Hansard and Journals
Misuse of Drugs (Medicinal Cannabis) Amendment Bill — First Reading
Misuse of Drugs (Medicinal Cannabis) Amendment Bill
METIRIA TUREI (Co-Leader—Green) : I move, That the Misuse of Drugs (Medicinal Cannabis) Amendment Bill be now read a first time. At the appropriate time I intend to move that the bill be referred to the Health Committee. The bill establishes a compassionate regime for doctors to prescribe cannabis to those of their patients they believe would benefit from it.
The bill takes the politics out of this critical health issue. Cannabis is medically proven to help manage pain, with fewer side effects than those of other medications. The provisions in the bill would carefully control the medicinal use of cannabis so that it is prescribed only for those who really need it. I ask MPs today to at least send the bill to the select committee. There will be a conscience vote on the bill tonight, and I sincerely hope that MPs will have the courage—and I accept that some will be nervous about the issue—to take a compassionate approach this evening.
The use of cannabis as a medicine is well documented in research from the UK, Israel, Germany, Canada, and the USA. The American Medical Association, the Institute of Medicine in the US, the Federation of American Scientists, the World Health Organization, and the Royal College of Physicians in the UK all support medicinal cannabis. In New Zealand the New Zealand Medical Association supports research into the benefits of cannabis for medicinal use, and the Pharmacy Guild of New Zealand told the 2001 cannabis inquiry that it considers it perfectly possible to distribute medicinal cannabis if it were to be legal to do so.
For patients, ill New Zealanders, those suffering from terminal illnesses, and those suffering severe pain from the effects of chemotherapy and other treatments that cause such distress, the issue of the medicinal use of cannabis is not to do with research; it is about relieving their daily painful suffering. Under the provisions of the bill, a patient can apply for a Medicinal Cannabis Identification Card when he or she suffers from a listed condition, and have the written support of his or her medical practitioner. The cardholder may cultivate and possess an amount of cannabis as agreed by the doctor of the cardholder. The Medicinal Cannabis Registration Board will keep and maintain a register of the cardholder’s details, and the cardholder will be registered with the police. It is a process or scheme that very closely resembles the Canadian system for the management of medicinal cannabis.
I have had many people come to see me, write letters to me, or send emails to me who plead for relief. Many are already using cannabis for pain relief, nausea management, or pain management of amputations. They are genuinely ill New Zealanders who are at their wits’ end and are treated by this Parliament and by the bureaucracy with contempt. They are entitled to the compassionate protection of the law. They are entitled to the medicine that works best for them. But all of those who have contacted me live in real fear both of thieves and of the law.
Many of their fears of the law are real fears. Sick and vulnerable New Zealanders are jailed for their medical use of cannabis. I will list some cases for members’ benefit. In 1999 a tetraplegic was jailed for 12 days for possession and cultivation of six small seedlings. His treatment in prison was despicable, including not being toileted for days. In 2003 a paraplegic man who used cannabis to control painful muscle spasms was sentenced to 150 hours of community service after police found two small seedlings in his home. The judge told the man he would face prison if he was found with cannabis again. In 2004 an amputee confined to a wheelchair for 30 years received a second jail sentence for medical use and possession of cannabis, and again was told by the judge that his jail time would get longer should he be caught again. He was badly assaulted while in prison.
Other patients report having their homes invaded and being robbed regularly by those who know they grow cannabis for medical use and know they are unable to fight back because of their illness. Those New Zealanders cannot turn to the police for assistance, and they continue to suffer in fear of reprisals and imprisonment—all because they have found a medication that will relieve their chronic pain. They need to use it because the alternatives are much worse. Indeed, the Ministry of Health recently reported to the Health Committee that cannabis has a wider safety margin, with fewer short-term side effects, than analgesics currently prescribed for chronic pain and disease; that medicinal cannabis appears effective and safe in all age groups; that the risks of a fatal overdose are very small, with no deaths reported in the medical literature; that the long-term effects of cannabis use are minor compared with the long-term use of benzodiazepines or opiates; and that cannabis can be a real alternative to those patients who need it.
New Zealanders should have the opportunity to present their views to Parliament. The people who are like the people in the examples I described earlier should be able to tell their stories to MPs. Those opposed to the bill should be able to present their concerns. I ask MPs simply to allow the bill to proceed to select committee so that the public, doctors, parents, patients, and families can have their say.
I have heard a number of concerns about the bill. A doctors’ survey carried out in 2003 about medicinal cannabis showed that lung damage from smoking it was a real concern of doctors. I will make the point first that for those New Zealanders whose conditions are terminal, who are soon to die in pain, the health risks of smoking are meaningless if the drug relieves their suffering during the remaining stages of their lives. But for all other patients—and there are others—there are many different forms of ingestion that have very few negative health effects. I have one constituent who uses a tea, because if he consumes his cannabis in any other way it is too strong and he cannot cope with it. Others use various forms such as tinctures, and massage oils can be rubbed into damaged muscles and into amputated stumps in order to relieve pain. With good information doctors are able to work through the various options for use that work best for the patient. In terminal cases, surely compassion has to be the dominant concern.
Patients do not want the euphoric effects of medicinal cannabis; they simply want to be free of the perpetual pain that confines their lives. They just want to be able to do the normal things that other people do. Doctors are the experts on medications, not members of Parliament. According to our doctors’ survey, 6 percent said they had recommended that their patients try cannabis, 10 percent said they currently had patients they believed would benefit from it, and 32 percent said they would prescribe it if it were legal to do so. Why anyone would prevent patients who suffer from chronic pain from disease from accessing an effective medicine with few side effects is beyond me. In fact, I consider it an act of cruelty for this Parliament to deny ill New Zealanders the best medication for them as prescribed by their doctors.
