye condition glaucoma. In 1971, during a systematic investigation of its effects in healthy marijuana users, it was observed that cannabis reduces intraocular pressure. In the following 12 years a number of studies in healthy individuals and glaucoma patients with marijuana and several natural and synthetic cannabinoids were conducted. Marijuana decreases intraocular pressure by an average 25-30%, occasionally up to 50%.
3. Formal trials of the medicinal properties of cannabis will allow for properly verified results and for adverse effects to be minimised
Supporters of formal clinical trials of the therapeutic value of cannabis argue that without such trials the utility of the substance cannot be conclusively determined and proper treatment modalities cannot be established.
Many supporters of such trials stress that an understanding of the action of cannabis is growing and that earlier studies focusing on its negative side effects may no longer be relevant. Gareth Pryce made this point in a letter to the British Medical Journal published on July 6 2001.
Pryce stated, 'What becomes clear on reading the papers on cannabinoid therapy ... is that in many cases the studies were doomed from the start in light of the huge advances in cannabinoid biology over the past few years ... In the future further understanding of this exciting area of neurobiology will enable us to develop vastly improved [cannabinoid] therapeutic agents to not only treat symptoms effectively but also greatly [side effects].'
According to this line of argument, it is premature to prohibit trials of therapeutic marijuana because of concern about possible side effects. Most chemically active substances have potential side effects. It is argued that one of the purposes of conducting trials is to discover how to maximise the benefits of cannabinoid therapy while reducing adverse reactions.
Dr Sam Lees, the Victorian president of the Australian Medical Association, has said, 'We need a trial. Doctors need the surety, if they're going to be prescribing cannabis then they need to know, one, that it works and, number two, what the method of administration is.'
4. There is currently no adequate medical treatment for some of the conditions cannabis is rumoured to assist
It has been claimed that in a number of the conditions for which marijuana is posited as a possible treatment there are currently no fully satisfactory alternative treatments. Lester Grinspoon and James B.Bakalar have made this claim about bipolar disorder in an article published in The Journal of Psychoactive Drugs, June 1998. The authors state, 'In bipolar or manic-depressive disorder, major depression alternates with uncontrollable elation, or mania. Symptoms of depression include loss of interest and pleasure in life, sadness, irrational guilt, inability to concentrate, appetite loss, lethargy, and chronic fatigue. Manic symptoms include sleeplessness, tirelessness (until exhaustion leads to a breakdown), and recklessly gregarious and expansive behaviour, which sometimes turns to irritability, rage and paranoid delusions. Bipolar disorder is treated mainly with lithium salts and anticonvulsant drugs, which can have serious side effects. Thirty percent to forty percent of patients with bipolar disorder are not consistently helped by or cannot tolerate standard medications. In the course of the authors' studies of the medical uses of cannabis a number of sufferers were discovered who believed marihuana to be more effective than conventional anti-manic drugs, or who used it to relieve the side effects of lithium.'
The New South Wales' Premier, Mr Bob Carr, has stated, 'We're talking about relieving suffering where no other drug or treatment can help.'
5. The cannabis use will be strictly controlled and monitored
People suffering with cancer and AIDS, nausea from chemotherapy, severe and chronic pain, spinal cord injuries and multiple sclerosis would be eligible.
Patients would have to register annually and would need a doctor's certificate advising that conventional treatment would not relieve their suffering.
People with minor convictions for personal drug use would be eligible to apply. But those with more serious drug convictions, or who were on parole or under 18, would be banned.
The form of distribution has yet to be finalised. Options include tablets and a special cannabis inhaler being trialled in Britain.
6. The cannabis will only be made available to ease the suffering of the seriously ill
As already noted, access to the cannabis trial would only be made available to people suffering with cancer and AIDS, nausea from chemotherapy, severe and chronic pain, spinal cord injuries and multiple sclerosis would be eligible.
Patients would have to register annually and would need a doctor's certificate advising that conventional treatment would not relieve their suffering.
An HIV sufferer, Mr Justin Brash, has declared his support for the trial. 'I am relieved that the New South Wales Government has recognised the plight of sufferers of serious and terminal illnesses by offering them medicinal cannabis for pain and nausea relief.'
7. Those favouring such trials do not support the decriminalisation of cannabis
The New south Wales Premier, Mr Carr, has made it plain that neither he nor his Government favours the decriminalisation of cannabis. Mr Carr has stated, 'The case against decriminalisation of cannabis is stronger than ever. This measure is only for a group of people who cannot be assisted by conventional treatment. This is a compassionate scheme.'
Supporters of the trial claim there is no connection between allowing cannabis to be tested for its therapeutic value and wanting to see it legally available as a recreational drug. Because heroin-based treatments are available under prescription for therapeutic purposes it does not follow that heroin is legally available as a recreational drug.
8. There is widespread community and expert support for trailing the therapeutic uses of cannabis
The director of the Cancer Council of Victoria, Professor David Hill, has claimed that the 'caring and tolerant view' is that patients should not be barred medicinal use of the drug. The AIDS Council of Victoria also supports the trial and would like to see a similar trial conducted in Victoria. The Australian Medical Association of Victoria also supports the trial of marijuana for medicinal purposes provided it is done in a controlled way.
