Medical Cannabis - Legislation
Tuesday 10 November 2020
Reply to Notice of Motion
6 Mr Dean to move — That the Legislative Council calls upon the Government to further consider the legalisation of medicinal cannabis having regard to laws which apply in other Australian jurisdictions, with a view to allowing the prescribing of medicinal cannabis under proper process to those patients whom it would benefit, and also prevent these patients and carers from having to act unlawfully for treatment.
Ms ARMITAGE (Launceston) - Mr President, I also thank the member for Windermere for bringing this motion forward. It has been an ongoing issue and we have all had representations from many constituents over a long period of time. There is no predetermined list of conditions for which a cannabis medicine can be prescribed. However, the Commonwealth department of Health indicates numerous health conditions potentially can be treated by the use of such medicine, including epilepsy in children and adults, multiple sclerosis, chronic non-cancer pain, chemotherapy, induced nausea and vomiting in cancer and palliative care. Quite a significant range of conditions and associated symptoms could potentially be treated and alleviated by allowing sufferers access to cannabis medicine.
The Therapeutic Goods Administration, which currently oversees the administration of access to cannabis medicine, specifically refers to such treatment as not being a cure-all, but one which is evidence-based and considers the patient's individual circumstances. The TGA says evidence suggests that when used in conjunction with other treatments, medicinal cannabis may benefit some patients with specific conditions. Moreover, the TGA stipulates the provision of cannabinoid - CBD - is on a last-resort basis and only to be approved when other treatments options have been tried and failed.
At present in other Australian jurisdictions, CBD is available by prescription only, made by a registered medical professional. A doctor makes his professional judgment by assessing the patient's symptoms, family history, and other treatments that have not had the desired effect on their symptoms. To me, these are reasonable and fair conditions to apply to access to an apparently very potent medicine, which is also still very much in the experimental stages of research.
We cannot, however, ignore the direction the current levels of evidence point us. Cannabis medicine can have manifestly positive benefits on a variety of conditions, something which is supported by both quantitative and current scientific evidence. This is not helped, however, by the fact there is no authoritative high-quality evidence on the safety, effectiveness of unregistered cannabinoid products for any medical condition. As a result, in Tasmania, the medical cannabis Controlled Access Scheme requires relevant medical specialists on referral from a patient's general practitioner to apply for an authorisation for each patient they wish to trial the product. This is clearly a quite significant undertaking which takes a lot of time and resources. I understand little research has been done into examining the long-term effects of medicinal cannabis on a person's health considering all the variables at play, including the long‑term effects of a significant illness on a person's long-term prognosis.
It is understandable that reliable evidence, one way or another, will take a long time to come through; however, this is exactly what sufferers of these illnesses lack - time and care for the long term. These people are sick and in need of relief now. It is important to emphasise just what a significantly positive effect cannabis medicine has for some people. A constituent some time ago sent me pages and pages they had kept on their child's neurological condition. Over time, this person suffered dozens - perhaps hundreds - of grand mal seizures, incontinence, dribbling, difficulty in speaking and slow movement. On one day alone, this person suffered 14 grand mal seizures. This does not even begin to consider the mental and emotional toll these physical symptoms had on this person's life and that of their family and carers.
At the time these constituents came to see me, their GP had advised them that while the prescription of CBD would likely have extremely positive effects on this person's condition, the process, under the Controlled Access Scheme, was just beyond them. Of course, this person was on a cocktail of other medications in an attempt to treat their primary and secondary symptoms. These included valium, a relaxant; prednisolone, a steroid; phenobarb, a barbiturate; and an assortment of others, each with their own side effects. It is difficult to comprehend why the process to acquire one medicine to go off these others, which were not working anyway, was so difficult, and why we could abide letting this person continue to suffer this low quality of life.
Early in 2020, the Senate Community Affairs References Committee handed down a report into the current barriers to patient access to medicinal cannabis in Australia. Of the 20 recommendations of this committee, I will refer to just numbers 10 and 11.
