Rebecca Butterworth

Marijuana is having a moment, viewed by some as an unregulated substance with risky side effects and by others as a pain-crushing, mind-calming vital medicine. Australian users, politicians, doctors and the terminally ill are fighting over its place in our health system. REBECCA BUTTERWORTH investigates the case for legalising the leaf Down Under.
Pot Luck
 
Within an hour of taking a couple of drops
of cannabis oil in a cup of tea, Natalie Daley,
32, feels relief. “It helps me sleep. It stops the
vomiting. It feels nice and I can function.” Natalie has adrenal cortical carcinoma — a rare, aggressive and likely terminal cancer.
When she was first diagnosed, chemotherapy
nausea kept her on the couch for weeks at a time,
unable to play with her four young children or
even cook a meal. After a friend suggested she try cannabis oil to help relieve her symptoms, she found some on the black market. “To me it’s not a drug, it’s a medicine. I feel like I may have a second chance at life – to be able to see my kids grow up and hopefully grow old with my husband.” But because the use of marijuana for medicinal purposes is illegal in Australia, Natalie is worried about being arrested. “I am worried about the police turning up on my doorstep, and I don’t really need that extra stress.”
 
Ask the average Aussie about medicinal cannabis and most of us picture a long-haired stoner looking for a legit way to blaze up. Not a terminally
ill young woman wanting to spend precious time with her family. Or a fibromyalgia sufferer needing it for pain relief. The way that those who use it medicinally talk about it would lead you to believe it’s some kind of wonder drug. One that’s having a huge moment: scientific evidence about its safety and medicinal value is growing.
Cannabis has been linked with benefits for chronic pain, chronic nausea, multiple sclerosis, dementia, diabetes, epilepsy, glaucoma and Tourette’s syndrome, among others [See “Drag- ging down disease” over the page]. The way it works as a medicine is like this: once inhaled, chemical compounds called cannabinoids quickly enter the bloodstream. (There are around 85 known cannabinoids in
marijuana, tetrahydrocannabinol – THC – being the most potent and famous.) In theory, they race all over the body and fit like little keys into cell receptors in the
brain, tissues and organs. Once locked
in, cannabinoids push cells into a more
relaxed state. The lock-and-key effect works because, as researchers discovered
in the late 1990s, the brain already
makes its own cannabinoid-like substances. “Marijuana essentially
mimics the behaviour of these naturally
occurring neurotransmitters which can give your body’s built-in pain
defense a helping hand,” says Dr Lester
Grinspoon, an associate professoremeritus at Harvard Medical School.
 
THE GREENS PARTY
Despite growing evidence of its usefulness in certain situations, medical use of cannabis remains illegal in Australia. Around the world, cannabis is legal for medicinal purposes in countries such as Canada, the Netherlands, Israel, the Czech Republic and 23 states in the US. In Canada, patients or carers get cannabis seeds from the government and can grow their own. The Netherlands legalised cannabis use for seriously
ill people in 2003. Their government regulates the industry and has a database for patients and carers. Cannabis growers are licensed, supply only to pharmacies, and are required to destroy surplus plants. So there are controlled models
of supply and demand that work.
Nevertheless, when a NSW Parliament Committee unanimously supported the medical use of cannabis by patients with a terminal illness and AIDS sufferers
in 2013, NSW Health Minister Jillian Skinner rejected the recommendation and cited limited evidence about the efficiency of cannabis for medical purposes. It’s not just those who need it who are keen to see the laws changed – in 2010, the Australian Institute of Health and Welfare (AIHW) reported that 69 per cent of Australians support medicinal cannabis, and 74 per cent support clinical trials. Many health professionals are also on board. Dr Alex Wodak is an emeritus
consultant at the Alcohol and Drug Service at Sydney’s St Vincent’s Hospital and president of the Australian Drug Law Reform Foundation. “There’s very good evidence now medicinal cannabis is a useful second-line drug to relieve distressing symptoms in half a dozen different serious medical conditions,” he says. Dr Wodak believes that cannabis has other benefits over opiates, too: “We now have more deaths from prescription opiates in Australia than we do from heroin. It means that doctors shouldn’t regard opioids as the default drug. If they don’t work, why can’t doctors try medicinal cannabis?” And the anecdotal evidence is even stronger.
 
WONDER DRUG
Star Stuart was 35 when she fell off
a verandah and broke her back. Suffering chronic pain, she was put on a cocktail of medications including oxycontin, endone, anti-inflammatories, valium and antidepressants. “Being on so many different drugs makes you really groggy. It knocks you around and you just sleep – it’s really quite bad,” she says. After four years, nothing had changed. Someone introduced her to medicinal cannabis oil. “[Since taking it] I’ve come off valium and also the antidepressant,” says Star. “I’m down to only 30mg of oxycontin, instead of 120.” Star says that her doctor supports her using the oil because he can see the difference. “It’s like taking
a big breath, and letting it go.”
She isn’t the only one benefiting outside the law. Dan Haslam is a 24 year old with terminal cancer who vaporises cannabis for crippling chemo nausea. (Vaporising heats the plant without creating smoke.) His mother Lucy is now one of the country’s key medical marijuana campaigners. “I watched Dan go from being unable to eat and considering ending his treatment, to eating three meals a day,” she says.
“It was as close to a miracle as I’ll probably ever experience.”

