Understanding Medical Cannabis – 1. Australia21: Concerned about The Greens — and even doctors — going ‘soft’ on cannabis? 3. Cannabis Tech: The Awakening Of The German Cannabis Market

1. Australia21: Concerned about The Greens — and even doctors — going ‘soft’ on cannabis?

Well, yes. And no.

It can be argued that cannabis use was only made illegal in Australia because of pressure from a racist government in the United States of America, which was running a scare campaign about Mexican immigration in the early 1900s. False claims about the dangers of ‘marijuana’ were used to demonise Mexicans and other people of colour, without most Americans realising it was the same as the cannabis plant, or hemp, that they had been using perfectly legally as a medicine and relaxant for centuries.

It’s true that cannabis use can be linked to increased rates of psychosis in some particularly vulnerable people. But there’s also a swathe of authoritative research demonstrating that cannabis is actually less dangerous than some currently legal drugs, including alcohol.

Australia21 - archival US anti-marijuana adIn 2011, the highly reputable British Association for Psychopharmacology examined the relative physical, psychological and social harms of these two most frequently used intoxicant drugs in the UK. Among other impacts, the study took into account the rates of schizophrenia and psychosis from cannabis consumption and liver cirrhosis hospital admissions and deaths from drinking alcohol. The comparison confirmed previous research showing that alcohol was more than twice as harmful as cannabis to users, and five times as harmful as cannabis to others around them.

In Australia, alcohol is linked to 5,000 deaths and more than 150,000 hospitalisations each year. In 2017, Australian Medical Association President Michael Gannon slammed the federal government for its ten-year National Drug Strategy listing methamphetamine as its top priority, although ice use “pales into insignificance with the problems caused by legal drugs like alcohol.” Cannabis doesn’t even come close.

It has to be recognised, however, that there’s strong medical evidence that both cannabis and alcohol can have negative impacts on developing brains — the younger that people start using them, and the greater the frequency, the greater the risks of harm.

Dr Alex Wodakwho ran the Alcohol and Drug Service at St Vincent’s Hospital in Sydney for 30 years, supports the Greens’ policy because it’s based on the principle that any drug or substance (including alcohol, tobacco and pharmaceuticals) has the potential to be of harm to the individual or to the community.

Dr Wodak, who’s President and a Director of Australia21, recommends strict penalties for people caught selling cannabis to anyone under 18, just as there are for alcohol.

He says regulation would also enable governments to mandate plain packaging, like we have for cigarettes. The packages could provide health warnings, information about seeking help, and consumer product information including the content of psychoactive ingredients and their concentration.

“Government-commissioned guidelines for less risky alcohol consumption have existed for decades. Regulating cannabis would enable government to start commissioning guidelines for less risky cannabis consumption,” says Dr Wodak.

But even if you accept the evidence that cannabis is less harmful than alcohol and health warnings can help keep the risks in check, the question remains: Why make any narcotic more easily available? Doesn’t that just compound the drug problem and put our children in greater danger? Surely two wrongs don’t make a right.

Australia21 - marijuana joint being litWouldn’t legalising cannabis increase the use and the associated harms?

The Greens’ argument that making cannabis legal would actually reduce the harms from its use sounds totally counter-intuitive, so it’s not surprising that the gut reaction of a lot of people has been to reject the policy.

For example, Jo Baxter from Drug Free Australia told Channel Ten’s The Project that a policy of taxing cannabis would never offset the burden on our health system if it was legalised.

“It would send the message that it’s permissible and safe to use, and it would increase use, particularly among young risk-takers.”

Not so, according to the Australian Medical Association.

“Importantly, we know that countries that have adopted non-punitive responses to drug use have not experienced major increases in the prevalence of drug use, and have reduced the stigma associated with drug use and seeking treatment from doctors,” says AMA Vice President Tony Bartone.

Dr Wodak agrees with that assessment.

“Supporters of cannabis prohibition frequently assert with great confidence that punitive approaches reduce consumption while a lenient approach increases use. Yet credible evidence to support this contention is unimpressive.

“A study comparing residents of more liberal Amsterdam and more punitive San Francisco using the same methodology found less illicit drug use (including cannabis) in Amsterdam,” says Dr Wodak.