In asking only that this bill be allowed to proceed to the select committee, I finally note that if the bill were enacted, New Zealand would not be a world leader or a trailblazer. In fact, it would be following the example of 13 states in the US, and Canada, Spain, the Netherlands, and other countries that have a process for the provision of medicinal cannabis and whole-plant material. A number of members have expressed other concerns about the bill, but I assure every member of this House that we are open to all views, considerations, and amendments to the bill. That is what we expect to be the outcome of the select committee process, and we would welcome those contributions.
The medicinal use of cannabis is gathering increasing support and recognition around the world in communities just like those in New Zealand and in families just like those in New Zealand. Patients just like those in New Zealand are using medicinal cannabis in a way that is controlled and managed by their doctors and by the bureaucracy and ministries of health because it is the best possible medication for those people. Communities just like ours are choosing patients over politics, and compassion over cruelty. I ask that the MPs of this Parliament choose likewise. I commend the bill to the House.
Hon Dr JONATHAN COLEMAN (Minister of Immigration) : Well, that was a very well-thought-out contribution from the Green member Metiria Turei. I see that the Misuse of Drugs (Medicinal Cannabis) Amendment Bill has been on the Order Paper for the past 3 years. Indeed, I am sure that the Green Party is very excited to hear it being debated in the House today, but I wonder whether we are really having the debate that Green members want to have. I question whether their concern is really about the medicinal applications of cannabis or more about trying to bring cannabis into the mainstream as an accepted part of New Zealand society. I have to state up front that in this conscience vote I will oppose this bill for a variety of reasons. But I find it interesting that Green members want to promote this issue very specifically in this debate.
I have the greatest sympathy for those living in chronic pain. There is no question that when we look through new schedule 4, inserted into the Act by clause 13, we see that many people with a variety of syndromes really are in need of good medical care, and they demand the sort of analgesia, or pain relief, that will give them very real relief. But I do not believe that the correct path for those people would be to give them access to unprocessed cannabis, as this bill would allow.
It is true that when the active ingredient of cannabis, THC, is extracted, it certainly has analgesic properties, and there are various preparations of that. A drug called Sativex is available through the Ministry of Health, with ministerial approval, and has that pain-killing or analgesic effect. But to propose through this bill to allow people who are debilitated by pain from various syndromes to have access to unprocessed cannabis, I think, is quite a misguided approach to the issue. I accept that the member Ms Turei has the best of intentions, but I cannot help feeling that there may be a wider, underlying Green Party agenda here.
Be that as it may, it has been stated that this bill aims to amend the Misuse of Drugs Act 1975 to enable cannabis to be used for medicinal purposes. The bill allows people to be registered as users of cannabis for medicinal purposes. It also allows registered users or a designated agent to cultivate and possess a small amount of cannabis for the registered user—and I will elaborate on that a little bit later.
The range of conditions specified in the new schedule 4 is quite an impressive array. It ranges from the chronic effects of end-stage HIV infection, through to migraine, multiple sclerosis, and nausea associated with cancer chemotherapy—all of which are very important and debilitating syndromes, indeed. But we can also see some other conditions being proposed that cannabis be approved for. There is asthma; quite frankly, smoking cannabis for asthma is not the right treatment. I do not know how that ever ended up in this schedule. Cannabis would be the last thing we would want an asthmatic to have access to. Depression and mental illness are also listed. The use of cannabis for the treatment of depression and mental illness, as I think most health professionals would tell us, is completely contraindicated. In respect of many clinical patients suffering from depression and mental illness, psychiatrists and mental health nurses would be in general agreement that cannabis use makes those conditions worse.
Metiria Turei: Do you disagree with the UK medicinal cannabis research foundation, Mr Coleman?
Hon Dr JONATHAN COLEMAN: It does make it worse. Schizophrenia is on the list. That is a psychotic illness. For people who have dealt with patients suffering from serious psychotic illness there is no question that access to cannabis is often a co-factor in the development of that illness—in the way it plays out—and is completely contraindicated for people with that sort of affliction.
There is clearly some looseness about this bill, and maybe it needs more thought as to what the possible uses of medicinal cannabis may be.
But I think there are other issues with this bill, too. I could not help but be struck by the notion that the police would be expected to distribute cannabis seeds to holders of Medicinal Cannabis Identification Cards. Really, I am not trying to be flippant about this, but the police have enough to do. The bill also proposes that cannabis seeds seized in drug raids—in raids on people who have been growing marijuana—are then redistributed to people who have a use for medicinal cannabis. I do not think the police will think that that is a particularly good idea, and I certainly do not think the public will want to see public resources used for that purpose.
There is also the issue of who will be the agent for, or the cultivator of, the cannabis. Will there be an agent who is allowed to cultivate cannabis en masse for a number of people with afflictions that need treatment? I mean, it sounds to me like a pretty impractical regime. The member talked before about the problem whereby people growing cannabis at home find they are targeted by people who want to break into the house, steal the cannabis, and sell it or smoke it. I do not see how making cannabis use legal will deter people from being targeted by those who want to get hold of their dope. So I think there are some fundamental flaws here.
