20 April 2003
Sunday Star and Times
A move to allow cannabis to be prescribed for medical use has won surprisingly broad acceptance. Donna Chisholm reports.
A motorbike smash made Matt Sullivan a paraplegic. Cannabis laws have made him a criminal.
Last month, a Huntly court sentenced him to 150 hours' community service for cultivating the cannabis he used to relieve the muscle spasm which has plagued him since he lost the use of his legs at the age of 19.
Two Ngaruawahia police with a search warrant spent two hours combing his house before confiscating some smoking gear and the two 40cm plants they found in his garage. The case spent a year dragging through the courts before his conviction.
"It's frustrating," says Sullivan, 35. Before turning to cannabis, he had exhausted the medical profession's repertoire of prescribed drugs, including the sedatives halcion and valium, because he could not cope with their side effects including drowsiness and memory loss.
He says just a few puffs of cannabis can ease the spasm which sees his legs involuntarily stiffening into the fetal position when he gets into bed.
Had he been unable to use cannabis, he says, he could not have returned to work. An apprentice fitter and turner when he had the accident, he retrained as a computer-aided draftsman and was in the job for 10 years before a freak work accident - he cut his foot on his wheelchair plate and came close to amputation through the resulting bone infection and ulceration - forced him on to accident compensation.
Ironically, he says, alternative therapies of manuka honey and aloe vera have done for his foot injury what orthodox medicine could not. "If aloe vera was illegal, I'd have had my leg chopped off. It's very similar to what's going on with cannabis."
But with parliament's health select committee looking to recommend a law change to enable medical users to be prescribed cannabis, patients like Sullivan may no longer be on the wrong side of the law.
Committee chair Steve Chadwick, a former midwife, says she understands the conditions in which cannabis can be very effective. "It tends to come from people with motor neurone disease or traumatic paralysis." She wrote a letter of support for one constituent, a married man with children, who'd been arrested on cannabis charges. "He's a lovely quiet guy and he was in a shocking accident and has chronic pain. He feels he's been unfairly targeted but he's not doing this to break the law. His GP supports his use."
The judge discharged him without conviction at the end of last year. "It's a bit like why did they take snuff (in the old times)?" says Chadwick. "There are conditions that benefit from it."
She believed up to five cannabis plants could be allowable for patients, but the committee would probably find only the tablets acceptable. "I also hear there's a suppository available . . ."
Auckland University pharmacology lecturer Nick Holford agrees. "From a scientific viewpoint there is substantial evidence it has some medical use, predominantly for suppressing nausea in patients on chemotherapy and it seems to have benefits in patients who have some kinds of chronic pain."
It's harder to answer, he says, whether cannabis can achieve something legal drugs cannot. "Different people will claim one drug is better for them than another drug so it's hard to make a global statement. If you look at drugs available for pain relief for arthritis, there are 15-20 on the market and some patients prefer one, others another. They're both better than nothing."
So how effective is cannabis? "Moderately effective. Nausea is a very hard condition to treat. It's better than placebo but it's not a complete cure-all. Some people benefit, some don't."
He believes it should be legalised for that sort of medical use. "From the general perspective of drugs in society, cannabis has more beneficial properties than cigarette smoking. If you were to choose one over the other I'd much rather we had legal cannabis and illegal nicotine products. It's a political-societal issue, it's not a science issue. But you're dealing with politicians who wouldn't know science from their rear end."
Cannabis tablets have been produced and are at late clinical trial stage in the United Kingdom, says Chadwick, but doctors say the effects are more rapid when the drug is smoked.
Some users also prefer to inhale it through a vaporiser, which reduces adverse effects on the lungs.
Cannabis use has long been recognised in spinal units. At Burwood in Christchurch in the late 1990s, staff estimated 10% of patients had an established habit while others used it occasionally.
The then clinical director Alan Clarke said while cannabis use was widespread in the disabled community, it wasn't helpful in rehabilitation because heavy users tended not to take care of themselves. "We don't like cannabis use or the way it impacts on a patient's health. However, in the spinal unit it is taken in context."
One of the most high-profile disabled users is New Plymouth tetraplegic Danuiel Clark. Clark was jailed in 1999 for 12 days after police found six 30cm seedlings in his home - his seventh conviction.
His claim that no one took him to the toilet for four days and he was left in his own excrement made national headlines. It was rejected by the prison.
He said then he heard about cannabis from other spinal unit patients. "Everyone I know in a chair smokes pot for spasm relief or pain relief."
Green MP Nandor Tanczos, a friend of Clark since the early 1990s, picked him up from jail after his sentence.
Auckland HIV patient Greg Soar, who in 2001 set up GreenCross, a support group for medical cannabis users, says he needs just a couple of puffs every four or five hours to ward off the nausea his "toxic and vicious" antiviral cocktail causes. But that amount would cost him about $20 a day and often he can't afford it - "a lot of sick people can't".
He often uses a vaporiser to steam the cannabis rather than burn the plant material.
Without cannabis he vomits daily; with it, he throws up every four or five days. He remembers one day becoming so ill with nausea and vomiting he had to phone one of his daughters and ask if she knew where he could get some.
When a friend arrived soon after with a joint, "my nausea went in just two tokes. I sat in the lounge and cried because I couldn't believe what cannabis had just done for me".
The anti-nausea drugs his doctors prescribed were 40%-50% effective and "made me zombied" while the cannabis was 90% effective.
His doctors knew about his cannabis use and didn't discourage it.
Soar, 41, had smoked cannabis before he was diagnosed with HIV in 1997. "I held down a career for 18 years as a locomotive engineer for NZ Rail and only smoked on the weekends."
He says if he can conquer his nausea and vomiting, he may be able to return to work.
Even those vehemently opposed to the decriminalisation of cannabis have sympathy for patients like Sullivan and Soar.
Health select committee member Judith Collins, for example, while railing against the risks of cannabis smoking and its widespread use in the community, says she can see a place for tightly controlled use among some patients prescribed the drug in tablet form.
"I have some sympathy for that because it is not taken as part of a social thing."
Fellow member Heather Roy, who wasn't on the committee during its inquiry into medical cannabis use, sympathises with the medical arguments. "I believe it is quite effective in pain relief."
National MP, committee member and former geriatrician Lynda Scott said its use would have to be well-controlled and monitored. Smoking would not be suitable because of the difficulty in assessing dose.
"I wouldn't want it to be able to be abused."
Although police won't comment publicly on medical marijuana use other than to say they'll uphold any legislation finally passed, officers have in the past expressed concern about the number of people arrested who give the excuse of a medical condition - even headaches.
In Britain, research groups are conducting the world's biggest clinical trials to determine the medical benefits.
One government-backed study involves 660 multiple sclerosis patients and researcher John Zajicek believes cannabis will pass scientific scrutiny.
"I'm fairly confident we are going to find an effect in reducing muscle spasms."
Results are expected by June.
In the second trial, biotech company GW Pharmaceuticals has been studying a cannabis-based spray administered under the tongue in the same way as angina medication.
The group is growing 40,000 cannabis plants a year in the English countryside.
While the new medicines are designed to reduce the "highs" users experience, Holford says there is a limit to how much side effects can be minimised.
A legal change can't come soon enough for people like Sullivan.
"Twenty years ago I would have died from my injuries. Today they are keeping us alive but with what quality of life?
"If they are going to come up with all these great ways to keep us alive,
we have to move into newer drugs, newer remedies. What are the police doing
telling me what medicines I can take to have any sort of quality of life?"
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