The Greens want advertising of cannabis banned from the outset, saying use of the substance shouldn’t be condoned or encouraged. But they argue the idea of prohibiting it altogether to protect people ignores an important reality: many Australians are buying black market cannabis already.

The 2010 National Drug Strategy Household Survey found that cannabis is the most commonly used illicit drug in the nation. According to the federal government’s own figures from 2016, millions of Australians choose to use cannabis each year despite it being illegal; Dr Bartone says 35 per cent of the population has tried it. And research shows the drug is easy to obtain in Australia. So advocating abstinence as a widespread policy has proven very ineffective.

The Greens cannabis infographic

 Wouldn’t punishing cannabis users stop them from getting harmed?

Far from preventing damage, many health professionals and social services providers warn that criminal convictions often cause or worsen a whole range of harms for individual drug users and Australia as a whole.

The highest proportion of illicit drug arrests in Australia are for cannabis possession — and 90 percent of those arrested are consumers, not manufacturers or traffickers. The sad irony is that often leads to the loss of employment, housing and family and community support. This can spiral into further crime, while also increasing homelessness, domestic violence, child protection interventions, mental health issues and suicide rates.

To top it off, there’s no evidence that offenders who’ve been jailed reduce their drug consumption — quite the opposite, in fact. It’s well known that spending time in jail, particularly if prisoners are young, puts them in greater physical and mental danger, exposes them to harder drugs and turns many into life-long criminals instead of rehabilitating them.

So Australia’s current laws cause collateral damage to the drug users’ families and their communities — and all Australian taxpayers end up footing the bill for the negative flow-on effects.
That’s why the Australian Medical Association supports reforming drug laws.

Although it’s cautious about the model the Greens are proposing, the AMA agrees that harm reduction strategies should take into account both the potential damage from using substances such as cannabis, and the potential damage and negative impacts of the different approaches for controlling the use and supply of the substances.

“We support their harm minimisation intent, believe that criminal penalties for personal use are unhelpful,” AMA President Dr Michael Gannon tweeted after the Greens’ announcement.

Vice President Tony Bartone went further:

“Prohibition of cannabis use with criminal penalties has the potential to produce harms and risks. Furthermore, the effectiveness of criminal prohibition of cannabis use in reducing the health-related harms associated with cannabis use is questionable.”

“The way Australia manages drug use is clearly not working. Increased investment in policing and incarceration is not having the desired impact. There are other more appropriate measures available,” Dr Bartone told the ABC.

Australia21 - Young man with green hair exhaling from a marijuana bong

Aren’t the support services for problem drug users inadequate?

Another critic of the Greens’ policy, former WA police commissioner Karl O’Callaghan, told the ABC he was worried that removing criminal sanctions for cannabis use could trigger or exacerbate mental health problems for people like his son, who had battled with drug addiction.

“They are very significant and trying to get adequate help, even today, without decriminalisation is very, very difficult. I would be concerned that parents would be left with nowhere to turn if the services are not in place as a result of this proposed policy.”

Prevention and treatment programs are far more likely to help someone overcome substance addiction than sending them to jail, but Mr O’Callaghan is right: there’s a chronic lack of services. Drug rehabilitation and education are (dare we say it) criminally underfunded, a fact highlighted by a recent federal parliamentary report.

This is exactly why health and social service organisations and policy leaders from across Australia held a summit in March 2018 and signed a joint statement calling on Australia’s federal, state and territory governments to treat drug use primarily as a health and social issue and to remove criminal sanctions for personal use and possession.

Also, in 2017 a prominent group of serving and former senior police, prison officers, lawyers and Alcohol and Other Drug experts put their names to Australia21’s groundbreaking report Can Australia respond to drugs more effectively and safely?calling for decriminalisation of personal use and possession, hand-in-hand with the provision of more health and social services to reduce drug-related problems.

According to former Australian Federal Police Commissioner Mick Palmer, who’s now a Director Emeritus of Australia21, one of the flaws of the current law and order approach is that it discriminates against those who are most vulnerable.

“People most likely to come to notice of police are Indigenous people, homeless people, people who suffer mental health and other health related problems, including people like Vietnam vets.”

