The Hon. Sandra Kanck introduced the Controlled Substances (Palliative Use of Cannabis) Amendment Bill to the South Australian Legislative Council twice in 2008. The first occasion was 23rd July. This is the second reading speech.
Wednesday 23 July 2008 LEGISLATIVE COUNCIL
CONTROLLED SUBSTANCES (PALLIATIVE USE OF CANNABIS) AMENDMENT BILL
The Hon. SANDRA KANCK (16:36): Obtained leave and introduced a bill for an act to amend the Controlled Substances Act 1984. Read a first time.
The Hon. SANDRA KANCK (16:36): I move: That this bill be now read a second time. This bill proposes that fines be waived for the personal cultivation and use of marijuana for people suffering designated medical conditions. This would be on the proviso that a medical practitioner has signed a palliative cannabis certificate to indicate that the person is suffering from a specified illness or disease, the symptoms of which might be palliated by the smoking or consumption of cannabis or cannabis resin. The certificate would:
(a) certify that the person has a specified illness or disease;
(b) describe the symptoms;
(c) declare that in the doctor’s opinion the use of cannabis would palliate those symptoms;
(d) state that the doctor has discussed with the patient the risks associated with the use of cannabis; and,
(e) prescribe the amount and method of administration and the period of time for which the use is recommended.
Such a certificate would be valid for a maximum of one year, but it could be revoked earlier by the doctor. The doctor would be required to provide the minister with a copy of the certificate within seven working days of issuing it, and similarly provide advice if it has been revoked.
Given that in South Australia cannabis is a controlled substance and is illegal under normal circumstances, under this legislation the medical practitioner is given protection so that they would not be subject to legal disciplinary proceedings by virtue of issuing a certificate if they did it in the form prescribed in the bill. Failure to provide the appropriate advice to the minister would attract a fine, and any false or misleading statements made by a doctor in relation to any of the above could see them imprisoned for two years or fined up to $10,000. The bill also provides for the sale of approved equipment for the consumption of cannabis to a person who holds a palliative cannabis certificate.
Cannabis is a drug that has been referred to in literature in all cultures. It was being used in China as a herbal remedy 5,000 years ago; in the US the 1896 edition of the Pharmacopeia had 20 pages devoted to its uses; and until 1934 cannabis was widely used in pharmaceutical preparations in the US. Queen Victoria is said to have used it to relieve period pain.
The Howard government produced a booklet that was issued with the ‘Tough on Drugs’ stamp on it. It came from the commonwealth Department of Education, Science and Training. The booklet is called Cannabis and consequences: Parent brochure/information booklet, and it gives a little (dare I say it) ‘potted’ history of cannabis, as follows: Cannabis is relatively new to modern Europe, possibly introduced by Napoleon’s army returning from Egypt around 1800. Cannabis was known to early civilisations in China, India, Mesopotamia and Egypt from 4,000–2,000 BC. Used as an analgesic and sedative, cannabis was one of the earliest known medicines. After its intoxicating properties were discovered it appears to have been used in rituals. The plant was first used as a fibre for making cloth, rope and paper. Known as Indian hemp, the cannabis plant was a commercial crop in the United States until the 1930s.
Cannabis use was progressively restricted in the Western world between 1890 and 1940. The 1931 League of Nations convention, which sought to limit the production of opium, also banned other drugs including cannabis and cocaine.
I suppose the question that needs to be answered is that, given it was used so widely in the past and then made illegal in so much of the world, why is there a demand for it now? I think it is because we all respond differently to medications. I use aspirin for headaches but if you give me paracetamol it does nothing for me; when I have been in hospital and have been administered pethidine the first thing I experience, within a matter of minutes, is nausea and vomiting. However, simply because I have those reactions does not mean it should not be prescribed for anyone else.
It is because of the different responses to drugs that cannabis should be part of our palliative armoury. There are some people with conditions that cannot be alleviated with the normal range of chemically-synthesised drugs. Some of these conditions include multiple sclerosis, and up to 30 per cent of people in Europe who suffer with multiple sclerosis use cannabis to alleviate their symptoms. A British study showed that the use of cannabis by MS sufferers resulted in improvements in their walking speed, reduction in muscle spasms, pain relief, and better sleep.
