Why it is time to deal with medicinal hashish as a substitute remedy, not a pharmaceutical

The recent approval of two domestically manufactured cannabidiol (CBD) oil products – non-intoxicating cannabis compounds – may have given patients new optimism with cannabis formulas. The slow progress in product approval had led some patients to fear that they would have to go to the black market.

But these new approvals are little consolation for the majority of people who continue to self-medicate with illegally sourced cannabis, including through “green fairies”, personal networks, drug dealers, or through their own cultivation.

Many of them are precisely the communities that have primarily advocated the legalization of medical cannabis, but which currently remain outside of the meager legal system.

After years of anticipation and 18 months since the Medicinal Cannabis Scheme (MCS) was set up, many who use cannabis medicinally are still missing out.

Affordability and persistent problems with accessing prescriptions are part of the problem. There is also a lack of clinical studies to prove the effectiveness of cannabis in treating many diseases.

But, given the equity and fairness of the whole system in question, a different approach may be needed. In particular, should we start thinking about medical cannabis as an alternative therapy rather than a pharmaceutical drug?

Slow progress and guilt

It has been four years since the government announced its “commitment to make medical cannabis more available,” and nearly three years since an amendment to the Drug Abuse Act allowed the Department of Health to regulate the MCS to develop.

The regime was opened to product applications in April 2020, with local industry working on certification and product development. Extensions of the “transition period” were decided in order to continue the sale of products imported from overseas. However, this ended abruptly on October 1, leaving only four Canadian products approved under the MCS available in New Zealand pharmacies.

Domestic manufacturers made slow progress due to regulatory thresholds, which were almost as tough as pharmaceutical products. In response, the health minister accused the industry of not working hard enough to meet these standards.

In the meantime, patients and prescribers have few legal products to choose from.

Lack of clinical evidence

Five percent of New Zealanders use cannabis for broadly defined medicinal purposes, with pain, sleep, and anxiety being the most common conditions. However, evidence of the effectiveness of cannabis in these disorders from scientific and clinical studies remains limited.

For decades, international drug treaties banned the study of the potential medicinal properties of cannabis. But while more clinical studies are needed, the safety profile of medical cannabis – especially the non-intoxicating CBD products – is good and well tolerated.

Read more: CBD, Marijuana, and Hemp: What’s the Difference Between These Cannabis Products and Which Are Legal?

Even so, many doctors are understandably reluctant to recommend and prescribe cannabis-based products.

Our survey of over 3,600 medical cannabis users found that only one in three patient inquiries for medical cannabis prescriptions was successful. Other researchers have only found a 20% success rate.

This is unlikely to change until double-blind, gold-standard, placebo-controlled studies demonstrate the effectiveness of cannabis-based products in certain health conditions.

A restrictive regime

The stigma and reputational risk of discussing cannabis use with medical professionals also discourage patients from requesting a prescription. Studies with medical cannabis users found that patients hide their cannabis use in order to avoid moral judgments in the relationship between provider and patient.

Read more: Cannabis products are sold as sleep aids – here’s the evidence of their effectiveness

In addition, not everyone will benefit equally from the new prescription medical cannabis products. Our research suggests that the current system favors pākehā and higher income individuals.

In contrast, those on lower incomes, Māori, and those who grew their own cannabis for therapeutic use were the least likely to be involved in the MCS.

This tends to reinforce the perception that the new prescribing regime is too restrictive, bureaucratic and expensive.

Read more: Medical cannabis for the treatment of chronic pain? We have no evidence that it works

The way forward

At this point, reshaping the policy debate on alternative therapies could benefit both patients and the medical community.

Similar to what we already do for a number of dietary supplements, the non-intoxicating cannadiol products could easily be made available without a prescription and pharmacy. This is already happening in jurisdictions in the US and the EU.

By classifying medical cannabis as an alternative therapy, there is the potential for patients to be more open about their use to their GPs. Allowing patients to grow their own could also bring more justice to the system.

Above all, this would recognize the patients’ right to therapeutic self-determination and increased access, and would exempt doctors from prescribing “drugs” for which in many cases there is no clinical trial evidence.