Recommendation 10 was that the Council of Australian Governments Health Council develop a national framework for medicinal cannabis access, to set out goals for further harmonisation of related federal, state and territory laws. Recommendation 11 was that the Tasmanian Government immediately join all other jurisdictions in participating in the Therapeutic Goods Administration's single national online application pathway for accessing unregistered medicinal cannabis and reducing state-based requirements for medicinal cannabis approval.
The same Senate inquiry estimated that of the unknown number of people who have tried to legally acquire medicinal cannabis through the Tasmanian Controlled Access Scheme, only 17 patients have been granted access to the medicine. This follows a very detailed process. First, a person seeking medicinal cannabis must be referred by the GP to a specialist, who must then make application to the Tasmanian Department of Health for assessment by a multidisciplinary expert panel of clinicians. If the prescription is authorised, the medicinal cannabis product must then be dispensed through a Tasmanian hospital pharmacy.
As an aside, I note that this scheme is fully funded and patients who receive access pay only the Pharmaceutical Benefits Scheme co-payment amount. However, despite this, the Senate inquiry report states -
It was a widely held view that not allowing Tasmanian patients to access medicinal cannabis outside of the CAS is putting them at a significant disadvantage to the rest of the country.
Many patients, their families and carers simply and understandably do not have the wherewithal to go through the entire CAS process, only to be rejected at the end.
As a result, many Tasmanians feel compelled to obtain cannabis unlawfully. We should not allow the state of Tasmanian law to criminalise people who are seeking help. That is neither productive nor just. A further benefit of lowering the barriers to access medicinal cannabis is also the particular scientific type. As I understand it, cannabis bought from drug dealers, for example - that is, marijuana grown hydroponically or outside, then smoked or ingested - contains higher levels of THC, the part of the drug with psychoactive properties. Medicinal cannabis in the form of oil or pills, I believe contains lower THC, but higher amounts of CBD. This has the twofold benefit of delivering the symptom-alleviating properties that the cannabis possesses without inducing the psychoactive high that a person gets when they smoke regular cannabis.
We should remember that people who are seeking medicinal cannabis are not doing so in order to get a high. They are doing it to access the symptom-relieving effects it has on conditions which significantly impair their quality of life. It makes complete sense to reduce barriers to access medicinal cannabis if we have appropriately robust legislation and guidelines overseeing that access. I do not understand what value is added by the Tasmanian CAS requiring a specialist to assess a patient's suitability for medicinal cannabis when a person's general practitioner knows them and their conditions better, and has done for a longer period of time.
Reducing these barriers also makes financial sense, not just for people who are legitimately trying to access this medicine, but also for the state, which subsidises access for many people to access these specialists. What are we also saying about our GPs if we do not trust them enough to exercise the appropriate level of professional judgment in assessing a patient's suitability for medicinal cannabis? It all seems very inconsistent to me.
What I am saying is that for the limited use of that CBD that is being proposed here, the evidence we have now is probably enough. For the purposes of making laws that will benefit the class of people it is supposed to, bringing Tasmanian legislation in line with other jurisdictions - that is to say that GPs are trusted as the medical professionals they are to prescribe cannabis medicine - and it will have the benefits that are intended.
We are in the unique position to learn from the approaches taken in the other jurisdictions and to implement quickly, efficiently and appropriately a CBD prescription scheme in Tasmania that will have the added benefit of freeing up resources being expended on the current processes under the Tasmanian Controlled Access Scheme.
This is not to say that prescription of cannabis medicine should be taken lightly, nor should a very liberal approach be taken to implementing a prescription scheme in Tasmania. Many factors need to be considered; however, I definitely support an approach that takes a cautious, reasoned approach which relies on current best evidence that could bring life‑changing relief to some people in the shorter term.
I certainly support the motion before us.