15th March 2018: Public & media getting wise to extent of the awfulness
Did nobody think it would happen?
At long last the media is waking up to exactly how bad things have gotten in Australia where medicinal cannabis is concerned and are starting to show a keen interest.
Whether it was the New York Times and then The Project stories in February of mother and son Lanai and Lindsay Carter and their years-long struggle to obtain a consistent and suitable supply of the drug to treat Lindsay’s seizures or the plight of the Taylor family so movingly portrayed on the 7.30 Report last Wednesday (7th March): the blow-back against this country’s unworkable and absurd regulations seems genuinely to be underway.
From desperate Ministers making policy moves on the fly to conservative medics being publicly branded as liars and the Federal Health Minister finally conceding something’s gone horribly wrong, the ‘system’ is now under siege. And things are poised to get worse.
After the 7.30 Show came of course the shocking piece on ABC News Sunday (11th March) about little Suli Peek whose tragic and unforgivable case this website has previously covered in detail. Her death – sudden, unexpected and in the very hospital that had denied her a prescription for cannabis, the one medicine that actually worked – is currently the subject of a Coronial Investigation with an Full Inquest possible later – so a reckoning is certain to come. A second, still more damning exposé of what happened was broadcast today (15th March) showing the how the hospital sometimes ‘turned a blind eye’ to Suli and others being administered black market products.
But even with both reports aired, due to the sheer complexity of Suli’s case, the ABC has just scratched the surface. No mention was made of the fact that the Queensland Premier herself as well as Jeanette Young the Chief Medical Officer promised a legal supply of the medicine then denied ever doing so. Nor of the decidedly fishy arrangement the State has with GW Pharma, who make Epidiolex, the only product the Hospital seems prepared to dish out.
Add to all this the row over the RACP/AMJ ‘Perspectives’ piece we reported on three weeks ago in which Iain MgGregor – one of the world’s top cannabinologists – accused the College and Journal of ‘egregious falsehoods’ and you see a perfect storm mustering – one that stands every chance of blowing away the botched and unworkable system that’s been such a blight on the medical landscape since legislation was changed around cannabis at the beginning of 2016.
You could tell as much from the Today programme recently in which veteran advocate Lucy Haslam demanded ‘bureaucrats and the Government get out of the way.’ If they don’t, they’ll have an uncomfortable year as their positions becoming less and less tenable seemingly by the day.
Opponents in fact even appear to have difficulty getting their untruths straight. An hilarious article in BuzzFeed News Tuesday (13th March) demonstrates an embarrassing lapse in consistency, leaving those concerned looking incompetent at best and at worst like out and out con-men: ‘The Royal Australasian College of Physicians (RACP) has denied one of its chapter presidents, associate professor Adrian Reynolds, has contradicted a position statement made in February’s Medical Journal of Australia, while appearing in an ABC News interview,’ the piece says, finishing with the College refusing to comment.
Even the normally staid RACGP President Dr Bastian Seidel – more and more an heroic and honest voice in what’s becoming an increasingly filthy debate – has doubled down on his earlier position that the current cannabis scheme in Australia is a ‘basket case’ and that GPs should be able to prescribe it the way they can anything else. His comments are backed up by a Position Statement from the College calling on the Government to streamline the approvals procedures.
Such a stance of course puts Seidel and his organisation at stark odds with the AMA and its own President Michael Gannon (an obstetrician by trade and thus hardly a man blessed with what you might call outstanding insight – either into the plant or the sorts of conditions it might treat). Gannon and others like him continue with their now befuddled, hollow and ever more discredited claim that there’s ‘not enough evidence’ for its use and point blank refuse to engage with those of their peers who might differ. That cannabis is, at least where harms are concerned, the most widely researched substance on earth apparently makes little difference. That their position runs contrary to all current global demographic and prescribing information (much of which they’ve been offered) seems irrelevant. Rather, the objectives underlying the current, insanely restrictive access pathways as well as the other views and actions espoused by AMA, RACP and ANZCA the pain specialists, alongside their friends in Federal and State governments are quite obvious. These are effectively to block the use of optimal ‘full-plant’ ‘natural’ cannabis at all cost with the aim of developing ‘medicinal cannabis’ as though it were best (and only) provided as a patented, single-agent therapy ‘like all other medicines’ – a lofty and some would say ludicrous ambition unique to Australia and the last thing most people want.