The experience with alcohol shows that some people are likely to struggle with dependence and other adverse reactions like overdoses, whether the substances they take are legal or not. But in the case of illicit drug use, Mr Palmer says getting help is a whole lot harder.

“Impairments are occurring now under a totally unregulated black market regime and when people suffer adverse reactions, they are less likely to immediately seek help and tell the truth, due to the unlawfulness of their conduct.”

As Dr Bartone pointed out, removing the stigma and threat of prosecution for cannabis use would make it easier for people to seek medical treatment as soon as they need it.

The Greens argue that regulating the market would provide welcome revenue through the taxation system, which could be spent on appropriate mental health services. Australia21’s own research has identified further potential cost savings from reducing the prison population and supporting police and the judicial system to focus law enforcement more usefully.

Isn’t cannabis a ‘gateway drug’ for more dangerous substances?

Health Minister Greg Hunt was a vocal critic of the Greens’ cannabis policy, claiming that legalising it would create physical and mental health problems.

“Marijuana is a gateway drug. The risk of graduating to ice or to heroin from extended marijuana use is real and documented,” Mr Hunt told reporters in Melbourne.

But Mr Hunt is wrong. The Gateway theory was used for decades without evidence and has long been discredited. There’s actually stronger correlation between early alcohol/tobacco use and later heroin use.

“A 2014 study showed that in US states where medicinal cannabis was lawful, the rate of opioid overdose deaths was 25% lower — and that it was lowest in the states that had legalised it earlier,” says Dr Wodak.

Papers published since have supported that research.

Mick Palmer is disappointed with the Health Minister’s response.

“Mr Hunt is an intelligent man who should  be able to do better. I don’t believe anyone proposing change is ignoring any adverse impacts – physical or otherwise. The reduction of harm is at the very heart of what drug reform is all about.

“Some 2-3 million Australians are already using cannabis – and many are holding down very responsible positions. They currently purchase cannabis from criminal black markets, without knowledge of its toxicity or purity and the profits line criminal’s pockets. No one is suggesting there is a perfect solution here, but Australians have the right to expect our political leaders to be prepared to consider and discuss any proposal that has any potential to improve the status quo.”

Mr Palmer is also critical of Labor leader Bill Shorten, who called the Greens’ policy ‘political click-bait’ and dismissed drug use as a state and territory responsibility.

“I was extremely disappointed that Mr Shorten should simply play politics with this issue. Not to recognise the value of considering the Greens policy is, I believe, a reflection of the sadness of contemporary politics.

“The health of many ordinary decent Australians who – for whatever reasons – take cannabis recreationally, or who become addicted, should be of concern to everyone and particularly our politicians. We need Commonwealth leadership,” says Mr Palmer.

Doesn’t international evidence show increased car accidents and hospital admissions?

In an interview on The Project, panellist Waleed Aly challenged Greens leader Dr Richard Di Natale about figures from Colorado in the United States, showing a jump in traffic fatalities since recreational cannabis was legalised there in 2012. But the original analysis by the Denver Post was questionable.
The Colorado Department of Transportation and public safety officials dismissed it because there wasn’t enough data to positively prove that the deaths were linked to the cannabis or its legalisation.

The US National Institute on Drug Abuse and the American Automobile Association both caution that THC, the principal psychoactive constituent of cannabis, can remain detectable in body fluids for days or even weeks after intoxication, so testing positive doesn’t necessarily mean drivers are impaired or at fault for fatalities — it may merely show an unsurprising rise in the legal use of cannabis. On the other hand, they point out that many drivers who test positive for cannabis also have alcohol and other drugs in their system, which may contribute more significantly to crashes. A 2017 report to Congress by the National Highway Traffic Safety Administration based on US-wide experiences concluded there was poor correlation between impairment and THC levels in the blood or oral fluids.

Mr Aly also quoted figures indicating a rise in hospital Emergency Room visits for cannabis-intoxicated children in Colorado, but the interpretation of those figures has been disputed too.
To begin with, ‘children’ referred to anyone up to 21 years old. Cannabis use wasn’t necessarily the underlying cause of the emergency or even related to it, but was noted if there was any possibility that it may have been relevant to the patient’s treatment — as were other possible causes. The figures were not backed by any lab testing.