The member said there is no problem with long-term marijuana smoking; I think that is a commonly mis-held belief in society. When we look at the research, we find that marijuana smoking is 10 times worse in terms of lung cancer risk than cigarette smoking is. It is actually a factor in depressive illness. I think many members here have known of people who have used marijuana over the long term, and have seen the effects on some of those individuals in terms of a lack of ability to get on with their lives. I am not saying that everyone who smokes marijuana has been afflicted like that, but we cannot make out that marijuana use and smoking are good things. There is no question about that. I think we have to be quite clear that we need fewer drugs in society, and by passing this bill we would be sending a signal that marijuana smoking is OK.
Hone Harawira: Get rid of alcohol and cigarettes, then.
Hon Dr JONATHAN COLEMAN: Look, alcohol is a major problem in society as well, but we are talking here about cannabis; we are not talking about medicinal alcohol. This is the medicinal—
Hon Lianne Dalziel: She said smoking for terminal illness—be fair.
Hon Dr JONATHAN COLEMAN: Well, if we are talking about terminal illness, then I invite the member to look at the new schedule 4. We see a lot of stuff there that does not relate to terminal illness.
Hon Lianne Dalziel: Yes, I know, but you’re referring to smoking; she only referred to smoking for terminal illness.
Hon Dr JONATHAN COLEMAN: No, this is what the bill says. This is one of the problems with this bill, though: it is extremely loose. Members have to admit that. There are holes right through this bill. The member cannot bring this bill to the House and expect that it will get widespread support. I can tell members that if they took this bill outside the House, they would find that it is not the sort of legislation the public want this Parliament to be focusing on.
The member talked about the survey of 500 doctors and their attitudes to prescribing medicinal cannabis. It should be noted that 70 percent of those doctors did not want to have anything to do with it. I can see the problems doctors will be faced with. People will go to their doctor and say: “Doctor, I’ve got terrible pain. There’s nothing that can be done for it. Will you please prescribe me medicinal cannabis?”. I can tell members that the demand will be overwhelming for this stuff. Every chronic patient who will claim to have tried everything will want medicinal cannabis. But it is not the way ahead; the way ahead is through reasoned research to extract the active ingredient THC and to put it in a form of medication that can be titrated against the pain level. To say that a dose of THC can be administered in a metered spray or oral form, that someone’s level of pain is appropriate to justify medicinal cannabis, and that we can titrate that against that pain—that is the sensible way to go. But to give someone a licence to cultivate cannabis, and to have it in its unprocessed form for his or her own personal use, is not appropriate for the medical conditions described in the bill, and it is not the way ahead.
Metiria Turei: Will you subsidise Sativex?
Hon Dr JONATHAN COLEMAN: The member cited a range of research. She will note that I did not interject on her speech; I actually listened to her arguments. We happen to have a different point of view. My view is quite firmly that I will not be voting for this bill. It will be interesting to see what the final vote count is.
The ASSISTANT SPEAKER (Eric Roy): I am sorry. I meant to inform members that we are now on to 5-minute calls, with a 1-minute bell.
Hon LIANNE DALZIEL: I am very keen to explain why I intend not to support this bill, and, in doing so, I want to congratulate the member Metiria Turei whose name the bill is in on bringing the matter before the House, and to say that I totally support the underlying intention of the bill. If the bill had done all that the member said in her address it would do, I would support it 100 percent.
The reason I do not want the bill to go to a select committee is that the Law Commission is holding a review on the Misuse of Drugs Act at the moment. That is not a reason in itself for legislation not to proceed. If the bill was in a different form, I would support it. The bill will require people who agree with the underlying principle, as I do, to make extensive submissions on a bill that needs to be entirely rewritten, for a number of reasons that the Minister of Immigration spelt out. It is simply not fair on those who are represented on both sides of the wider drug debate that that occur. There will be people putting their effort into the Law Commission review, and that is certainly where I think the effort should occur, although I would be very happy to assist and to work with other members in the House, including the member who has proposed the bill, to come up with a form of bill—if this bill does not make it to the select committee this time—that addresses the issue that has been raised.
The reason I do not agree with this particular bill is that it introduces a complex regulatory framework, with a Medicinal Cannabis Registration Board being established to issue the Medicinal Cannabis Identification Card and the Designated Agent Identification Card. I have printed a copy of the Sativex document, “Requirements for Physician Application-Approval”. Doctors have to apply for it. It has to be signed off by the Minister of Health. As I understand it, five people only have had applications approved under this particular method. I think we can improve upon this, and I personally think that, on a general practitioner’s prescription, we should be able to have access to this kind of medication, which does as others have already commented.
In this bill the designated agent is required to prove himself or herself to be of good moral character. I totally object to that phrase being included in any law, let alone this law. We have taken the phrase “good moral character” out of a lot of laws over time, and I do not agree with it being inserted in this one. The requirement on the police, as the Minister of Immigration has said, to supply cannabis seeds to cardholders or their designated agents—seeds that they can supply only from stock seized during law enforcement activities—creates issues of concern.
Finally, the inclusion in new schedule 4, inserted into the Act by clause 13, in the schedule of conditions that are specifically contraindicated for cannabis use and, of course, mental illness is a potential exclusion criterion for the use of cannabis medicine in table II of the form that I have referred to. It states: “increasing evidence suggests that excessive or chronic use of cannabis is linked to psychosis and that it may exacerbate the symptoms of schizophrenia or precipitate this condition.” I personally think that if we looked at table I of this form, which details inclusion criteria, we would find the sorts of conditions that ought to be covered. To be honest, in the nearly 19 years that I have been in Parliament, I have never received a single letter from a constituent asking that cannabis not be made available to a constituent suffering from a chronic or terminal illness. The specific chronic disease states or terminal illnesses spelt out in the inclusion criteria include nausea, anorexia, and wasting associated with cancer and AIDS; chronic pain for which other pain relief is ineffective; neuropathic pain associated with a variety of conditions; and muscle spasms etc. associated with MS or spinal cord injury. Those are the sorts of changes that I would like to see brought before this House. If that were to occur, I would support the bill.