Meanwhile the prescribing route doctors have been offered, allegedly as some sort of ‘stop-gap’ – the TGA’s Special Access Scheme Category B – is seen as…well, a bit of a joke. Never intended or designed for something like cannabis, its purpose is to make medicines registered overseas yet unapproved for use in Australia available to individual patients on a one by one basis, not the thousands trying to get hold of a botanical products that’s not ‘registered’ or ‘approved’ anywhere. Put on top of that a further layer of State bureaucracy and the situation degenerates into farce.
So the system is failing, and will continue to fail because in Australia, unlike say Canada, Israel and The Netherlands where cannabis is successfully used as a medicine, no sensible or appropriate objective underlies regulation or the gathering of data. What ought to be the aim of maximising health benefits and wider health system improvement based on current international evidence (which is significant and growing by the week) is instead replaced with no more than the robotic and inflexible designs of a bureaucracy for which it is manifestly and painfully unsuited.
Much of this is admirably discussed in a recent paper by group of academics very much on the ‘pro’ side of the cannabis argument and originally commissioned for the AMJ as a counterweight to the ‘Perspectives’ piece mentioned earlier – the one that caused all the fuss. But the AMJ Editor-in Chief Nicholas Talley, immediate former President of the RACP, rejected it – the authors later to discover their work had been thought ‘too political.’
‘Medicinal Cannabis and the Tyranny of Distance: Policy Reform Required for Optimizing Patient and Health System Net Benefit in Australia‘ to give the piece its full title was eventually published in another learned journal, ‘Applied Health Economics and Health Policy’ and lays out in no uncertain terms not only what’s wrong with the Australian system but also the opportunities that might be afforded. As such it’s a critical read for all policy-makers though of circumstances as they now stand it says without ceremony: ‘The success, or rather lack thereof, of (the current) approach as far as access and net beneﬁt to patients and the health system is now evident‘.
This, and the Fairfax article by Iain McGregor contrasted with the AMJ / RACP ‘Perspectives’ / Position Statement provide a reasonable depiction of the opposing ‘camps’ in the dispute and from them one thing becomes clear. Which is that one side is depending on half-truths, dogma and occasionally just barefaced lies to defend its position whilst the other employs truth, science and genuine evidence.
Looked at another way, for medical cannabis actually to go forward in Australia policymakers are going to have to decide which of these ‘camps’ they believe in. The Federal Government, having stacked it’s ‘Expert Advisory Council’ with nay-sayers and those strongly opposed to cannabis for medicinal purposes, has been left with the mess it’s now in. And this while the other side is beginning to posit the view that if things are to recover the drug must, as a matter of urgency, be removed entirely from the Therapeutic Goods Administration and put in the hands of a regulatory body genuinely capable of managing it, just as is done overseas. And to go with it cannabis needs to be changed in the Medicines Scheduling.
Calls for these – or at least for some sort of drastic remedy to what’s become such a disastrous state of affairs – are happening already and are likely to grow over time. One example is in NSW where a Bill introduced by the Labor Opposition aims to side-step current regulation altogether by allowing registered patients to possess a certain amount of the substance or grow their own whilst remaining immune to arrest or prosecution.
There was, perhaps unsurprisingly, a knee-jerk reaction to this on the part of the NSW Government but interestingly also by Greg Hunt the Federal Health Minister and his mandarins at the TGA.
On 5th March, Hunt and his NSW counterpart Brad Hazzard announced they’d be ‘taking a machete’ to the ‘red tape’ that had been blocking access, removing the State tier of approval completely thus leaving approvals to be made at Federal level only while asking other States to follow suit. It was the first time Hunt had admitted that ‘Houston we have a problem.’