Another issue raised by Mr Aly was a spike in poisonings from edible cannabis. Colorado definitely erred in initially not requiring sufficient warning about risks of cannabis overdose from edibles — oral absorption of cannabis is quite slow, so some people who thought it wasn’t having much effect ate more than they should have, not realising it was still to kick in. Colorado quickly revised its protocols. There are now prominent warnings on the packaging, which staff selling the edibles are required to read to customers.

Mick Palmer agrees it’s important to learn from international experiences.

“Clearly, Australia needs to continue to carefully monitor and review results everywhere. But the indicators Waleed mentions are not reflected in any other jurisdiction which has legalised cannabis, that I have seen, and with all new programs, in any field, changes and improvements will need to be made as the program moves forward.

After decades enforcing drug laws, Mr Palmer eventually became an advocate of decriminalisation and regulation because he saw the failure of Australian and international policies first-hand.

“We’re not winning the war against drugs with the process we’re using at the moment. We can’t possibly win it.

“The core of the problem is prohibition itself.  As Neil Woods, a former UK undercover police officer who worked for several years in the drug enforcement field said recently, ‘the only way to win the war against drugs is to declare peace’. He is absolutely right.”

Many countries have either made cannabis legal or decriminalised its use with very positive results, including a drop in drug-related crime. They include Portugal, Spain, Italy, Denmark, Austria, Brazil, Netherlands and Norway. A number of US States, including California, Oregon and Colorado have similar legislation.

Mr Palmer believes regulating cannabis in Australia would reduce the costs of policing, customs, courts and prisons and allow better resourcing for a more effective response to the real criminals: the unlicenced producers and unregulated sellers pushing drugs.

Former South Australian police officer Damon Adams says a lot of currently serving police agree.

“Any time you have to seize any plants, whether it’s one plant or a hundred plants, it’s probably one of the most time consuming jobs you can do as a cop. You’ve got to get it all transported back to the station and they’ve all got to be catalogued. A lot of cops would like to see it legalised and regulated. It’s going to mean a lot more time for them on the streets to do proactive policing and go after criminals that actually have legitimate victims.”

Australia21 - marijuana seized by nsw policeWouldn’t legalising cannabis just make it easier for drug lords and pushers to sell it?

Look at the history of alcohol: prohibition didn’t stop people drinking, it only led to crime and corruption that empowered racketeers.

Similarly, prohibition of drugs has stimulated a market controlled by criminals who only care about their profits, not the toxicity of their product or the health of their buyers. Under our current laws there’s been an emergence of prosperous markets in crystal methamphetamines, cocaine and new party drugs, as well as the breeding of more potent strains of cannabis.

Senator Di Natale argues it’s time to hit the real criminals where it hurts, by undermining their control of the market.

“As someone who was a drug and alcohol doctor, I’ve seen how damaging the tough on drugs approach is to people,” Senator Di Natale told The Project.

“They’re sourcing products of unknown quality and purity, and of course all they’re doing is feeding the mega profits of criminal syndicates and criminal gangs. We’ve got to take this out of the hands of criminals and dealers, we’ve got to make sure it’s within the hands of health professionals.”

There’s no doubt it’s a radical idea, but Mr Palmer says regulation has worked in other countries.

“If people are obtaining the cannabis from authorised providers it will obviously be likely to be safer and have better quality control than a product bought from the black market with no safeguards at all.”

In addition, controlling the market would allow health professionals to provide advice and counselling directly to buyers at the point of sale.

Isn’t the AMA still opposed to legalising cannabis?

The Australian Medical Association is treading a very fine line. It says it can’t support the Greens’ bid to legalise cannabis use, but it does agree that it should be decriminalised. That is, people who use it should not be punished: no fine, no police record, no prison term.

In fact, the AMA updated its position on harmful substance use in 2017.
It now:

  • Supports a major change in funding priorities from policing and prosecution of substance users to interventions that avoid or reduce use, promote resilience, and reduce societal harms.
  • Supports responses to substance dependence and behavioural addictions that also address underlying causes, or exacerbating factors, such as social isolation, lack of early childhood interventions and support, exclusion, poverty, discrimination, criminalisation, poor education, inadequate health resources and mental health issues.
  • Supports the introduction of innovative policy models and trials, in a controlled manner, funded and evaluated appropriately, that might reduce harms and improve outcomes for users and society at large. For example: needle exchanges, pill testing, prisoner interventions and services, novel treatments and degrees of decriminalisation for some drugs etc.

