Page 3772 - Week 12 - Tuesday, 18 October 2005
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The evidence of benefit in these conditions is not strong, however, and recent studies have uncovered more serious side effects associated with regular cannabis use, such as worsening of psychosis and depression. For this reason, increasing the availability of cannabis for medicinal use must be done carefully and with caution.
The use, possession, sale, supply and cultivation of any quantity of cannabis are illegal in the ACT, but cannabis can be obtained. The simple cannabis offence scheme allows police to issue a fine if households are found to be growing one or two plants naturally. On payment of the fine, no conviction is recorded. A synthetic cannabinoid, nabilone, is also available legally through the commonwealth government special access scheme at a cost of $120 per 20 capsules. This equates to less than one week’s supply.
There are five options for improving the value of cannabis for medicinal use in the ACT. I will take the opportunity now to outline these options to members, including the advantages and disadvantages, along with a summary of the key issues in relation to each option.
The first option open to the territory is to continue with the current situation, but improve access to nabilone by providing specific funding to appropriate persons. Improving access to nabilone would allow those with severe and intractable symptoms, for which a cannabis product may be beneficial, access to a safe supply that does not require smoking. Studies in the 1990s showed that nabilone was more effective at relieving nausea and vomiting than the available alternatives. However, since that time new drugs have become available that are more effective than nabilone. A palliative care specialist in the ACT who has experience with patients who have used nabilone for the treatment of nausea, vomiting and pain due to cancer has found that it is often not effective.
Another option is to participate in a New South Wales trial of cannabis, if it occurs. Late in 2004, the then New South Wales Premier met with the commonwealth Minister for Health and Ageing to discuss proposals for either importing or cultivating medicinal cannabis for a New South Wales trial. On 3 May this year, the New South Wales government indicated that the preferred option for supplying cannabis for medical use remained the provision of a pharmaceutical cannabis-based product such as Sativex. Sativex contains two extracts of the Cannabis sativa plant provided as a spray to be used under the tongue. Sativex has not yet been approved by the UK regulatory agency, but further studies have commenced and results are due in 2006.
A third approach is for the ACT to move to exempt medicinal cannabis use from prosecution. Examples of exemption of cannabis use from prosecution exist at present in New South Wales, for possession only and for a maximum of two occasions, and the Netherlands, where possession of up to five grams for personal use is not prosecuted. Allowing exemption from prosecution for possession and/or cultivation would allow eligible patients to smoke cannabis.
Cannabis smoke consists of a variable mixture of cannabis derivatives, carcinogens and other toxic substances. Smoking cannabis for many years to relieve symptoms associated with chronic life-long conditions, such as multiple sclerosis, would expose patients to significant risks of serious health problems, such as cancer. For this reason I do not recommend this option. Legislation that authorises people to use cannabis for medical purposes, but does not control or provide a legal supply may be interpreted as endorsing
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