People who have nausea and vomiting associated with chemotherapy, as well as people with body wasting because of AIDS, find that the effect of cannabis is to suppress the nausea and vomiting. It can only be good for people trying to recover from cancer if they are able to hold down their food and get some nutrition into their body, and the effect of cannabis for people who have AIDS is to restore the appetite which, again, gives their body that capacity to fight off the impact of HIV. Other conditions that can be assisted are glaucoma, depression, bursitis, control of seizures, and neuropathic pain associated with spinal cord injuries. There are other conditions associated with spasms, but not particular illnesses, that people tell me can also be alleviated.
Again I turn to the booklet produced by the Howard government. Under the heading, ‘Are there any medical uses for cannabis?’—and, remember, this is the government that said it was tough on drugs—it reads:
Some cannabis users report that cannabis helps them relieve the symptoms of medical problems. In 2000, a NSW government report concluded that cannabis could be useful for certain medical conditions, and recommended more research should be conducted. The report suggested that cannabis may be most useful for the following conditions:
- pain relief (analgesia), for example in people with cancer;
- nausea and vomiting, particularly in people having chemotherapy for cancer;
- wasting, or severe weight loss, in people with cancer or AIDS; cannabis may help increase the person’s appetite and relieve their nausea; and
- neurological disorders; cannabis may be useful in relieving the symptoms of multiple sclerosis, spinal cord injury and other movement disorders, because it helps relieve muscle spasms.
One of the short-term effects of THC in cannabis is to expand the airways in the lungs, helping people who have asthma; however, cannabis users may develop tolerance to this effect.
As with all drugs, there is a potential for side-effects, and the use of cannabis for medical conditions, just as with other drugs, needs to be tightly controlled.
One of the websites I visited that advocates the use of medical marijuana has this disclaimer in relation to medical marijuana: There is no pharmacological free lunch in cannabis or in any drug.
Negative reactions can result. A small percentage of people have negative or allergic reactions to marijuana. Heart patients could have problems even though cannabis generally relieves stress, dilates the arteries and in general lowers diastolic pressure. A small percentage of people get especially high rates and anxieties with cannabis. These people should not use it. Some bronchial asthma sufferers benefit from cannabis; however, for others it may serve as an additional irritant.
It is important to remind ourselves that each year in Australia there are approximately 19,000 deaths from the use of tobacco, 2,000 from alcohol and 1,000 for all other illicit drugs combined. Paracetamol kills 400 people per year, and even aspirin causes more deaths than cannabis. In fact, ABS figures do not show up cannabis as causing any deaths. In the UK, recent figures show that 114,000 people died from tobacco usage in one year, 22,000 from alcohol usage and 16 from cannabis usage.
We need to recognise potential dangers, but we need to get things into perspective. In terms of this question of how safe cannabis is, I address the question of a link to psychosis. There is not anywhere in any of the literature a causal link between cannabis and psychosis. Certainly, there is evidence that shows that some people who are psychotic have a tendency to self-medicate with cannabis and, of course, that is interesting in itself because there is an ingredient in cannabis called CBD that inhibits psychotic symptoms among schizophrenics. It may be, in fact, that they have cottoned on to that and are using it to effectively alleviate some of their symptoms.
Dr Syril D’Souza who is from Yale University co-authored an article with Dr Asif Malik also at Yale University published on the website psychiatrictimes.com, and I will read part of that, as follows: If cannabis causes psychosis in and of itself then one would expect that any increase in the rates of cannabis use would be associated with increased rates of psychosis. However, in some areas where cannabis use has clearly increased, e.g., Australia, there has not been a commensurate increase in the rate of psychotic disorders. Further, one might also expect that, if the age of initiation of cannabis use decreases, there should also be a decrease in the age of onset of psychotic disorders. We are unaware of such evidence.