UP IN SMOKE
It’s difficult to know why Australia is lagging behind. So much for the popular arguments of lack of evidence that it works. Or that legalising is unworkable in reality. A 2012 report in Annals
of Epidemiology also showed that legalising medical cannabis has no effect on the recreational use of the drug. But what about the argument that cannabis could be harmful to health? Like nearly every pharmaceutical drug, marijuana isn’t a totally benign substance. Users can experience symptoms such as dizziness, slow reaction time and, of course, getting high, which, in a few people can come with anxiety and paranoia, says Dr Igor Grant, director of the University of California’s Center for Medicinal Cannabis Research (CMCR). “But these are short-term effects,” Grant adds. “Any long-term effects are unlikely, as far as medical use.”
Grinspoon, one of the world’s experts in cannabis, says that there has yet
to be “even a blip” in the incidence of schizophrenia in the US after millions of people started smoking in the 1960s. Furthermore, a 2006 study in Cancer Epidemiology, Biomarkers & Prevention
found the association between smoking cannabis and lung cancer, even long- term or heavy use, was not strong and may be low to undetectable. Even so, many users now use vaporisers.
Wodak recommends vaporising over smoking. ‘”Smoke’s got particulate matter in it,” he says. “Someone in their 20s – those lungs have got to last them another 80 years. So I’d much prefer inhaling a vapour.”
Perhaps the biggest issue for critics
is this: unlike TGA-approved drugs, marijuana lacks standardisation.
Dosing data and regulations are pretty much non-existent, leaving patients in
a trial-and-error atmosphere. Instead
of waiting for the answer, seriously ill people are doing their own research. While most scientists study isolated cannabinoids, people at home use the raw plant and results can vary. Dr Wodak says that baking and eating cannabis
can cause build-up in the body and
unreliable dosage. Inhaling is effective and quick, taking only 50 seconds to get into the bloodstream (unlike a pain pill) and, helpfully, patients can stop puffing when they feel it working, perhaps meaning smaller doses. Cannabis oil
is often used for young children with epilepsy, but is also used for adults. Despite the urgent need for more
knowledge, researchers’ hands are tied. “I don’t usually work on cannabis much,” says Dr Christopher Vaughan from the Pain Management Research Institute at the University of Sydney. “Getting THC is difficult and expensive because of all the regulations and restrictions.”
 
GROW PRO
However, not everyone’s afraid of the law. You might have seen Tony Bower on TV in police raid footage, standing beside thirty-odd cannabis plants in a remote part of the NSW bush.
Tony founded Australian medical cannabis company Mullaways, which produces cannabis oil for medicinal use. In the footage, police ask him what he’s doing. “Well – each of these plants represents a person we’re helping,” says Tony, exasperated.
Tony supplies Nicole Cowes,
whose daughter Alice has a rare
form of epilepsy that gives her 30 seizures a day. Since taking the oil, Alice only has the occasional seizure, and is no longer taking a cocktail of anticonvulsant medications. Tony supplies Nicole without charge, as he does many other people, including Star. He is frustrated at the government,
but not worried. “There’s a lot of people suffering out there, for no reason,” Tony says. “I put my head
up, so the government had someone
to concentrate on. I’ve got broad shoulders,” he adds.
And Tony is no hack. He gets his products regularly tested at the University of NSW (at least he did, until he says the authorities shut that lab down, too). What’s most surprising about Tony’s product
is that, he says, because the THC content is below the legal 0.5 per
cent limit, his oil contains no illegal substances. It’s just growing the plant that’s illegal. Mullaways is amongst several organisations ready to begin production of cannabis as soon as the law is changed or clinical trials are approved.
 
A GREEN LIGHT
Things are starting to spark up in Parliament. The NSW Nationals MP Kevin Anderson has announced his intention to introduce a private members’ bill to approve the use of cannabis by terminally ill patients. NSW health minister Jillian Skinner has also softened her stance on clinical trials of medical marijuana. Support is also stirring on
a national level. A previously existing federal cross-party parliamentary group for drug law reform, whose members include Dr Sharman Stone MP (Liberals) and Senator Dr Richard Di Natale (Greens), is getting the band back together to try to push past party politics. “To me, it’s a matter of being compassionate,” Stone says. After making her pro-medicinal cannabis views public, she received tonnes
of emails, all in favour of the drug.
“I think it’s a cruel thing to withhold
a pharmaceutical to a dying person.”
She adds that the ability to regulate
the industry is already within the Government’s power. “If we need to grow the product in Australia, we’ve already got a model for doing that via our poppy growing,” (referring to Victoria and Tasmania growing poppies successfully for morphine). “Our next step is probably going to be a private members’ motion.
It needs to be driven nationally.”
In August this year, a Melbourne couple were raided and questioned by police after giving their three-year-
old son cannabis oil for seizures. Greg Barns, a barrister and a spokesman
for the Australian Lawyers Alliance, is representing the couple. “I think it’s time for the courts to take a lead,” says Barns. “Unfortunately, Australia tends to do things more slowly. But I do think within five years we will see medical cannabis available to Australians.”
Meanwhile, Natalie Daley has more stress to deal with than just coping with cancer; she’s overrun by people calling her for help. “I have influxes of people wanting oil,” she says, even though she doesn’t make it. “These people are in pain... we need to get across to politicians how useful this plant really is.” WH
 
Rebecca Butterworth
November 2014