Dr PAUL HUTCHISON (National—Hunua) : Thank you for the opportunity to speak on this Misuse of Drugs (Medicinal Cannabis) Amendment Bill. In many respects Metiria Turei may be applauded for representing her constituency, but I do have many concerns about this bill. There are many tens of thousands of medical practitioners, nurses, and caregivers around the world who are extremely concerned about alleviating pain and the best ways to do that. It is important to point out that successive parliaments have spent considerable time on cannabis use, and medicinal cannabis use. For instance, in 2002-03 the Health Committee, and the Hon Steve Chadwick was chairman at the time, had an extensive inquiry into public health strategies related to cannabis use and their most appropriate legal status. More recently, the Health Committee has responded to a petition of Chris Fowlie, who requested that Parliament give urgent consideration to changing the law to allow individuals to obtain, possess, and use cannabis for the treatment of serious medical conditions when this has been endorsed by their registered medical practitioner.
I think it is important to reiterate the conclusions of the select committee, which were that we do not support changing the law to allow individuals to use the natural cannabis plant to treat specific and serious conditions when traditional methods have failed. We note that there is pharmaceutically based THC derivative medicine available by application to a general practitioner. Concern was expressed that this cost up to $15 a day, and that should be looked at. There were also two further recommendations: that the Government instruct the Ministry of Health to update the prescribing guidelines for pharmaceutically based THC derivative medicines to include Sativex as a medicine under the Medicines Act 1981 and to continue to make pharmaceutically based THC derivative medicines available to treat serious medical conditions when traditional methods have failed.
But I am concerned at the explanatory note in Metiria Turei’s bill. I believe it is not solid or evidence-based. She says that scientific research is now verifying anecdotal evidence that cannabis is a safe and effective medicine. That is not good enough. I absolutely agree with the Hon Jonathan Coleman’s comments about new schedule 4, in clause 13 of the bill. When we turn to schedule 4 we read that asthma, and pain, perhaps of any sort, would be included in the regime within this bill. Undoubtedly smoking cannabis is certainly absolutely inappropriate for someone with asthma. I had a prominent Wellington physician tonight point out how conditions like nail-patella syndrome are absolutely rare and there are many other options to treat it with. When one looks at new section 9B, “Medicinal Cannabis Identification Cards”, in clause 10, and the requirement in 9B(1)(b) to have “the written support of his or her medical practitioner or medical specialist;” one must recall just recently the striking off of the medical register of Dr Rhys Cullen, who abused his privilege. There is room for abuse in this bill by inappropriate prescriptions, and I agree that the provision in section 12, “Supply of cannabis seeds” by the police, will also be particularly cumbersome.
When one goes through the literature, one sees in TheLancet in July 2004, in the European Journal of Cancer more recently, and in the Journal of Pain in 2008, some of the most prestigious writers on this subject in the world. I quote from a randomised placebo-controlled crossover trial of cannabis cigarettes in neuropathic pain. The conclusion of those doing the trial was that no sound scientific studies supported the medicinal use of cannabis. They pointed out that over 111 compounds were identifiable in smoked cannabis, including several potentially harmful hydrocarbons. However, they saw the sense of carrying out similar trials in the future using vapourised, deliverable therapeutic doses. It is very important that we keep searching for evidence-based ways to alleviate pain, but I do not believe that this bill is a suitable instrument with which to do it.
Hon RUTH DYSON (Labour—Port Hills) : I begin my contribution to this debate by saying that the Green Party has had an extraordinarily high amount of good luck with members’ bills lately. I do not know what it is those members are doing, but if they could spread it around just a little it would be greatly appreciated.
I want to acknowledge Metiria as the member in charge of this bill. I think it can be really difficult when one has inherited a bill, particularly after such a long period of time. This bill has been hanging around for ages. As Dr Hutchison just alluded to, there have been debates at the Health Committee on two occasions on the issue of pharmaceutically based cannabis, and this bill has stayed to the side of those.
The Health Committee inquiry 5 years ago was quite rigorous, and I hope that my colleague the Hon Steve Chadwick is able to take a call. She chaired that committee, and I know that within our caucus we certainly had a lot of very useful and intelligent debate on the issue. As Dr Hutchison noted also, our select committee has just referred back to the House a petition that did not go as far as this bill has intended but certainly recommended changes to the current regime.
A lot of people do not realise what the current position is in relation to the regime around the medicinal use of cannabis in New Zealand. Sativex is available on prescription from a general practitioner and when endorsed by a specialist. The Health Committee recommended that the threshold for accessing Sativex be reduced. It is horrifically expensive. If people have been ill for quite some time, they are unlikely to be in paid work—even part-time work, let alone full-time work—so their finances are depleted. They already carry the huge burden of illness and pain, and on top of that we charge them like a wounded bull.
Our select committee felt unanimously that that was unfair and meant that the only pain relief or the only relief from nausea for many people was just not available. It is financially inaccessible. We suggested that the Medicines Act be amended to include Sativex so that it could be available on prescription from a general practitioner and would not need that higher level of endorsement.
