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Legalisation of cannabis for medicinal purposes The issue of legalising cannabis for medicinal purposes is being widely debated among state and federal politicians around Australia, and within medical and health organisations. LUCY HASLAM'S LETTER TO THE ANMF (VIC BRANCH) COUNCIL The ANMF (Vic Branch) Council recently received a letter from former nurse Lucy Haslam, who lives in Tamworth, NSW. Four years ago, Lucy’s youngest son, Dan, was diagnosed with bowel cancer at the age of 20. Lucy’s husband was a police officer for 35 years and both Lucy and her husband are opposed to recreational drug use. It was with reluctance that the family came to support their son’s use of cannabis to alleviate the side-effects of his cancer treatment – to treat pain, nausea and help him gain weight. Having conducted much research into the subject while coming to this position, Lucy has since been campaigning to have use of cannabis for medicinal purposes legalised in NSW and around Australia. Through her research, she discovered that there had been a NSW Parliamentary Committee Inquiry into this issue, with the report released in May 2013. The inquiry committee recommended that patients with terminal illnesses or AIDS, and their carers, be exempt from arrest and prosecu tion for medicinal use of cannabis. However, the NSW health minister chose to reject the recommendation. Lucy’s petition to the NSW health minister has attracted 180,000 signatures and she has succeeded in persuading her local MP, the Nationals member for Tamworth, Kevin Anderson, to submit a private member’s Bill to Parliament to legalise cannabis for medicinal purposes. This Bill may go before the NSW Parliament as soon as September. Lucy wants the law around cannabis use for medicinal purposes to be uniform around Australia, so was writing to the ANMF (Vic Branch) to encourage the Branch to support law reform in Victoria. CANNABIS AND THE LAW IN AUSTRALIA It is illegal to use, possess, grow or sell cannabis in Australia but the penalties differ across states. Some jurisdictions have decriminalised minor cannabis offences, so possession of a small amount for personal use receives a civil penalty (similar to a speeding fine) rather than a criminal charge. This is the case in the ACT, SA and the NT. In other states, use or possession of cannabis is still a criminal offence. In Victoria, NSW and Tasmania, police have the option of offering a caution. In Queensland, police officers offer a ‘diversion’, which includes a mandatory assessment and brief intervention program but police can offer an offender one diversion only. In WA, first-time offenders possessing not more than 10 grams of cannabis, must attend a cannabis intervention session within 28 days or receive a criminal conviction. Source: National Cannabis Prevention and Information Centre – www.ncpic.org.au In March this year, a 59-year-old South Australian man with leukaemia was sentenced to two years in jail for cultivating cannabis. Source: ‘Australia has no reason to disallow medical cannabis use’, Alex Wodak, Emeritus Consultant at St Vincent’s Hospital, Darlinghurst, and Laurence Mather, Emeritus Professor, Anaesthesia, Northern Clinical School, University of Sydney, ‘The Conversation’, 26 March, 2014 http://theconversation.com/australia-has-no-reason-to-disallow-medical-cannabis-use-24717 The current legal position around medicinal use of cannabis is not supported by the majority of Australians. Almost 70 per cent of Australians support the use of cannabis for medicinal purposes. Source: Australian Institute of Health and Welfare. 2010 National Drug Strategy Household Survey report Canberra: AIHW, 2011. THE PUSH FOR LAW REFORM As stated, NSW Nationals MP, Kevin Anderson, will submit a private member’s Bill to the NSW Parliament, possibly in September, to legalise cannabis for medicinal purposes. On 24 August, The Age reported that Victorian Labor Leader Daniel Andrews has promised to legalise use of cannabis for treatment of cancer, multiple sclerosis, HIV/AIDS, glaucoma and Parkinson's disease. He would seek advice from the Victorian Law Reform Commission on the prescription, manufacture and distribution of medical cannabis. The article reported that a multi-party group of federal MPs were working on a Bill to allow cannabis oil as a medical treatment for epilepsy, cancer and other life-threatening illnesses. Source: http://www.theage.com.au/victoria/victorian-labor-leader-daniel-andrews-supports-pushfor-medical-cannabis-20140824-107qma.html#ixzz3BYE6FVjU In Tasmania, a Legislative Council committee is inquiring into legalising the use of cannabis for medical purposes. Please see below ANMF (Tasmanian Branch)’s position as outlined in its submission to the inquiry. Countries which have decriminalised cannabis for medical purposes include the Netherlands, Israel, Canada and Spain. In the US 20 states have done likewise. Source: ‘Marijuana: an illegal weed or a much needed medicine?’ Dr Lesley Russell, Research Associate at the Menzies Centre for Health Policy at the University of Sydney. Sydney Morning Herald, 28 March, 2014 The American Medical Association reviewed the scientific evidence around medicinal use of cannabis in 2009 and recommended rescheduling cannabinoid-based medicines to allow their legal prescription in the United States. HISTORY AND SCIENTIFIC EVIDENCE AROUND MEDICINAL USE Alex Wodak, Emeritus Consultant at St Vincent’s Hospital, Darlinghurst, and Laurence Mather, Emeritus Professor, Anaesthesia, Northern Clinical School, University of Sydney, together with Vivienne Moxham-Hall, from the Australian Drug Law Reform Foundation and Evert Rauwendaal, Alcohol and Drug Services, St Vincent’s Hospital, collaborated on an article ‘(Re)introducing medicinal cannabis’, published in the Medical Journal of Australia last year. They said: ‘The medicinal use of cannabis was banned in Australia about 50 years ago when scientific evidence about its effects was meagre. ‘It is now clear that cannabis has genuine medicinal utility, but this has been largely overlooked, with research and society’s attention, in most parts of the world, being directed towards the hazards of its recreational use rather than the benefits of its medicinal use.’ The authors believe the production and supply of medicinal cannabis should not differ from other botanical medicines. The Netherlands Ministry of Health procures medicinal grade cannabis from an authorised agricultural company that cultivates the plant in compliance with current European standards and is subject to strict quality control. It is dispensed by a qualified pharmacist in raw botanical form by prescription. Patient information includes instructions for use with a vaporiser or preparation as a tea. The authors recommend that medicinal cannabis is available from pharmacies by prescription, either in raw botanical form, or as extracts in spray form. The authors concluded: ‘A civilised and compassionate country that supports evidence-based medicine and policy should acknowledge that medicinal cannabis is acceptably effective and safe, and probably also costeffective, especially when the costs of resource use and improvement to the lives and functionality of patients and carers are considered.’ Source: ‘(Re)introducing medicinal cannabis’, Medical Journal of Australia 2013; 199 (11), pp 759 761, Laurence E Mather, Evert R Rauwendaal, Vivienne L Moxham-Hall, Alex D Wodak, THE AUSTRALIAN MEDICAL ASSOCIATION SAYS: Cannabis extracts and synthetic formulations have been licensed for medicinal use in some countries, including Canada, the USA, Great Britain and Germany, for the treatment of severe spasticity in multiple sclerosis, nausea and vomiting due to cytotoxics, and loss of appetite and cachexia associated with AIDS. The synthetic cannabis product Nabiximols (Sativex), which is delivered as a buccal spray and so avoids the harms of cannabis smoke inhalation, is effective in the management of spasticity and pain associated with multiple sclerosis. The psycho-active effects of Nabiximols can also be managed through controlling dosage. In Australia, the synthetic cannabinoids nabilone and dronabinol are scheduled by authorities for medicinal use. Sativex is also being trialled in Australia for cancer and cannabis withdrawal. Canada has allowed the medical use of smoked cannabis if this is authorised and monitored by a doctor. There is a growing body of evidence that certain cannabinoids are effective in the treatment of chronic pain, particularly as an alternative or adjunct to the use of opiates, when the development of opiate tolerance and withdrawal can be avoided. Controlled trials have also shown positive effects of cannabis preparations on bladder dysfunction in multiple sclerosis, tics in Tourette syndrome, and involuntary movements associated with Parkinson’s disease. Source: Australian Medical Association website( www.ama.com.au) Since the ban on medicinal use of cannabis in Australia 50 years ago, evidence has accumulated around its efficacy in providing pain relief, stimulating appetite, alleviating nausea and alleviating symptoms associated with multiple sclerosis and other neurological conditions causing spasticity. Source: ‘Marijuana: an illegal weed or a much needed medicine?’ Dr Lesley Russell, Research Associate at the Menzies Centre for Health Policy at the University of Sydney. Sydney Morning Herald, March, 28, 2014 A recent review of research about medicinal cannabis use found 82 randomised controlled trials had positive results while only nine were negative. Source: ‘Australia has no reason to disallow medical cannabis use’, Alex Wodak, Emeritus Consultant at St Vincent’s Hospital, Darlinghurst, and Laurence Mather, Emeritus Professor, Anaesthesia, Northern Clinical School, University of Sydney, ‘The Conversation’, 26 March, 2014 http://bit.ly/1p7JWVJ THE RISING TIDE OF SUPPORT FOR MEDICAL USE OF CANNABIS In December 2013 the Medical Journal of Australia published a paper (cited above) calling for legal reform to permit the medical prescription of cannabis for certain patients. The Australian National Council on Drugs, which advises the Australian Government on drug policy, recently released a report on medicinal cannabis. The council reported that research suggested a number of cannabis pharmaceuticals could treat pain, particularly chronic and neuropathic pain. The background and information paper said clinical trials of various cannabinoids had also shown they could treat spasticity associated with multiple sclerosis and stimulate appetite and weight gain in people with HIV, advanced cancer and anorexia. While cannabinoids may be able to treat epilepsy, glaucoma, obsessive-compulsive disorder, schizophrenia, Tourette syndrome and spinal cord injuries, the report said the evidence for its use in these conditions was less clear. The report identified areas that required further analysis or investigation, one of which was how cannabis could be sourced and supplied for medicinal purposes. Source: ’Australian National Council on Drugs takes a deep breath on cannabis’, Sydney Morning Herald, 25 August, 2014 http://bit.ly/XQXdNi The Australian Medical Association advocates ‘therapeutic cannabinoids that are deemed safe and effective should be made available to patients for whom existing medications are not as effective.’ The Cancer Council of NSW has, since 2012, strongly supported the use of cannabis under medical supervision to treat pain, nausea and weight loss. The ANMF (Tasmanian Branch) strongly supports the decriminalisation of cannabis and cannabinoids for medical use. The Branch does not support indiscriminate access to cannabis in any form and would expect any supply chain to have effective quality control mechanisms in place. Source: ANMF (Tasmanian Branch) submission to the ‘Inquiry into the use of natural botanical medicinal cannabis flower and extracted cannabinoids for medical purposes’, August 2014 The NSW Nurses and Midwives’ Association has written to Lucy Haslam to inform her of its support for the decriminalisation of medicinal use of cannabis. ANMF (VIC BRANCH) POSITION The ANMF (Vic Branch) believes there is sufficient evidence to support the medicinal benefits of cannabis for terminal and life-threatening illnesses, and palliative care. Accordingly, we support appropriate regulation for sourcing, prescribing and administering cannabis for medicin al use. We are seeking members’ feedback on the legalisation of cannabis for medicinal purposes and ask that you take the time to reply to our member survey by noon, Monday 8 September.