I indicate to members that the AMA, to whom I provided a copy of the draft bill, has rejected the bill because of safety concerns, but what I find interesting about that is that there do not appear to be the same concerns in relation to prescribing drugs that come from chemical companies. So, I want to look at some of the drugs that our medical practitioners already legally prescribe. For instance, there is Strattera for ADHD. Side-effects of that include suicidal thoughts, weight loss, chest pain and swollen testicles, but doctors still prescribe it.
In relation to Viagra (I got this off the VicHealth website) it states in relation to side effects: You may not get any of them but tell your doctor or pharmacist if you notice any of the following and they worry you:
- nasal congestion,
That is not so bad. Then it goes on: Tell your doctor as soon as possible if you notice any of the following:
- unusual heartbeat,
- urinary tract infection, stinging or burning urine, more frequent need to pass urine, blood in the urine,
- changes in vision such as blurring, a blue colour to your vision or a greater awareness of light,
- persistent headache or fainting,
- bleeding from the nose.
Then it gets better: If any of the following happen, tell your doctor immediately or go to Accident and Emergency at your nearest hospital:
- signs of allergy, such as shortness of breath, wheezing or difficult breathing, swelling of the face, lips, tongue or other parts,
- chest pain,
- sudden decrease or loss of hearing,
- seizures, fits or convulsions.
Very rarely your erection may persist for longer than usual. If your erection continues for four hours, or sooner, if there is pain, you should seek medical attention urgently.
Rarely, men have lost eyesight some time after taking drugs to treat erectile dysfunction…it is not known at this time if Viagra causes this. if you lose eyesight in one or more eyes, seek medical attention urgently.
This is not a complete list of all possible side-effects; others may occur in some people and there may be side-effects not yet known.
So, these are some of the side-effects of Viagra and doctors continue to prescribe it.
Benzodiazepines are drugs that are often used for sleeping tablets and to calm people. From the website benzo.org.uk, according to Professor Malcolm Lader: Five per cent of those using benzodiazepines may be affected by so-called ‘paradoxical’ reactions in response to the drugs rather than the desired tranquilliser defects. Such reactions include increased aggressiveness (in some individuals even violent behaviour), depression (with or without suicidal thoughts or intentions) and sometimes personality changes. In some instances, reactions such as hallucinations, depersonalisation, derealisation and other psychiatric symptoms occur.
Five per cent of people are put on these drugs and doctors still prescribe them, despite the sideeffects.
There has been a lot of research into the effect of benzodiazepines and the relationship with hip fracture in the elderly. Research on that by Eileen E. Ming at Harvard University states: In long-term care sessions where 45 to 70 per cent of residents fall each year, 1,600 falls occurred per 1000 person years. By the way, that is compared to the rest of the population, which is 224.
It continues: One to two per cent of falls result in hip fracture, and the risk of hip fracture increases almost 100-fold from age 60 to 64 to 80 to 84. In the year following a fracture, there is a 23 per cent mortality rate, compared to an expected 8 per cent; 50 per cent of the ambulatory lose the capacity to walk independently; one-third of the community-dwelling require long-term nursing care; and many are incapacitated by the fear of falling again…BZDs— benzodiazepines— have been found to impair basic psychomotor function and postural sway in normal volunteers, a side effect which lasts at least through four weeks of continuous use; impairment increases with dose…Sedatives slow reaction time and reduce coordination and alertness…protective responses at the time of a fall may be too late to prevent a hip fracture. So, here we have another drug that amongst the elderly in particular has some quite catastrophic side effects in terms of losing balance and falling and hip fractures. The range of increased risk is between 1.5 and 5.8 times compared to those not using psychoactive substances.
Thalidomide is another very dangerous drug. I am sure most people will recall that in the 1960s it was prescribed to prevent morning sickness in pregnant women, and many of those women subsequently gave birth to children with deformities. It has now been rehabilitated, so to speak. It still causes those effects, which are pretty disastrous, but it is being prescribed by doctors now for blood cancer and leprosy.