The plan has drawn in-principle support from the leader of the Opposition, John Brogden and from the New South Wales National Party leader, Andrew Stoner. The Prime Minister, Mr Howard, has also expressed in-principle support, as has the federal leader of the Opposition, Mr Simon Crean.
Sydney talkback radio host, John Laws, has stated, 'If somebody is going to be made more comfortable in the closing stages of their lives, by ingesting a little marijuana, then so it should be ... I think the majority of people would agree with that.'
9. Currently the severely ill and their physicians risk prosecution for the therapeutic use of cannabis
One of the most well known cases of the threatened prosecution of someone using cannabis for medicinal purposes is that of Mrs Biz Ivol, 56, from South Ronaldsay, England. Mrs Ivol, who is wheelchair-bound, suffers from multiple sclerosis. She is a long-time supporter of legalising cannabis for medicinal purposes. She was charged following a police raid at her home in August 2001. Her trial has been postponed several times. She has pleaded not guilty to three charges of possessing cannabis, producing two cannabis plants and being concerned in the supply of the drug to others. The charges relate to cannabis-laced chocolates that she is accused of making and distributing to fellow sufferers across the United Kingdom.
Mrs Ivol has stated, 'I feel no one is doing anything to make things better for people with MS and that I no longer have any quality of life. I can't do my garden. I can't knit and I can't sew because my hands are dying. I can't read because my eyes are going - there's nothing worth staying for anymore on this earth.'
The New South Wales Premier, Mr Carr, has stated, 'No decent government can stand by while fellow Australians suffer like that, while ordinary people feel like criminals for simply medicating themselves.'
Further implications
There appears to be some confusion at the heart of the current debate surrounding the trialling of marijuana for medicinal purposes in New South Wales.
For some of the lobby groups speaking on behalf of those suffering from a variety of illnesses and medical conditions, the primary purpose of these supposed 'trials' appears to be to legitimise the use of cannabis for therapeutic purposes. From this point of view these are not trials in the sense that those supporting them wish to verify or clarify the medicinal properties of cannabis. Instead, it would appear, they wish to be able to take their medication of choice, marijuana, free from fear of prosecution. Even in some of the pronouncements of the New South Wales Premier, Bob Carr, there appears to be little doubt about the efficacy of cannabis. Mr Bob Carr, has stated, 'We're talking about relieving suffering where no other drug or treatment can help.'
In what sense then are these next four years meant to be a trial? It would appear that part of what is being tried is the means of administering the drug. The Prime Minister has indicated that he could only give his personal support to such trials if the drug were administered via table or spray. Sprays or inhalants appear to be among the forms of administration being considered.
From a medical point of view it is to be hoped that the choice of form of administration is being determined by concerns about minimising side effects and controlling the strength of dosage. From a political point of view it seems that at least part of the concern is that those participating in the trials are not seen to be getting free marijuana-induced 'highs' at taxpayers' expense. Sprays administered under the tongue and marijuana by tablet have the public relations benefit of appearing clinical, controlled and non-recreational.
There have been no details released as yet about the scientific aims of these trials. It is to be hoped that they have a genuine scientific purpose beyond a diffuse desire to ease the distress of people who are generally being presented, somewhat disingenuously, as terminally ill.
Given the obvious therapeutic promise of cannabis in the treatment of a variety of conditions and given the lack of medical consensus on how best to use it and avoid its side effects, these trials need to be conducted with genuine scientific rigor. This is an opportunity to refine cannabis as a medicinal drug. It would be a pity if all that is achieved over the next four years in New South Wales is that the taking of marijuana therapeutically is briefly decriminalised while no real work is done on studying and refining the drug so that it is used to its best possible effect.
Sources The Age
22/5/03 page 6 news item by Chee Chee Leung, 'Pike urges debate on medicinal marijuana'
23/5/03 page 4 news item by Darren Gray et al, 'Victoria lets NSW go it alone on trial'
23/5/03 page 4 news item by David Rood, 'Puff of smoke masks AIDS sufferers' pain'
23/5/03 page 4 analysis by Geoff Strong, 'How marijuana can help and sometimes hinder'
23/5/03 page 4 table, 'Altered states: Australia's cannabis laws'
23/5/03 page 12 editorial, 'A timid approach on medical marijuana'
25/5/03 page 14 cartoon by J Wright
The Australian
21/5/03 page 3 news item by Megan Saunders and Monica Videnieks, 'Medicinal cannabis trial approved'
22/5/03 page 5 news item by Megan Saunders, 'Crean backs medicinal cannabis trial'
22/5/03 page 11 comment by Don Baxter, 'Chronic pain is not a crime'
23/5/03 page 2 comment by Megan Saunders, 'Brogden confused, Carr lucid on dope'
23/5//03 page 11 comment by David Perrin, 'Side effects should cruel Carr drug proposal'
The Herald Sun
21/5/03 page 25 news item by Anna Patty, 'Marijuana to get trial run as medicine'
22/5/03 page 20 editorial, 'Caution on dope'
