Associate Health Minister Peter Dunne open to medicinal marijuana

Associate Health Minister Peter Dunne told TVOne’s Q+A programme that he’s open to the possibilities cannabis based medicines offer.

“I think it would be a really good thing if we could get clinical trials in New Zealand, because that way we can work through exactly what the formulations might be, what the product should look like and who the patients who it will benefit could be, because at the moment we’ve got very general talk. We talk about medicinal cannabis. Actually, there’s no such thing. There’s medicinal cannabis products. And I think it would be very, very good to get some much more specific and scientific evidence about the efficacy before we can make decisions,” Mr Dunne said,

Both Mr Dunne and medicinal marijuana campaigner Toni-Marie Matich said there was still a stigma attached to cannabis based products.

RAW DATA: Simon Dallow interviews medical marijuana campanigner Toni Marie Matich and Assoicate Health Minister Peter Dunne

Watch the full interview here.

SIMON Toni-Marie has a daughter with severe epilepsy and decided to break the law to treat her with cannabis oil for two years, so I started by asking her what effect it had.

TONI-MARIE It had a 50% reduction in her seizures and the most sustained reduction in her seizures and an improvement in her quality of life for almost two years.

SIMON And then what happened?

TONI-MARIE And then it stopped working.

SIMON As far as you’re concerned, if there was an appropriate product available, it would be beneficial to her?

TONI-MARIE I can’t really make that claim, because I am unsure. Her condition is progressive, and it is intractable, and it does build up a tolerance to medications. Normally, that would occur within three to six months, but this didn’t occur till close to two years, so that interests me from the medical and scientific perspective.

SIMON But you have a belief in the possibilities of a medicinal marijuana product?

TONI-MARIE Yeah, I do. Obviously there are therapeutic benefits. She has Dravet syndrome, and it is a subset of patients, and this is a treatment that’s known to work for that particular condition. Whether it works for any others or all the ones that are claimed to, we don’t know enough about.

SIMON Peter, how open are you to the possibilities of cannabis-based products?

PETER I think it would be a really good thing if we could get clinical trials in New Zealand, because that way we can work through exactly what the formulations might be, what the product should look like and who the patients who it will benefit could be, because at the moment we’ve got very general talk. We talk about medicinal cannabis. Actually, there’s no such thing. There’s medicinal cannabis products. And I think it would be very, very good to get some much more specific and scientific evidence about the efficacy before we can make decisions. That’s not the problem in New Zealand. The New Zealand problem is people being willing to undertake the trials.

SIMON Why aren’t they?

PETER It’s essentially a commercial decision by the pharmaceutical companies. They don’t see the likely market for products as being big enough in New Zealand, so why conduct trials here? It’s the New Zealand condition all over again. There are other possibilities we’re looking at, but there’s not a regulatory impediment to that happening. It’s really just getting a process in place that would work effectively. That’s why we’ve taken the view that we’re looking quite closely at the prospect of trials, and it’s only just at this stage in Australia or the United States.

SIMON We are small fry, aren’t we? What’s happening in those countries? Surely they’re further down the track than us.

PETER Yes and no. The Americans have some trials being undertaken at the moment, but they’re not likely to be concluded for a little while yet. The Australians, contrary to all the publicity flair last week, have only just announced that they’re going to make it possible to cultivate cannabis for trial purposes. Their process is probably two to three years away at least. We will follow that closely, and if there’s an opportunity for New Zealand to be a part of that, we will certainly pursue it. But the evidence at the moment, frankly, from right around the world is that this process is occurring very, very slowly.

SIMON How can we accelerate that?

PETER That’s the difficulty. We need people to come forward with products. And there aren’t actually that many products that have been proposed. There are some in the stages of development, some that, as I say, are likely to go to test in various markets. From New Zealand’s perspective, we’re open to the science, we’re open to the issues, and we’re open to… Effectively, if the United States’ FDA, for instance, or the TGA in Australia were to approve products, it’s highly likely we’d follow suit.