So the AMA is advocating a harm reduction approach that aims to prevent and treat adverse impacts from drugs, but effectively leaving regulation of cannabis in limbo. The criminal underworld would remain in control, like the proverbial fox in charge of the chicken coop.

Unidentified person smoking

ABC News: Supplied: Port Film Co-op

Dr Bartone has suggested the solution could be civil penalties for personal use and possession. Australia21 is concerned that would send a conflicting message that cannabis use isn’t bad enough to deserve being prosecuted as a crime, it just isn’t good to get caught doing it. We believe Australia’s peak medical body should tackle the taboos around drug use head on and provide clearer guidance to doctors and the rest of the community.

As Bill Bush from Families and Friends for Drug Law Reform argues, the AMA is failing the cardinal ethic of the medical profession: ’cause no harm’.
Neither the application of social policy nor practice of medicine should cause harm. Experience with tobacco shows far greater reductions in use can be made by regulation than by prohibition.”

A poll by Essential Media in 2016 found that 55 per cent of Australians supported taxing and regulating cannabis. Breaking the figures down, at least 50 per cent of men, women, ALP voters and Greens voters supported the change, while 47 per cent of LNP voters favoured taxing and regulating it. It’s safe to assume those figures would now be higher, taking into account the support being voiced by many people in leadership positions since 2016.

So what was once a radical view is becoming accepted in mainstream Australia: helping people with substance abuse issues is far more effective than punishing them, in terms of health, social and economic impacts. The debate has shifted from whether drug law reform is needed, to what model should be adopted to implement it.

The consequences of rejecting drug law reform are clear: Australia will continue down the same precarious path we’ve been treading for decades, with the same damaging results. Closing our eyes to failure is not an option the AMA, or any Australian, should find acceptable.

Australia21’s fourth national Illicit Drugs Roundtable was held in Victoria’s Parliament House on Wednesday 21st March 2018. A Joint Statement on the outcomes was released by the participantscalling on Australia’s federal, state and territory governments to treat drug use primarily as a health and social issue and to remove criminal sanctions for personal use and possession.

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2. The Guardian: Legalising cannabis adds $3.6bn to Australian economy, budget office says

Legalising cannabis would reap the Australian economy almost $2bn a year, the Parliamentary Budget Office has found.

The Greens plan to not only decriminalise cannabis but also legalise it for adult use is the latest case study of political differences, with both Labor and the Coalition looking into legalising it for medicinal use, but going no further.

But claiming that the “war on drugs had failed”, the Greens leader, Richard Di Natale, last week proposed the full legalisation of cannabis, which would allow adults to grow up to six marijuana plants for personal use.

Under the policy, cannabis would be taxed and regulated by the government, in the same way alcohol and tobacco are.

And that could create a potential pot of gold for the government. The PBO estimates the Greens plan would raise $3.6bn over four years from July 2019, based on a 25% excise, as well as GST.

Law and order agencies would also be able to redirect resources spent on policing cannabis, to other illicit drugs, Di Natale said.

The PBO based its estimates on production licence fees of $3,500 an application, with annual fees varying up to $2,300, depending on the size of the operation.

However, the PBO also warned its estimate was hampered by the limited information available to judge cannabis consumption and its market price.

Using Australian Institute of Health and Welfare statistics, the Greens estimate 35% of Australians have used cannabis.

The PBO assumed the average recreational cannabis user purchased three grams a week for its analysis.

Di Natale said the PBO estimate showed the budding plan was not only socially responsible, it made economic sense as well.

“The Greens’ plan to legalise cannabis for adult use will bring in billions of dollars in public revenue that would fully fund drug education and treatment programs and provide a much needed funding boost for our hospitals and Medicare,” he said.

“We need to get real about cannabis. Almost 7 million Australians have used cannabis despite currently risking a criminal record for doing so.