Although most people talk about the primary purpose of medicinal cannabis as being pain relief, it is also very useful in easing muscle spasms. That is a very common condition and one that is very hard to treat otherwise, and it can have a very detrimental effect on the quality of life for people. As my colleague Lianne Dalziel mentioned, it is also an appetite stimulant on some occasions for some conditions.
So in New Zealand we already have pharmaceutically produced cannabis-based medicines. This bill is saying that that regime is quite onerous and quite expensive. Sativex is expensive in terms of accessing general practitioners and specialists, and it is also expensive to access literally as a nation. Other countries have looked at this issue and said: “Well, why don’t we just have the right for people to grow their own cannabis for medicinal purposes?”, and that is really what this bill proposes.
I agree with my colleague Lianne Dalziel that if the member had the opportunity to quietly rip up the bill, start again, and submit a newly drafted bill, I am sure the member may have done it. But it is not beyond the ability of the select committee—I have seen it done on many occasions—to throw out the entire bill except for the point of it, and rewrite it in language that members of the select committee are all comfortable with and, certainly, have learnt on the basis of the submissions.
Likewise, in respect of the other point my colleague Lianne Dalziel made in regard to the Law Commission review, I do not think it would be beyond the ability of the select committee—as a member, I would certainly support it, and I think Dr Hutchison would as well—to park this bill until the Law Commission results were progressed a bit, and then, having heard what the Law Commission is doing, progress this bill. Is it way out of keeping? It may be the case that the Law Commission looks at it and we could just pick up those submissions and learn from them, or the commission may look at it rigorously and decide it is not something we should progress.
In my view, Parliament should never be afraid of a controversial debate. We should never be afraid to learn from international evidence and from what other countries are doing, even if we disagree with them. I will support the referral of this bill, with all its faults, to a select committee, because I am not afraid of the controversy around that debate.
DAVID GARRETT (ACT) : I was not going to speak on the Misuse of Drugs (Medicinal Cannabis) Amendment Bill, and I was going to save my vote as a surprise at the end, but I have found myself unable to resist the temptation to rise to speak to it after hearing the contribution from Metiria Turei and after what has occurred over the last couple of days.
Like other members, I am sure, my BlackBerry has been buzzing since last Monday with exhortations from various people, dozens and dozens of them, about the anti-smacking bill—the child discipline bill. But I have received just as many from the thousands and thousands of amputees, cancer victims, end-stage HIV sufferers, and others who exhort me to support this bill. I find that rather amusing.
Metiria Turei managed to get through her speech—10 minutes, I think—with a completely straight face. She had this House believe that this bill is all about the medicinal use of cannabis. In dozens of other arguments since I have been here, the Greens have given us dire warnings about the thin end of the wedge, and measures that were supported by both major sides of the House found obstacles over there because they were the “thin edge of the wedge”. Not on this one, though.
Let us take Tasers as an example. Members on both sides, with various degrees of caution, see the use of Tasers as a good alternative to being shot, but the Greens see it as the police going around terrorising everyone and extracting confessions from people on the ground. But, apparently, the provisions in this bill will not go any further than cancer victims, end-stage HIV sufferers, and amputees.
Todd McClay: And people without appetites.
DAVID GARRETT: Yes, indeed.
But having said all of that, on a matter of principle I intend to support the bill, because I think that bills should always go to a select committee. Ms Dyson probably will not appreciate my support, but the arguments she made a second ago make plenty of sense. The select committee process is valid, things come out of it, and I have confidence that if the bill was to get to a select committee, the idea that cannabis is a treatment for psychiatric illness would very quickly emerge as a ludicrous one.
I have a close friend in Taranaki who is a psychiatric nurse, and she has talked to me about the young people in the psychiatric ward of Taranaki Base Hospital. She told me every single one who has acute psychosis has problems with cannabis use. In respect of asthma, well, cannabis was used for that in the 1920s. I was not around in the 1920s, but Indian hemp, as it was then called, was a recognised treatment for asthma. We now have much better things. My young boy has asthma and he has a puffer rather than a joint.
But having said all of that, I think that, on principle, as I have said, bills, especially members’ bills, should have the courtesy of being sent to select committee for examination. For that reason alone, I intend, for myself, to support the bill at this stage.
RAHUI KATENE (Māori Party—Te Tai Tonga) : The Misuse of Drugs (Medicinal Cannabis) Amendment Bill is essentially about allowing registered medical practitioners to prescribe cannabis to those with certain serious medical conditions such as cancer, arthritis, or Alzheimer’s disease. There would not be a Māori in Aotearoa who has not felt the force of those conditions, so one would think that we would look at this bill with considerable sympathy. Indeed, just a couple of weeks ago I lost my mother as a result of Alzheimer’s, so I know only too deeply the agonising ordeal for individuals and their whānau in enduring the impacts of these illnesses. Anything that can make our loved ones’ lives easier comes within our gaze, and we know there are some pretty compelling reports in medical journals around the world that support the medicinal properties of cannabis, especially with pain relief, anti-spasticity, and anti-nausea.
That research provides a strong basis for supporting the use of medicinal cannabis where other therapies have failed for people with very debilitating diseases and where the delivery mechanism is safe. That is where the Māori Party starts to become unstuck. Studies show the effectiveness of treatment when cannabis is applied in the form of tablets or an oral mucosal spray; it is generally well tolerated and its short-term use is safe. There are other methods: the use of tinctures, inhalers, and vaporisers can be used to manage the delivery of medicinal cannabis. But the reality is that we know that the most readily available form of cannabis would be through smoking it, and that is where the Māori Party has objections that cannot be ignored.
