In December 2018, the New Zealand parliament passed a bill to create a regulated market for medicinal cannabis and a legal defence for users who take the drug for palliative reasons. Under the Misuse of Drugs (Medicinal Cannabis) Amendment Act, the government has until December 2019 to establish a regulatory system that will allow cannabis to be cultivated and prescribed medicinally in New Zealand – though cannabis products containing the psychoactive substance tetrahydrocannabinol (THC) will still be illegal. However, two professors at the University of Otago, Michelle Glass and John Ashton of the Department of Pharmacology & Toxicology, have written an article for the New Zealand Medical Journal arguing that a closer look is needed at the government’s regulatory scheme. Louis Laws spoke with Michelle Glass about their concerns regarding the medicinal cannabis plan.
Michelle Glass is a Professor in Pharmacology at the University of Otago. She is an expert in the molecular pharmacology of cannabinoid receptors.
John Ashton is an Associate Professor in Pharmacology at the University of Otago. He is an expert in cannabinoid research.
This interview has been edited for clarity and length
Louis Laws: What is your main concern with what the government is proposing?
Michelle Glass: Our argument at the moment is that the term ‘medicinal cannabis’ is used very broadly and actually to refer to a wide range of products. I use the term ‘product’ loosely because some of them are not really products: everything from raw cannabis plants through to actual pharmaceutical medicines are being called medicinal cannabis. We are saying that ‘medicinal’ has a specific meaning. To be a medicine [there is] a whole set of standards wrapped around it, and we just think it is a little bit dangerous to start loosening those standards. Drugs and medicines of any type have adverse effects, they can have unwanted activity, we have these standards to try and protect patients so I guess we are just saying lets really think about what we are doing here.
LL: You say New Zealand has a clear framework in terms of how it defines the standards of pharmaceutical drugs and other classes – how does this accommodate cannabis in its own class?
MG: There is not a new class yet, but the fact that we are developing regulations around access to medicinal cannabis says that there needs to be a new class and that will presumably be in place by December. And so what we are saying really is that we know what a medicine is, we know what is in it, we know how stable it is, we know how it should be stored, we know if it works and who it works for and who shouldn’t take it and that sort of thing – all of that has been presented and has been analysed by the people within the Ministry of Health to say ‘Yes, this is a medicine that we would approve for use in New Zealand’. We [believe we should] use that existing framework.
LL: What are the potential issues in determining these regulations for medicinal cannabis?
MG: It depends on your perspective, really. There are already cannabis-derived medicines that have used this framework. In New Zealand at the moment, that only applies to Sativex but we know that there are other drugs coming from overseas at the moment that are working through [US Food and Drug Administration] approval and that sort of thing. So it is likely that in New Zealand there would be other actual medicines that are derived from cannabis, but what seems to be being talked about here is perhaps something that is less than one of those. Some of the submissions to the medicinal cannabis panel were suggesting people might grow their own – there is no other medicine that we say grow your own for.
LL: There is no way to really gauge or regulate the outcome from those products is there?
MG: There is no idea what you are actually having and if you are going to ask a doctor to prescribe something I think they need some certainty around what that product is.
LL: How do we regulate other pharmaceutical drugs? As you were saying there is a framework and a criteria that they need from the pharmaceutical drug itself, can these regulations be applied in the same way to cannabis or does it need a whole other regulation behind the product?
MG: I don’t think there is anything particularly unique or special about cannabis. I don’t know why we would treat it as different to any other medicine.
LL: How do you propose we regulate cannabis in a medical sense?
MG: I don’t actually see that anything needs to change. We have already got cannabis-based medicines approved by Medsafe in New Zealand so I don’t see that we need a whole other set of regulations that would allow something less than those to be prescribed. There is a lot of talk about people wanting to develop a New Zealand industry and that would need some change in regulations because right now I don’t believe you could get a license to grow and produce and so that would need to change. But that is at the very early end of the process and we are talking about what are we asking a doctor to prescribe and that should be a medicine.
LL: What do the media get wrong when it comes to talking about medicinal cannabis?
MG: I guess what always bugs me is that the term ‘medicinal cannabis’ is used to cover everything from hemp plant extract though to pharmaceutical grade products that have gone through the clinical trials and meet all of the regulatory standards. And these things are so far away from each other. With medicinal cannabis, there is no one thing that is medicinal cannabis so it shouldn’t be used as a catch-all for everything. I think part of the problem we have right now is getting a feeling for where the public sits because no survey that I have seen actually defines what they mean by medicinal cannabis.
LL: Why is it important that we are discussing this issue when it comes to regulating medicinal cannabis use now before anything happens? Why is it important that we get this conversation going and that people know the caution behind medicinal use?
MG: Well the regulations need to be in place by December. When the bill got passed last December it had a clause in it that this would be in place by this coming December. This is coming in one form or another, so now is the time to be discussing this and to ensure people are aware of what the issues are.
LL: What are some of the potential issues we might face if this is not addressed?
MG: I think it comes from both perspectives. I think we have a group of patients who are currently accessing black market products and they are looking for an alternative, and then we have doctors who want to be able to prescribe something of known quality. And so I think we stand really to make nobody happy, we are going to go one way or the other and make nobody happy. There is no easy solution to this, I think, but it is a bit of a slippery slope once you start declaring something as a medicine that isn’t; what else would we be opening the door to? So that really needs to be protected and we really need to think carefully about whether this is the time to be making an exception to what is a medicine.
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