SIMON Let me just clarify that, then. So this clamour for medicinal marijuana products is there, the demand is there, but the supply isn’t. Simply, the products aren’t available.

PETER The products that have been developed historically have focused on epileptic seizure conditions and pain relief. They’re the two major areas. Now, there’s a lot of talk about other conditions that might benefit. At this stage, we have Sativex, which is available in New Zealand on prescription. It’s not available elsewhere universally. We have a product called Epidiolex, which is about to go to test. There’s only about three other products of pharmaceutical standard worldwide that have been prepared – one’s available in Jamaica, only for eye conditions; one’s in Germany and has been withdrawn; and there’s a Dutch product likely to go to testing shortly.

SIMON And at this stage in New Zealand, Sativex is the only product approved for usage, but every usage has to be approved by you.

PETER No. Sativex can be prescribed by a doctor. It then needs the formal approval of the director-general of health. I am not involved in Sativex decisions. What I think you’re thinking of is there is a provision under the Medicines Act that applies to all medicines, not just medicinal cannabis products, where if a person’s doctor and specialist have exhausted all other avenues of treatment and believe that there’s a particular preparation that would work for their patient and they can satisfy the Ministry of Health that that’s the case, a recommendation comes to me to make that available. There’s only been one such instance of that.

SIMON This is the Alex Renton case?

PETER Yeah, that’s the only time it’s ever happened.

SIMON He had 40 alternative treatments that didn’t work for him, and then a cannabis-based product was approved. You approved that product usage, didn’t you?

PETER Yes.

SIMON But you also said there was no compelling evidence in its favour.

PETER That was the recommendation I received from the Ministry of Health. It said, ‘We don’t think this product necessarily will do any good for him in his condition, but we’re very confident it will do no harm.’ I thought that was a sufficiently strong reason to approve the availability.

SIMON And, Toni-Marie, this is something you’ve been pushing for, isn’t it? Compassionate use.

TONI-MARIE Yeah, so, our organisation does have a large database. We’re heading over 10,000 people now. Not all of them are patients. There’s carers and their parents. But what they’re seeing is they’re seeing this global epidemic of medical cannabis. They’re seeing the Charlotte Figi stories, and they’re seeing the cure cancer stories. There’s lots of those about, but when you look into it, and I’ve been looking into it for four years – and I do have a science and horticulture background, so I’m very sensible on this – it’s actually only a small subset of individuals that the International Cannabinoid Research Society have identified as therapeutically benefitting. So it’s not a cure-all, and there really does need to be some balance.

SIMON You’re talking about a long lead-in time for these products to get to market. How long are you prepared to wait for your daughter, though? You want it to be evidence-based, I know this. You want conclusive answers, don’t you?

TONI-MARIE Yeah, I do, and it’s not just about her. It’s about really sick, vulnerable people, and when you’re in that position, you don’t make the most logical decision, and they need to understand we don’t know. The evidence and the research is still evolving. To what degree it will work for any one person, we don’t know. And there are contraindications, and there are side effects. And our MC specialists in California and Colorado at the Canna-Centers, one has 200 patients, another has about 600. People come in there, sometimes it just doesn’t work for them; other times there’s side effects and contraindications, and it’s a trial and error, as with any other medication. So it’s not as broad as everyone thinks it is therapeutically.

SIMON What would you like to see the government do, though?

TONI-MARIE Well, we’re planning to run a national symposium on medical cannabis in April. We want to see government officials, organisations with patients that approach them, the science and medical fraternities attend and really start balanced, mature discussion about what’s the climate for medical cannabis in New Zealand, what’s the actual, factual data in relative to compassionate grassroots, you know, the people, but also with respect to the medical and political frameworks. There are no regulations in the States. Australia saw that legislation get dragged through Parliament kicking and screaming, and they can’t agree on whether it’s going to go through the TGA or who’s going to grow it.