Hunt was, he said, writing to other S&T Health Ministers and would be raising the issue at the April meeting of COAG.
Already though, people are asking if the measure was more an excuse for the NSW Government to block Labor’s Bill without looking completely malevolent whilst keeping cannabis firmly under TGA control than it was actually to help.
Sources, including Labor itself, concede Hazzard was probably attempting to do the right thing – the Minister is understood to have realised a number of key ‘advisors’ had been deliberately holding things up – and that measures were called for to make access easier and better for patients.
But the move’s somewhat panicked nature, plus the unanswered question of what will now happen to the State’s much vaunted $multi-million ‘hotline’ for doctors when the TGA has one of its own give cause for suspicion as does the state of play with patients like Kath McClean – authorised to use cannabis at TGA level but thus far prevented by the State.
NSW Nationals MP Trevor Khan – himself a long-time cannabis advocate – hinted on Twitter Sunday (11th March) that the Government would block Labor’s Bill since the announcement was in keeping with what the RACGP had been calling for and was therefore ‘welcome and we expect meets our expectations‘. He did nevertheless add that he’d be monitoring developments closely: ‘I ask no-one however to suspend their cynicism,’ he tweeted, presumably realising that if, by mid-April, when the Bill becomes due for debate, things haven’t improved drastically in NSW there’d be ‘issues’. Others though wonder at the wisdom of Hazzard and his colleagues entrusting at least some of the LNP’s political capital – i.e. the cannabis vote – to the Federal Health Minister and those within the TGA whose machinations over the matter have time and again been proved treacherous.
Amidst all this mayhem sits a collection of presumably panicking wanna-be growers, many with ODC Licences, many ASX-listed. Not one has spoken up on behalf of patients, not one has publicly – seriously – criticised Government.
A few seem to have bought into the TGA’s hare-brained idea that pharmaceutically-produced ‘cannabinoid medicines’ are the way to go in Australia meaning their business models will depend on the actual plant remaining forbidden, even for medical reasons. One of them, Ross Walker (a cardiologist) from publicly listed firm MGC Pharma, told The Australian not long ago ‘there is a vast difference between carefully controlled clinical cannabis medications and the random recreational use of the “stoner” drug,’ adding (some might suggest imbicilically) ‘marijuana should stay illegal because it’s a completely different substance and…has the potential to to cause chronic neuro-psychiatric problems‘. The fact that, as Walker seems blindly to think, ‘our Health Department is cautious because the gold standard for medicine is the huge, randomised controlled clinical trial: a lengthy process that can cost many tens of millions of dollars. Very few trials of this size have tested the benefits of medicinal cannabis….‘ doesn’t seem to faze him a bit.
And although his outfit recently announced it would be importing a CBD product called CanEpil which it plans to offload at the ‘reasonable’ price of $800 per 50ml bottle no mention is made of how it intends to get the stuff – unregistered and unapproved in Australia – through the SAS applications route in sufficient quantities to make it worthwhile.
Other businesses still – many without a clear strategy – say they want to start ‘educating doctors’ as if the optics of doing so will appear to medicos as anything other than what they actually are – drug companies peddling their wares.
Even the chance to export looks increasingly ridiculous while there’s no way of accessing an already large market domestically – that particular goldmine, we don’t need reminding, is being serviced quite nicely thank you by a thriving and growing black market. Overseas meanwhile, Columbia has said it wants to be ‘the world’s weed supplier’, a Danish tomato farmer Europe’s main grower of medicinal cannabis and Canada is facing a glut.
In light of all this, it wouldn’t be outrageous to suggest that investors might have been hasty in terms of a ‘green rush’ or that the prospects of exporters are a pipe-dream. The Government, in other words, might have shafted these companies just as royally as it has patients.
All in all then things are as much of a mess as they could be – and where the growers are concerned, there’s so much manure around one can only hope there’s a horse somewhere.
Australians will need one when the current system is at last thrown from the window.