Among the drugs that doctors prescribe—I believe justifiably—is morphine, because it has a very important role to play for the relief of extreme pain. But everybody knows what morphine in its illegal forms can do. In relation to this whole question of harm, the US Institute of Medicine concluded: Except for the harms associated with smoking, the adverse effects of marijuana are within the range of effects tolerated for other medicines.
Let us look at what is happening in other countries. There are places in the world where there are no laws at all about cannabis, such as Bangladesh and, in Belgium, it has been decriminalised. Obviously, no legislation is needed to allow the medical use of cannabis in those countries.
At the present time in the United States, 12 states—Alaska, California, Colorado, Hawaii, Maine, Montana, Nevada, New Mexico, Oregon, Rhode Island, Vermont and Washington—have removed criminal sanctions for possession of marijuana if it is used to relieve medical conditions. Michigan will vote on a medical marijuana initiative later this year, and a bill was introduced in the Ohio legislature last month.
In terms of the application of the law in those 12 states, some give out ID cards to the users. Most state laws are silent about the procurement of marijuana; whether users can grow it themselves or buy it from somebody and, if so, from whom. In New Mexico the governor himself introduced legislation which envisaged a state licensed and protected system of cannabis production, and that was passed last year. Regulations to allow this are now being prepared, and at least 150 people have already formally applied to be able to use the drug. In addition to the state’s involvement, both patients and carers will be able to grow their own cannabis.
Polling back in 1995 showed that two-thirds of Americans believe that medical marijuana was justified. Proposition 215 in California, which brought about the decriminalisation of marijuana for medical use, got a strong 56 per cent of the vote. In California, hundreds of medical marijuana dispensaries are now offering assorted varieties for sale and providing advice about which varieties are best for differing medical conditions. Cannabis dispensaries were never authorised: they just sprang up.
The Bush administration has been trying to stop regulation for their legitimisation, and threats have been made to arrest state legislators if they proceed down this path. Doctors do not prescribe under California law; rather: they write a statement saying that they think it is okay for a particular patient to use cannabis, which is similar to the proposal in my bill.
Despite all the foregoing, US federal law still prohibits the growing, possession, supply or use of cannabis for medical purposes. The DEA can, and does, conduct raids in states where medical
marijuana has been decriminalised. However, this year a bill has been introduced by former presidential candidate, Ron Paul, to make it legal at the federal level.
In Israel, cannabis is being used on a limited basis to treat PTSD in former soldiers. Additionally, trials are taking place in many other parts of the world. The Israeli Health Ministry grows marijuana which it gives away to more than 150 registered patients with cancer, AIDS or chronic inflammation of the intestine. The facility is being expanded, and consideration is being given to distribution through government-approved hospitals and perhaps private pharmacies where it could be sold.
In Canada, federal government regulations, under the Controlled Drugs and Substances Act, allow people with certain illnesses to apply for permits to possess and/or grow marijuana for personal medical purposes, or to designate another person to grow it for the person who has the permit. All usages must be prescribed by physicians. The symptoms covered are: severe nausea, cachexia, anorexia, weight loss, persistent muscle spasms, and seizures or severe pain associated with any of the following medical conditions: cancer, AIDS, HIV infection, multiple sclerosis, spinal cord injury or disease, epilepsy and severe forms of arthritis.
In the Netherlands, there is a medicinal program that allows pharmacies to sell standardised quality-controlled marijuana from authorised growers to sufferers of chronic or terminal diseases, such as multiple sclerosis, HIV/AIDS, neuralgia, cancer and Tourette’s syndrome. It is a program that is not working very well because cannabis coffee shops are able to sell cannabis at a cheaper rate than pharmacies. The Netherlands is having second thoughts about the program because they are simply not able to compete.
There is a lot of support, and growing support, for the use of medical marijuana here in Australia with organisations like the Country Women’s Association (who see particularly that it could be used for people who are experiencing the effects of chemotherapy when having cancer treatment); the New South Wales Cancer Council; the AIDS Council of Victoria; and, here in South Australia, the South Australian Voluntary Euthanasia Society.