“As a drug and alcohol doctor, I’ve seen the ‘tough on drugs’ approach causes enormous harm. It drives people away from getting help when they need it and exposes them to a dangerous black market.

“The Greens’ plan will raise billions for our healthcare system and focus law enforcement resources into where they’re needed most.”

The government has ruled out backing the Greens policy. The health minister, Greg Hunt, last week labelled cannabis a “gateway drug”, while the Labor leader, Bill Shorten, accused the Greens of angling for “political clickbait”.

Canada has committed to legalising cannabis this year, and nine states in the US have already done so, along with Spain and Uruguay.


3. Cannabis Tech: The Awakening Of The German Cannabis Market

Last year, Germany entered the list of medical cannabis countries, which in turn has begun to open up Europe. But as North Americans (both those from the U.S. and Canada) are learning, the European market bears little resemblance to what is happening anywhere else at the moment. Even in other medical markets.

That is even truer in Germany.

There are cultural differences. There are market differences. And they are coming together in a unique way to create a new kind of movement that will also have its own, overdue influence, globally. This new kind of discussion will be had for the benefit of science, medical advancement, and patients everywhere if not those who support and serve if not take care of them. And it will have a distinctive Teutonic twang.

This Is Federal Medical Reform

No matter how great the news that Trump is at odds with Jeff Sessions’ new war on state pot markets, American reform is still doddering in a lack of federal reform. With that, comes banking and of course health insurance. And no matter how exciting the Canadian recreational market is, the reality is that medical users, also known as insured patients in Germany, will consume greater amounts of cannabis per month on a regular basis than the average recreational user just about anywhere.

Even better news for an industry that is flocking here from all over the planet? In theory at least, when Germans become medical cannabinoid users, they will pay a lot less for it than any other kind of user anywhere else. Why? German public health insurance picks up the tab. Public health insurance in Germany covers 90% of the population and costs about $250 per month. The model, in theory also says that when a person gets sick they should be able to go to any doctor, get a prescription for whatever they need and pick it up at the local pharmacy (Apotheke) for about $12.

As of March 2017 that also applies to GMP certified cannabis. Up to 5 oz. of it a month. Which can be bought at regular pharmacies.

Despite all the administrative hurdles (and they are high) and multiple battles for access (because theory is not yet practice) there are already approximately 30,000 German patients as of April 2018, 15,000 of whom have covered claims at this point (up from a mere 1,000 people able to get prescriptions as of last March).  While that 15k number is a victory, the other half is still paying about $3,000 per month out of pocket and hoping that their insurer will approve their claims. Or suing when that does not happen soon enough. Only 60% of those who have submitted claims so far have been successful in being reimbursed.

But one thing is very clear. Germans are taking to cannabis reform. And this green genie is not only out of the bottle, but appearing in all forms – flower, oil, concentrates and other things. Including of the non-medical kind. The German government is currently offering tax incentives for the growth of certain kinds of hemp. Cannabis-related sex aids are already popular items. And remember, prostitution is absolutely legal in Germany. For both sexes. This is not a prudish discussion here.

On any level.

MedPayRX at Diamunich Digital Insurance Agenda Conference

And that includes access for Germans who have conditions that are still off the map of effective treatment. Like epilepsy. The German government, in fact, has targetted epilepsy as a focus within the public health sector. Why? The social services sector will pick up the tab for the chronically ill. No more chronically ill, no more tab. The difference between both the individual and the state, just in this one situation of disease management, will be massive, and life-changing. Not to mention save at least $3,000 per month, per individual, for the rest of their lives. That is a bill that ultimately remits to the German taxpayer.

If there is a common sense fix, even and especially if it can be derived from a plant, this is the kind of thing that will make sense to even the most stereotypical, paper-obsessed, bureaucratic bean counters.

And sooner rather than later, just because of the economics of the situation. The population that will be served by cannabis is not only greying. It is not hospital based.

That discussion is being had by those who make the rules. And in this country, the rules say that this is a discussion that now must be had. In March last year, German law changed to say that cannabis is now a legal drug, even of last resort, whose use, when prescribed by a doctor, must be covered under German public health insurance.

Finally, cannabis is (almost) a mainstreamed, regular drug, just like many, many others.

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