SIMON It’s bogged down, isn’t it?

TONI-MARIE They’re years away. We’re in a unique position to take all those negatives and positives and set our own platform and tone in New Zealand and have a global standard, and that’s going to take time; it’s not something we want to rush.

SIMON But we want this to happen as quickly as possible, surely. Is the whole debate being held back by the values of a different era? Is it the stigma associated with cannabis?

TONI-MARIE Absolutely. We’ve written to and approached 300 organisations this year to have really logical, responsible discussion for their patients. Look, it took six months and three banks to get a bank account.

SIMON Why is that? Is that the stigma again? Banks won’t have you because you’re associated with…?

TONI-MARIE You know, there’s cannabis. There’s actually cannabis, the scientific name. There’s industrial, known as hemp. There’s medical and recreational. Now, this is different, and people don’t understand. Recreational, you’ve got THC – the psychoactive ingredient.

SIMON The high.

TONI-MARIE Tetrahydrocannabinol – the high. But what you’ve got is this unique plant. It’s got 500 compounds in it. It’s got 80 cannabinoids. THC is just one. There’s hydrocarbons; there’s amino acids; there’s terpenes. When a person takes a joint and they light it up and they smoke it, they actually burn away 95% of those known to be beneficial compounds and they over-activate the THC.

SIMON A lot of people don’t understand. They think the medicinal cannabis products are going to enable the patient to get high, that it’s really a backdoor ruse for recreational use.

PETER And some are using it to push that barrow, and that’s what we’ve got to completely decouple, because I think there is a very good case for pursuing all of the scientific evidence we can and all of the processes that Toni’s spoken about for the possibility of medicinal cannabis products being available. But it’s quite a separate argument from the recreational use one. And the more the recreational use one gets in the way, the more difficult it makes the argument, frankly.

SIMON I want to come back to the compassionate-use element – the discretion for that to be used. Are doctors a problem in this?

TONI-MARIE Absolutely. They’re schooled in Western medicine, so they don’t understand. And we have the ability to bring in the Medical Cannabis Institute and help work through and educate those who may have an interest at some stage in the future when products are available for scribing, and they need to keep an open mind. And our patients go to the doctor’s, they can’t have a conversation with them; they don’t want to even look into it. So there is that whole compassionate side that does need addressing, but they’ve got to be safe, they’ve got to be consistent products. Our doctors need to know how to prescribe them. What are the contraindications? What are the side effects? We don’t know those yet, and we don’t have those products. And these are sick, vulnerable people, and I wouldn’t want anything less for my daughter. It took me 18 months to develop her product under the radar and expensive through the pharmacological and the horticultural industry.

SIMON Peter, what then do you say to people watching who can’t get relief from ongoing horrendous pain, who are self-medicating with unregulated cannabis products or cannabis itself and they’ve simply been told that marijuana might help them. What do you say to those people?

PETER My first message to them would be to go and talk to their doctors and their medical specialists about their condition, about the possibilities of looking at some of these other preparations that may be available. And if that is an outcome, then to go through the process that’s available under the law at the moment. The second thing I would say – and I agree entirely with Toni – that we’ve got to have firm evidence, we’ve got to have a very clearly defined concept of what the product is, what it will do, who it will benefit, how it will be applied and how it will be regulated. And I think that the work that she is doing and the conference next year provides a good platform for the start of that discussion. But as we’ve acknowledged right throughout, this is a long journey. But I think the immediate one is if there are people in genuine need, to talk to their medical practitioners – I do think there is a bit of prejudice there in the medical profession – to talk about the possibility of Sativex, are there other preparations that might be effective for them and to explore those possibilities.

SIMON And you’re open to all those possibilities?

PETER Absolutely.

SIMON Peter Dunne, Toni-Marie Matich, thank you very much for joining us on the programme.

TONI-MARIE Thank you.