There is a host of evidence showing that the health effects of smoking cannabis are similar to smoking tobacco, as the inhalation of smoke from any organic material is the harmful activity. A New Zealand study conducted last year found that regular cannabis use increases the risk of lung cancer. In essence, cannabis smoke contains the same cancer-causing substances, or carcinogens, as tobacco. However, cannabis cigarettes do not have a filter, so more of the tar reaches the lungs. In addition, people inhale cannabis smoke for longer than cigarette smoke—contrary to a certain US President. Part of the attraction or the addiction, I understand, is to get the full effect of the cannabis, but that means the smoke is in contact with the lungs for longer. Therefore, there is a greater respiratory burden because cannabis smokers inhale more deeply. There are other side effects associated with smoking marijuana, not the least being the range of its adverse respiratory effects such as a chronic cough, recurrent bronchitis, and a significant impairment of lung function. Cannabis smokers are significantly more likely to experience heart complications, including heart disease and sudden cardiovascular death. In a report published just last month in the Chemical Research in Toxicology journal, research indicated that, as with tobacco smoke, cannabis smoke damages the DNA and increases the risk of lung cancer and other cancers.
We are genuinely conflicted about this bill. Of course we would not wish anyone to suffer the pain of chronic illness without having effective relief. I would have done anything for my mother, but she would never have picked up a joint. Neither would I have wanted her to, for many reasons other than pain relief; many of those reasons would have been about her mokopuna and my mokopuna. We believe that marijuana’s future as a medicine must not involve smoking it. We cannot ignore the fact that access to and legal possession of marijuana by adults for medical reasons can model exposure and access to use by children and adolescents. The issue of managing access to cannabis will always be enormously risky. The Māori Party has always believed that if we, as a nation, are truly committed to whānau ora, we must address the social hazards that create such havoc on our health such as tobacco and cannabis smoking. We fully accept that cannabis is well known as a smooth muscle relaxant, and it is useful for certain conditions and in some pain therapy, but we will never agree that smoking is an acceptable means of delivery for any medicine. On those grounds, the Māori Party cannot support this bill.
KEVIN HAGUE (Green) : It gives me great pleasure to stand today and speak in favour of Metiria Turei’s Misuse of Drugs (Medicinal Cannabis) Amendment Bill. I hope that other members of the House, regardless of their views on the separate issue of decriminalisation of cannabis, will also feel able to support it.
Members may be aware that I worked for the New Zealand AIDS Foundation for 10 years, including 5 years as its executive director. During that time I became very aware that many people who are living with HIV and AIDS, possibly most, had found that cannabis was an effective medicine for them, whereas other medicines had failed. Those people used it for that purpose, often with the blessing, either explicit or tacit, of their doctor. I also have a lot of experience with people with spinal injuries, and exactly the same situation applies. Many other members of this House will also know people with chronic and debilitating conditions who have used cannabis in the same way and for the same reasons. In my AIDS Foundation role I was lobbied by people living with HIV and AIDS to do more to try to achieve access to cannabis for medicinal purposes. I very much regret that I was not able to do more to advance the issue from that role.
The principal reason given for the illegal status of cannabis generally is that it poses health risks to the user, and that point goes to those arguments made by the previous speaker, Rahui Katene. The HIV and AIDS field has seen us have the need to advance our thinking on many fronts, and one of those is in the idea of catastrophic rights. It is obvious, really, that in the case of people facing very serious consequences of their illness, such as those to whom this bill would apply, the normal rules we have to protect them from harm should be suspended. This doctrine is normally applied to allow such patients to access new drugs that are still in experimental phases and have not yet been proven to work or to have no harmful effects. But it applies even more to cannabis, where the risks are known and are known to be relatively minor.
I was in California last year and was very struck by the green pharmacies now dispensing medicinal cannabis, which I had not seen even a few years ago. That reflects a growing international consensus that cannabis should now be available as a medicine. Now it seems we also have a growing consensus in New Zealand on the benefits of cannabis for medicinal purposes. I sit on the Health Committee, as do Paul Hutchison and Ruth Dyson, who have previously spoken. We recently reported on Chris Fowlie’s petition. The Ministry of Health told the select committee that evidence supports the medicinal use of cannabis for the treatment of serious medical conditions when traditional medicines have failed, providing a broad spectrum effect. The ministry said that toxicity associated with excessive doses is unlike that for other analgesics currently prescribed for chronic pain and disease, in that it has a wider safety margin with fewer short-term side effects and minor long-term effects, compared with current drug regimens. The ministry also told us that medicinal cannabis appears effective and safe in all age groups. That is on the basis of the ministry’s literature review, not on the basis of the single study that Paul Hutchison mentioned.
The remaining question, then, given there is consensus of benefit, is how best to provide access for patients. The committee has recommended that pharmaceutically derived THC derivative Sativex is brought under the Medicines Act to allow general practitioners to prescribe it without specialist endorsement. That would be a good step forward. It also opens the door for it to be considered for subsidy by Pharmac. It would be great to hear from Government members today on how the Government will progress the select committee’s recommendation, but I have not heard that yet. The select committee also expressed concern that, as things stand, with no subsidy, costs could restrict access for some patients.
It may be that it was not appropriate for the committee to take things to the next logical step but it would be appropriate for this House to do so. If there is clear evidence of benefit and improved quality of life for seriously ill and dying patients, and it has less risk than the currently available treatments—which are also less effective, but cost is a barrier to the version produced by pharmaceutical companies—then, for goodness’ sake, let us allow those who meet the criteria to access the natural product. In the minds of members, on this issue logic will be grappling with fear. Logic says “Support the bill.” Please be brave.