I mentioned that the South Australian branch of the AMA told me that it does not support my bill. However, in the letter it sent to me, it provided a copy of the AMA’s national policy which does not say that it is against the use of medical marijuana; rather, it says that there needs to be more research. I want to read that particular part of the AMA position statement (as it calls it) into the record. The AMA position is as follows:
1. The Australian Medical Association does not condone the use of cannabis for non-medical purposes—it is a harmful drug.
2. The Australian Medical Association believes that cannabis use, as with all licit and illicit drug use, needs to be viewed in terms of social determinants and the social gradient, whereby people living further down the gradient are at greater risk of drug harms.
3. The Australian Medical Association considers cannabis use to be both a health and social issue.
4. The Australian Medical Association considers cannabis to be a drug that causes a range of health and social harms at the individual and community level.
5. The Australian Medical Association supports a harm reduction approach to cannabis use.
This is a fairly long policy and, in fact, there are nine pages of it, so I will not read it all out. However, under the heading Medical Use of Cannabis, it states:
26. The Australian Medical Association considers cannabis may be of medical benefit in:
HIV-related wasting and cancer-related wasting; and
Nausea and vomiting in people with cancer, undergoing chemotherapy, which does not respond to conventional treatments.
27. The Australian Medical Association believes that more research needs to be undertaken to determine the medical benefit of cannabis in:
Neurological disorders including (but not limited to) multiple sclerosis and motor neurone disease; and
Pain unrelieved by conventional treatments.
28. The Australian Medical Association supports research to examine whether cannabinoids provide any greater benefit than the newer antiemetics.
If anybody wants to see a complete copy of that, I will be happy to provide it to them.
In the United States, support has come for medical marijuana from the United Methodist Church, the Episcopal Church, the United Church of Christ, the Union for Reform Judaism, the Progressive National Baptist Convention, the Presbyterian Church and the Unitarian Universalist Association.
In introducing this bill, I ask members to exercise common sense and compassion when determining their position. In relation to common sense, I quote US presidential candidate Barak Obama who, when recently asked if he became president would he halt the Drug Enforcement Administration’s raids on medical marijuana growers in Oregon, replied: I would, because I think our federal agents have better things to do, like catching criminals and preventing terrorism. The way I want to approach the issue of medical marijuana is to base it on science and, if there is sound science that supports the use of medical marijuana, and if it is controlled and prescribed in a way that other medicine is prescribed, then it is something we should consider.
A man whose friend died from cancer wrote to me. He stated: During her illness she asked me for some cannabis, which I took to her…this personal experience showed me that cannabis really does provide relief from cancer. It is my deepest regret that I could not take her more and of better quality. In her last weeks she was bedridden and hardly able to move and her body withered away and her stomach bloated. These are the effects of morphine. Diagnosis came too late for her but, with cannabis, she could have lived a little longer with a higher quality of life, but prohibition deemed that she live in suffering and die an early death in a morphine-induced narcosis, as a state-sponsored morphine addict. To allow someone to die by withholding their medicine is no different to holding someone under water and preventing them from having air.
The war against marijuana is ideological; it is a matter of what substance fits with what set of values. In the West there is a view that nature is bad and synthesising is better. It is time for us to consider the use of medical marijuana as part of being a humane and compassionate society. If we know that a substance works by improving the health of people and we continue to deny access to it, particularly when so many people use it illegally without any bad effect, then there is something else driving the argument—and it is certainly not science.
In a civilised society, debate on drugs should not be about criminality or belief systems but about health. Bit by bit the demand for medical marijuana is growing and, bit by bit around the world, the medical efficacy of this drug is being recognised. This is the second time that legislation for medical marijuana has been introduced to the South Australian parliament, and I am sure it will not be the last, given the phoney ‘tough on drug’ stance of most members of this parliament—most of whom drink alcohol and less of whom smoke tobacco. However, like the vote for women, it is an idea whose time has come and, eventually, such legislation will pass.