Monday, August 15, 2016

NSW is legalising medical cannabis - so why is it devolving into a Big Pharma spinfest?

Something very strange is happening in NSW. To the surprise of many, Liberal Premier Mike Baird last year announced he would legalise medical cannabis. He cited the plight of Lucy Haslam from Tamworth whose son had an incurable fatal condition and who received palliation from cannabis oil where normal treatments had failed. Her sterling activism had apparently shifted the mountain, although her son has sadly since passed away.

This seemed strange because Mike Baird appears to be in lockstep with Police Commissioner Andrew Scipione, and the police always oppose any moves to legalise cannabis because they garner huge budgets from prohibition. And Big Pharma always opposes it because anyone can grow it and it might threaten sales of their own drugs. In fact that's happening - the use of pharmaceutical painkillers is dropping rapidly in US states which have legalised medical cannabis.

But wait. People in the know tell me that actual cannabis oil will not be legalised - the research ball has been thrown to the pharmaceutical industry to extract relevant molecules from cannabis and produce medicines accordingly.

This rang alarm bells for me. Who is to say that a few extracted molecules will mimic the effects of the whole oil, which contains thousands of chemicals interacting in ways it would take us decades to research? Who decided to focus the 'trials' this way? Why not, for example, go to the US and interview a few thousand people who have used it?

Then this opinion piece appeared in The Newcastle Herald, written by one of the hired researchers, Professor Jennifer Martin from Newcastle University.

The piece rang more alarm bells. It read to me like clever prohibitionist propaganda, demonising cannabis on very specious grounds. But Professor Martin's piece was well written and persuasive, and I have no reason to doubt her scientific expertise so I thought about it for a couple of days.

It became ever more clear to me that the piece was as suspect as my initial feelings had indicated.

This starts with the headline itself: There is no rush to act on the legalisation of cannabis for medical purposes. 

Except that IF medical cannabis indeed provides unique relief to people in serious pain, as mountains of anecdotal and other evidence suggests, the longer you wait, the more they suffer. I know first-hand of several people whose chronic or fatal symptoms are being relieved by whole cannabis oil when legal medications had failed. Or so the patients say, and I have no reason or inclination to challenge them. By the way they are taking high-CBD oil which has very little or no psychoactive effect. They are not getting stoned, just getting relief. And yes, there might be some placebo effect, but please don't tell the patients.

I know this is anecdotal, not proved, but when a declining 94-year-old woman who has never used cannabis in her life is suffering chronic pain and calls it "a miracle cure", I have no reason to contradict her.

So whatever the science, there is good reason to hurry up this process in my view.

In the second paragraph Professor Martin writes:
There is no new evidence. For all of the conditions discussed, apart from one or two uncommon medical conditions, we already have safe and effective therapies available, and funded by the taxpayer. 
Well this is very arguable. It's well known that opioids, for instance, have limited efficacy. The patient's tolerance rises until the effect is minimised, it becomes addictive, and it makes people constipated, not a great condition if you are bed-ridden. Most medicines have side-effects, some of them fatally toxic. Some conditions like severe Epilepsy are difficult to treat and there is plenty of research showing that cannabis helps. No new evidence? Here is a list of 60 peer-reviewed studies summarised by result.

Professor Martin continues her criticisms:
Currently available cannabinoid products have little quality control, testing or certification. Contaminants such as heavy metals, fungicides/pesticides and other chemicals are known to be common in herbal medications.
Common in herbal medications? Like Chinese ones perhaps? What has that to do with organically grown Australian product? If the quality is inconsistent, might that have something to do with prohibition? People may have to grow it in indoor hydro setups and who knows what they use? But this has nothing to do with the substance itself and presumably a government-licensed grow-op can regulate this right now. Cannabis is a weed, easy to grow without fungicides or pesticides, so why would growers pay for this stuff for no reason? Harmful chemicals have been put into milk, and fungicides and pesticides are used on all our commercial fruit and veg. This argument is little more than a red herring.

Professor Martin continues:
Other psychoactive drugs have been mixed with ‘medical’ cannabis. 
Have they really? Did it cause any damage?  Again, why would a supplier spend extra money to do this? This is not an argument against medical cannabis, rather an argument for good regulation and licensing.

But then Professor Martin brings in the kicker:
The stability of the product over time, in heat and light, and its potentially toxic degradative products are also uncertain. 
Oh dear, things can go off. On that basis I'd better stop buying baked beans. Or people could just put their oil in the fridge. Again it's a very flimsy argument - I never refrigerate cooking and kitchen oils. They seem pretty stable.
Medical marijuana should refer to specific cannabinoid molecules isolated from the plant, grown in Good Manufacturing Process (GMP) facility, 
Should it, Professor Martin? Is there no case at all for testing the whole product? Really? Or does this simply repeat the brief you have been given? Yes, we understand that researching a 'therapeutic good' requires very stringent standards but come on, this substance has been used by millions of people for hundreds of thousands of years. It's not exactly a new and untried antidepressant chemical or a toxic cancer treatment. Population studies show over and over that it is relatively harmless. But a good researcher must keep within their funded brief and such external evidence is irrelevant, right?

But you still have to be careful says Professor Martin:
Despite the hype, the patient experience of medical marijuana is not always good. “It was so frightening I lay down all day until the ‘afraidness’ went away “ (patient with heart failure). “It made me cough and I couldn’t get my breath.” ”Panic attacks and being frightened”.
 Um, I think these anecdotes refer to people who took or smoked high-THC recreational cannabis, not low THC medical cannabis. It's really a straw man argument. We know that only about 30% of people like the psychoactive drug. Among others it indeed can induce paranoia etc. That's why they don't use it. But high-CBD cannabis oil doesn't get people stoned or have any of the above effects, so Ms Martin's argument is not valid.

Then Professor Martin says suffering people can just wait for years:
Whilst this research will not report for several years, we do not believe there is any rush to bring medical marijuana into widespread use.
There is a subtle logical fallacy in this. Apart from giving no regard the continuing suffering of patients (not really her job, to be fair), Ms Martin is assuming that her research will not produce any startling results, that existing medications are fine and people can just use them until the Establishment makes up its mind. Isn't the purpose of the research to establish whether this is so? How can Ms Martin reach this conclusion until the research is complete?

Interestingly, Ms Martin uses the term 'Marijuana' throughout, a Mexican-sounding term popularised by the American prohibitionists back in the 1930s to demonise the drug by associating it with Latinos, blacks and jazz musicians. Real scientists use the term 'cannabis'. But perhaps Ms Martin is simply being reader-friendly in her choice of words.

Then Professor Martin saves the best till last:
Finally, one nagging thought. If marijuana provided such a uniquely beneficial drug, why haven’t the major pharmaceutical companies been into it?
Well, perhaps because it's illegal? Just a thought. And perhaps because anyone can produce high-grade medicinal cannabis with a bit of sunshine, some good potting mix and a $250 oil-making machine. Where's the profit potential in something that can't be patented?

I'm wondering where the funding for Professor Jennifer Martin's research comes from. Has the privatisation-fixated Baird government funded it or have they brought in some private funding - for example from Big Pharma, who would benefit only from a patentable molecular compound? Just asking.

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