NICKY WAGNER (National) : I rise to oppose the Misuse of Drugs (Medicinal Cannabis) Amendment Bill, but firstly I wish to congratulate Metiria Turei on getting the bill drawn from the ballot. The Greens always seem to be particularly lucky when it comes to member’s bill ballots. I know that many Green Party supporters will be keen to see this bill passed.
The legalisation of marijuana has been a long-time Green policy, and although it has not been acknowledged recently, everyone knows that the Greens would like to see marijuana made legal. I say “everyone” because time and time again when I visit schools, kids tell me that they support the Greens. When I ask why, I am told that it is not because they are interested in the environment, and it is not because they support or even really have any knowledge of the Greens’ policies. They tell me that they support the Greens so “we can smoke dope legally, Miss”, and that is the problem with this bill.
At first glance the use of cannabis by the chronically ill when they find all other medications unsuitable sounds practical and sensible, but it is not quite that simple. Ross Bell from the Drug Foundation said in the Dominion Post this morning that this bill is not a debate over the change of the legal status of marijuana and that it is not a backdoor attempt to legalise marijuana, because there will be tight controls over the dispensing of cannabis for medicinal use. Again that sounds sensible, but tight control is hard to achieve.
Most New Zealanders would like to see tight control on cannabis, full stop. We all know the dangers of the drug, particularly for young people, and it is very difficult to control. It is even harder to achieve tight control. There are dozens, maybe even hundreds, of legal drugs that can be used to treat sick people without having to legalise a highly prized, illegal, recreational drug and to provide for it to be grown for personal use. I would be more sympathetic to the situation if there was not any alternative to unprocessed cannabis for medicinal purposes, but there is. Sativex is a pharmaceutically based mouth spray that can be used by a patient when all traditional treatment options have failed.
In 2008 the Health Committee reviewed the present situation and concluded that the law should not be changed to allow the possession and use of unprocessed cannabis for medicinal purposes. The Health Committee recommended that Sativex be listed as a medicine under the Medicines Act 1981. That means that it could be prescribed by a general practitioner without any need for specialist support, and I and National support that recommendation.
The advantage of Sativex is that it is a quality-controlled product. It can be prescribed in a measured dose, and because it is a mouth spray it has no harmful side effects. It is a useful medicine for those who have trouble taking more traditional products, and I know people who are using it very successfully. It is particularly suitable for managing HIV and AIDS, and spinal injuries. It is used in the care of Alzheimer’s and for pain management. It is being used successfully, and that is a positive step.
Sativex is the only cannabis-based product available presently on the market. There are over 60 active therapeutic compounds in cannabis, and there is increasing interest from scientists in creating unique new medicines from the cannabis plant. National would support any innovation in this area. But I struggle with this bill. I feel that the medicinal path is really a red herring.
All prescription medicine of any type needs to be controlled and dispensed in a safe, reliable, and consistent manner. This bill suggests that seriously ill people should grow their own medicine. Is that really where we want our health system to go? I can imagine the outrage if we suggested that people grow their own penicillin on top of their jam. Sick people deserve better than that. I support the use of Sativex and also the development of new cannabis-based drugs.
Hon STEVE CHADWICK (Labour) : I am pleased to take a call, because I think members’ days are particularly interesting days. It is great to see the number of members who have come down to the House on this issue, which has made some of them sit in their seats and squirm a little bit. I thank them for coming down and listening to the debate, because often the debate changes people’s perspective and their point of view on this issue.
As our health spokeswoman, Ruth Dyson, said, I chaired the cannabis inquiry in 2003. It was quite a different inquiry then. It was an inquiry into the public health strategies related to cannabis use and the most appropriate legal status. But we did have a recommendation back to the Government—and Labour was in Government at that time—that cannabis is among a number of substances that we should look at for medicinal use. We got a response from the Government to say that this work was under way, and we were closely watching what was happening in the UK at that time with a pharmaceutical preparation. It was great to know that, ultimately, that has come into the country and patients can be prescribed Sativex.
We have heard tonight about how complex that process is for patients and how expensive it is for them. I will definitely support this bill being referred to the Health Committee tonight. I think is it is a poorly written bill, but I know from previous bills that have been before the Health Committee that good members on the committee who are not pharmaceutical experts but politicians in the House listen to evidence that comes before the select committee and can turn around an improper and rather clumsy bill to make it so much better.
I want to point out two issues in schedule 4. People have expressed surprise at how some of these conditions are seen to benefit from medicinal cannabis and the therapeutic use of cannabis. I am the national patron for a terrible condition called Guilain-Barre syndrome, where patients are paralysed but suffer the most extensive pain that is cruel to watch. Some of those patients are paralysed but suffer dreadful pain and are unable to go on opiate derivatives because it depresses their respiratory tract, and that is of extreme danger to them. Some of those patients have mentioned that cannabis has helped them enormously to get through that terrible acute pain phase. The same applies to those with multiple sclerosis who get terrible spasms of their body and find it hard to find another pharmaceutical drug that helps them so much. It also applies to amputees who get phantom pain and after the amputation are screaming with pain in a limb that is no longer there. Pain clinics struggle to find some sort of pain relief for those people, yet we have a product that those who have used cannabis say has completely taken away those acute pain symptoms that give them no quality of life.
We are not medical experts in this House. But I did like the now sponsor of the bill, Metiria Turei, saying that as politicians we should show some compassion and that we should also look at alternatives. We have Sativex, and that is great, but we should also be doing the right thing for the public of New Zealand. I believe in the principle, as David Garrett said, of taking this to a select committee. I say to Mr Garrett that we find some strange bedfellows in some debates.
