MEDICINAL CANNABIS IN AOTEAROA: A COMPREHENSIVE SOLUTION FOR 2018 AND BEYOND.

After surveying the Drug law reform community there was an observed need for an official body to advocate for patients exclusively. After an abortive attempt in 2015, Registered a charitable trust in early 2016 First phase was funding Sativex, cute kids frequently raised 10k+ for themselves, not as success full with adults. Second phase was exploiting the “Non Pharmaceutical” Pathway for cheaper products, first success was Tilray, 25-30% cost saving, next step is an inbound product range from Cannimed offering 50% cost savings. 80% of all applications in 2016 were the work of MCANZ. Most Recent phase is a pivot towards political advocacy with 2 Cannabis bills before parliament, and our MC2018 policy booklet. History of MCANZ

MC2018 Policy booklet. Inspired by “Whakawatea-te-Huarahi” from the Drug Foundation, which only briefly covered Medical Cannabis. Contact with NZMA Board members, politicians, local industry startups, illicit growers and international industry experts. 21 Revisions, 2-3 months work.

Background, Unmet demand Canada, which has a scheme that covers a robust industry for products and the ability for patients to grow, has 20k patients licensed to grow, and 200k patients licensed to purchase products Israel, a more conservative model, has 30k for a population of 8 million. At the time of writing, best estimate from talking to suppliers was about 70 patients. With the expansion of CBD that number is closer to 120 If we follow a Canadian Regime, and matched there current numbers, we would have 25k patients, 15k for Israel.

Phase 1, the interim changes Schedule 22 of the MODR means Medicinal Cocaine, Opium are easier to prescribe than Cannabis. Rather than a defence for Terminal cases, we suggest a blanket “Medical necessity defence”. MOH to initiate a round of training for prescribers. As a unregistered range of medicines with wide range of uses, education is key, many GPs are holding back until they know more. Summary, GPs get free reign and education, patients get a free ride from the courts.

The Bones of the legal Framework Preparations currently go to class B Deschedule all non psychoactive compounds, not just CBD Low Dose CBD products to go to pharmacies. Manufacture to standards similar to Canadian GPP

Medical Cannabis as a Medical specialty WHO studies suggest changing prescribing habits of older doctors is futile. Even countries with liberal attitudes have a very small pool of prescribers, it is lucrative. In Canada some prescribers are reckless, doing skype consults with 0 follow up etc, and are being reprimanded NZ already has a GP who has single handedly prescribed more CBD than anyone else in Australia NZ, - responsibly To circumvent these practices, rather than chastise those “pro pot prescribers” Set up standards for prescribers to be “specialists” Rather than dispensaries run by lay people, this group of prescribers could have a variety of stock on hand to perform a function as a “dispensary lite” “Specialist” status entails high competency, cultivating expertise, and increased oversight by the MOH in exchange for a desirable status for the prescriber. – Carrot and stick.

Licensed producers American systems are prone to diversion to the illicit market, with separate licenses for growers, manufacturers and retail. Canadian Licensed producers provide All in one solution “Vertically integrated”. Advantages in security, quality control (product recalls!) and economies of scale.

Product classifications Canada and USA operate on a permit basis, patient decides what cannabis and how to use it. Australia, NZ, UK etc are focusing on products. With a vast array of strains on hand, the 2 issues methods need merging. Doctors are not going to be writing out scripts for Alaskan thunderf*** or Green Crack for example.

Product Bands Cannabis is broken into classification groups for prescribing based on strength and Ratio Patient has a choice of strains in that group Australia, NZ, UK etc are focusing on products. With a vast array of strains on hand, the 2 issues methods need merging. Doctors are not going to be writing out scripts for Alaskan thunderf*** or Green Crack for example.

Vaporizers Currently Vaporizers are drug utensils. Vaporizers minimize the harms from smoking Cannabis, from at least 80% for the cheap units, but 90%+ for the higher end units. Some Vaporizers are registered medical Devices in other jurisdictions Legalize them all – huge population level harm reduction.

Patient Subsidies Imported products for Epilepsy could cost as much as 100k a year for a teenager with a severe form of epilespy. Local products could still cost 10s of thousands PHARMAC requires multiple phase 3 clinical trials to fund or in the case of Med Can, “pigs to fly” MCANZ proposal is for Taxes generated from Licensed producers be ring fenced for funding patients. Pharmac to administer a separate scheme where emerging evidence and patient efficacy is taken into account, if a patient has epilepsy and has a successful trial, then this scheme can absorb the ongoing costs.

Home grow Setting up local products will take years, in the mean time patients will continue to grow. Doctors barely prescribe MC, let alone dealing with permits for patients to grow. Licensing agency would certify individual patients to grow their own. Criteria would be clinical evidence, ethics review, and criminal background checks. Permits would be time limited, and after assessing the patients needs, a permit would be granted.

Questions ?

Permits Permits would be for a size of area, not plant counts. The permitted area for the patient could be transferrable to a green fairy or compassionate grower. Compassionate Growers would be held to a higher standard, intent would be similar to foodgrade, to ensure they are not reckless with the production and quality control of products. For example, West Coast Green Fairy supplies a few people in Westport. He has a handful of chronic pain patients who have been granted 2m2 each, and 2 cancer patients who have been granted 4m2 each. The toal amount he is aloud is 20m2, he buys indoor grow tents to cover half those needs, and then has an outdoor greenhouse of 10m2 in size. He has annual inspections to ensure he isn’t “overgrowing” and he periodically has his product sent off for testing to ensure his products have low levels of mold, and that he isn’t using any banned pesticides.

Timeline

Questions?