GPs can now prescribe CBD products, but where do we go from here?

Obtaining a medical cannabis prescription in New Zealand just got a whole lot easier. Doctors now have the power to import and prescribe cannabidiol (CBdD), a medicinally potent and non-psychoactive cannabinoid that was previously classified as a controlled drug.

In the past, patients who needed access to CBD-based medication had to go through the laborious process of acquiring ministerial approval. Removing CBD from the list of controlled drugs enables doctors to issue CBD prescriptions directly to patients and eliminates many of the licensing and other regulatory requirements that pharmacies, prescribers, and wholesalers formerly faced.

Why the sudden change of heart?

Well, not only do the new rules improve patient access to CBD-based medicine, it also helps align New Zealand drug laws with global shifts in medicinal cannabis policy. In recent years, Australia, Canada and many parts of the United States have introduced laws allowing for the use of medical and/or recreational cannabis.

“This change is about future-proofing access to CBD products, as the reality is that there will continue to be barriers beyond New Zealand’s control to people accessing such products from overseas,” commented Mr Dunne in a June press release.

While many medical cannabis supporters are hopeful that the new rules will bring about positive change for Aotearoa, it’s difficult to predict exactly how the changes will affect patients.

What do the law changes mean in a practical sense? Will they help bring prescription prices down? And what can the government do to further improve access to medicinal cannabis? To answer these questions and more, we sat down for a chat with Shane Le Brun, coordinator at charity group Medical Cannabis Awareness NZ.

New rules have gone into effect regarding the medical cannabis prescription process. What’s changed?

The compound in cannabis CBD is now allowed to be prescribed by GPs. However, this doesn’t include high CBD-content products, only pure CBD products of which there are few available internationally. When pure CBD products are made available, they will be able to be prescribed like a regular medication with no interference or management from the Ministry of Health.

2. How will the changes affect patients?

Initially, I think many people will see the changes as little more than a taunt. For example, patients with treatment refractory epilepsy deserve a shot at trialling a CBD product but none are available and there are no funding pathways.

3. Which cannabis-based products are now available in New Zealand? How can patients access them?

At the moment there is Sativex, which can be prescribed by a GP only for its on-label (approved) use of treating multiple sclerosis. It is available off label for other conditions such as chronic pain, though this requires a separate application by a medical specialist (such as an anaesthetist) to the Ministry of health.

Based on our advocacy at MCANZ, patients can now also access Tilray, a product containing THC10:CBD10. Tilray is functionally similar to Sativex in that it is a “balanced” cannabis- based product. In the future, we expect New Zealand patients will have access to a greater variety of CBD products from Canadian companies, perhaps even including Bedrocan. The pure CBD product Epidiolex, typically used for treatment-resistant epilepsy syndromes, is likely to be at least two years away.

4. Are we going to see a flood of doctors suddenly prescribing medical cannabis to their patients? Why/why not?

No, I don’t think we’re going to see a flood due to the fact that the CBD products that are initially available are likely to be nonpharmaceuticals. There will be some professional pressure to avoid prescribing these products as they are not made to GMP standards and are not backed by clinical trials.

However, I do know some doctors that are incredibly supportive of CBD-based medication. I think we are likely to end up going down the same path as many other countries, where a small portion of doctors are responsible for the majority of prescriptions for cannabis-based products. This situation could be avoided if everyone in the healthcare industry treated cannabis objectively, but so far that hasn’t happened. A number of multiple sclerosis patients have been denied a prescription for Sativex – and that’s an on-label use! I find such resistance in the face of clinical evidence to be abhorrent.

5. It’s been widely publicised that Sativex, the most well known cannabis-based medicine in New Zealand, costs more than $1,000 per month. Will the recent changes make Sativex and other cannabis-based products more affordable? Why/why not?

There is going to be no change in affordability with the easing of restrictions on CBD, at least in the short term. Prescriptions could potentially become cheaper in the long term as the patient pool expands in New Zealand and overheads might decrease on a per unit/per patient basis.

Our focus at MCANZ is to find more affordable nonpharmaceutical alternatives to reduce those costs to the patient. We hope to have some positive announcements in regards to that shortly.

6. What do you think the government needs to do to further improve access to medicinal cannabis?

There are two main options going forward to improve access, both of which have been implemented in Canada.

The first approach involves making allowances for the local manufacture of what I would call ”near pharmaceutical” grade products. This can be done at a fraction of the cost of Sativex and would likely end up being similar in price to products in Canada, which tend to double in price by the time they’re shipped to New Zealand.

To support the use of these products, we’d need to introduce an access scheme and/or a vigorous education campaign so that GPs can prescribe these products while reducing the stigma and fear surrounding their use. Essentially, each patient would act as their own N=1 study. I’m quite fond of this plan as I think even a conservative government could stomach it.

The second part of improving Kiwis’ access to medicinal cannabis involves forcing policymaker to recognise that growing one’s own medicine is – as it considered in other jurisdictions – a human right. Human rights aren’t enshrined in New Zealand courts in a way that they can overrule government policy, and as we’ve seen in recent weeks our government has a rather dim view of human rights.

I’m pessimistic that either of the major parties would ever be willing to let people grow their own cannabis, but if they did there is a lot we can learn from North America in regards to what does and doesn’t work.

While I support the idea of patients with permanent conditions being allowed to grow their own cannabis, I do think there need to be some safety checks in place. It’s not common knowledge here, but house fires are a big issue in California due to people getting a little bit greedy and having too many 1000 watt light bulbs in one grow tent. Colorado’s ridiculous limit of 99 cannabis plants per household (the number has since been reduced to 24 plants for medical patients and caregivers and just 12 plants for recreational users) is also a little bit loose if we looking at things solely for medicinal purposes. I would propose limiting cannabis cultivation in terms of square metrage and perhaps have licenses issued with annual checkups and inspections.  

A licensing regime could also be used to educate users and minimise harm. This could go a long way toward helping patients understand the difference between harmful and helpful products, and also reduce some of the risks involved with the cannabis cultivation process.

I personally met with someone who had tried to extract butane in a caravan with the door closed and the heater on, and had suffered scars to his face and arms as a result. There is also an overabundance of “green fairies”, renegade growers who trying to produce affordable medical cannabis alternatives. While they might have good intentions, ultimately the product they’re distributing is of questionable quality and is certainly not suited to patients with serious health conditions.

Education would reduce the number of people that are using contaminated cannabis which is unsafe for immunocompromised patients such as those undergoing chemotherapy or people living with AIDS.
Interview with Shane Le Brun