I think, as well, that this raises issues in relation to the need to review drug law and drug policy. This country is calling out for a comprehensive review of drug policy. I am glad we will receive the Law Commission report.
If we deny the public of New Zealand the opportunity to submit on a bill like this, we close down community conversations. We close down raising public awareness of an issue that in this case I do not believe is a wedge issue, as some members have said tonight, to legalise marijuana. It is nothing to do with that.
METIRIA TUREI (Co-Leader—Green) : I thank members for their contributions this evening. I thank those who have agreed to support the Misuse of Drugs (Medicinal Cannabis) Amendment Bill or the principle behind the bill. We are talking about sick New Zealanders, those who suffer, and taking a compassionate approach to their needs, as opposed to a bigoted or prejudiced approach about the issue of cannabis in general.
I will address some of the issues that have been raised. It is true that cannabis issues have been debated in the House comparatively regularly, and that is because no action has been taken. Nothing has really changed. Until something changes to provide relief to those patients—frankly, the registration of Sativex in itself is not enough—we will continue to bring these issues before the House, because sick people deserve our support and compassion. The fact that Sativex might be registered in this country and available to patients does not mean that they can access it. It might mean that those who are wealthy are able to access it, but those who have been ill for some time and have had serious income issues as a result of that illness are not. People should not suffer simply because they are unable to afford the best medicine that is available to them, when there is an alternative that is cheap, accessible, and controlled and managed by a doctor in accordance with the conditions of that person’s illness. All this bill asks for is that medication that will work for a patient and is managed by a doctor be available to that patient in an accessible way.
There were concerns about the list of conditions that the legislation applies to. I understand the concerns and why they were raised. I note, though, that the list of conditions was based on the list that was provided in 2001 by the UK’s Medicinal Cannabis Research Foundation. It includes depression and mental illness, as well as the conditions listed in the bill. The inclusion of those conditions was based on evidence and research that had been conducted elsewhere. I also remind members that I have said—and will continue to say—that the Green Party and I would be open to appropriate amendments to the bill, if the bill were to go to the select committee. We could have that discussion there.
There is no doubt that cannabis is an effective medicine. The research has proved it. A 2005 British survey of 500 HIV/AIDS patients found that a third of them used cannabis for symptomatic relief, and more than 90 percent of them said that medicinal cannabis reduced their nausea, improved their appetite, and resolved their muscle pain and other symptoms. Research in 2005 found that four out of every 10 Dutch patients who had prescriptions for medicinal cannabis used it to treat multiple sclerosis or spinal cord injuries. A 2002 British survey of multiple sclerosis patients found that 43 percent used medicinal cannabis, and that 67 percent would use it if it were legal. Because they were frightened of the law, they were not able to access this medicine that would be advantageous for them.
I note the concerns of the Māori Party as to the delivery of the medicine. I reiterate that there are other forms and methods of delivery that do not involve the inhalation of hot ash and smoke—for example, the use of tinctures, which for some conditions are much more effective. There are ways of ingesting cannabis through the stomach, whether it is in a tea or in some other edible form. That method can be much more effective for some patients. The use of vaporisers and inhalers is available for whole plant material. Both those options are available.
Finally, the public support the bill. Sixty-three percent of New Zealanders polled in a TV3 survey said they supported the provision of medicinal cannabis to patients.
Our community needs our help. There are people in our community who are in serious, daily pain that prevents them from living any kind of decent life. The only thing that prevents them from having access to relief from that pain and suffering is that this Parliament will not allow the debate on the issue to be heard. So I ask MPs again: all we seek is that the bill goes to a select committee so that those patients, their families, and their doctors can talk to us and provide information, research, and evidence, which we can consider.
|Ardern J||Fenton (P)||Kedgley||Robertson G|
|Beaumont||Fitzsimons||King A (P)||Roy H (P)|
|Chauvel (P)||Harawira||Moroney (P)||Twyford (P)|
|Cunliffe (P)||Hide (P)||Norman (P)|
|Adams||Dean||Key (P)||Shanks (P)|
|Anderton (P)||Dunne (P)||King C (P)||Sharples (P)|
|Ardern S (P)||English (P)||Laban (P)||Sio|
|Auchinvole (P)||Finlayson||Lee (P)||Smith L (P)|
|Bakshi (P)||Flavell (P)||Lotu-Iiga||Smith N|
|Barker (P)||Foss (P)||Macindoe||te Heuheu (P)|
|Bennett D (P)||Gilmore||Mahuta||Tisch (P)|
|Bennett P (P)||Goff (P)||Mallard (P)||Tolley (P)|
|Borrows||Groser (P)||McClay||Turia (P)|
|Bridges (P)||Guy (P)||McCully (P)||Upston|
|Brownlee (P)||Hawkins (P)||Nash||Wagner|
|Calder (P)||Hayes (P)||O’Connor (P)||Wilkinson|
|Carter D||Heatley (P)||Parata||Williamson (P)|
|Carter J||Henare (P)||Parker (P)||Wong (P)|
|Choudhary (P)||Horomia (P)||Peachey||Woodhouse (P)|
|Collins (P)||Huo (P)||Quinn|
|Cosgrove (P)||Hutchison||Ririnui (P)|
|Curran (P)||Joyce (P)||Robertson H (P)|
|Dalziel (P)||Katene (P)||Roy E||Teller:|
Motion not agreed to.
The result corrected after originally being announced as Ayes 34, Noes 86.