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OPINIONSocietyAugust 29, 2023

It’s been legal for years, but medicinal cannabis users are still being penalised

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Image: Tina Tiller

People who use medicinal cannabis in New Zealand are not seeking to get high, but they’re facing repercussions from police and their employers. It’s time the law caught up, argues Clare Halford, a doctor who prescribes it.

Since medicinal cannabis was legalised in 2020, we have seen vast demand from New Zealanders for alternative pain assistance and the benefit that this treatment has on their quality of life. 

Despite this, many people who use medicinal cannabis are being unfairly penalised because of New Zealand’s outdated (or non-existent) policies and legislation regarding drug use. 

There is a significant difference between the cannabis usage and behaviour of someone who gets stoned recreationally and the ever-increasing number of people who use medicinal cannabis to treat various ailments such as chronic pain conditions, anxiety, sleep disorders, depression and the side effects of chemotherapy. 

Our patients are simply seeking relief from these health issues – they’re not looking to get high. They want to be functional, not stoned.

Yet, these patients find themselves facing the same repercussions as those who use cannabis recreationally, with a number losing their job, being fined or having their prescription cannabis confiscated by police.    

It’s worth noting that as with other prescription medicines, medicinal cannabis can have a mild sedative effect, but this is generally much more mild than other pharmaceutical drugs that are prescribed for pain. In fact, University of Sydney-led research found that 1500mg, the highest daily medicinal dose of cannabidiol (CBD), had no impact on people’s driving or cognitive abilities.

The conservative mindset around medicinal cannabis use in everyday life needs to change. It’s not right that a person with a genuine need for this treatment is unable to take it for fear they will lose their job, or their licence.  

So how do we address this issue to ensure medicinal cannabis users are treated the same as those who take “traditional” medicine to provide relief of their health problems?

First, the current understanding of “impairment” needs to be revised with consideration given to how medicinal cannabis is prescribed, used and metabolised in the body in comparison with the recreational use of drugs and alcohol. 

Medicinal cannabis is frequently much lower in dosage than recreational cannabis for several reasons – oral THC is most often given in low doses and medicinally grown cannabis flowers given by the inhaled route are typically needed in smaller quantities due to their purity and more reliable THC content. We also advocate patients’ use of approved dry herb vaporisers that are vastly more efficient and safer than smoking and maximise efficient delivery of the medicine. 

At the Cannabis Clinic, we strive to use the least amount of medicinal cannabis for the best results – we “start low and go slow” on dosage, tailoring exact amounts to each patient individually based on their experiences with it. 

However, most studies (on which these “impairment levels” are based) have been done on people using recreational doses of cannabis (ie they are intended to produce intoxication). In contrast, there are very limited medicinal cannabis studies that test the effect of much lower dosages, predictable and consistent timings and longer-term use. 

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Secondly, we need to see clear and reasonable guidelines for the safe use of THC and driving, as these do not exist yet. 

As it stands, it is against the law to drive while impaired by taking any impairing substance (including prescription medicines and over the counter and pharmacist-only medicines).

Recent changes to the legislation include new illegal limits with lower limits for infringements, and tougher penalties for drivers found to be driving while impaired. 

As part of the legislation, police can conduct random roadside drug testing and use oral fluid testing kits to determine if someone is impaired by drugs while driving. This part of the policy has been pushed back as the appropriate device hasn’t been found – indicating the complexities in testing for “impairment” rather than simply testing for drugs in one’s system.  

But this new legislation makes no delineation between prescribed or recreational cannabis. People using cannabis long term (for medicinal reasons) will test positive to THC blood and saliva tests and may be unfairly penalised.

Finally, a more predictable guideline consensus needs to be reached so that employees and employers both know where they stand, and what to expect across the board. 

We’ve had a number of patients who have been put on extended leave, been dismissed or threatened with dismissal and have had to stop taking the medication they so desperately need. 

Recently, we had a middle-aged man with very severe insomnia who had tried everything to help over the years – once he got onto a tiny amount of medicinal cannabis, his sleep was restored for the first time since his teens. Even though this person had a corporate desk job with no safety-sensitive work, the company he worked for simply could not see past the fact that he’d tested positive for THC in a urine test after starting the medicine. 

Despite an appeal from his GP who stated that the alternative meds she would be forced to prescribe (which were vastly less effective) would be more risky in terms of impairment the morning after taking them, the company refused to budge on their stance and forced this person to make a choice between sleeping with no side effects or working and feeling terrible all the time. He chose to pack up his desk, and is now looking to change careers altogether. 

We should also look to other places in the world who have addressed many of these problems already. 

In Norway, the UK, Ireland and other countries, exemptions are issued for medicinal cannabis users – they will not be prosecuted after a positive THC test if they were not impaired at the time of testing AND carry a current prescription.

Possibly, higher levels of THC  for prosecution could apply if the person was a legitimate medicinal cannabis patient and had no evidence of impairment.  

Ultimately, nobody wants drug-impaired drivers on the road or in the workplace, but our drug laws and policies need to take medicinal cannabis users into account.  These people are not getting stoned recreationally and they shouldn’t be treated as such. We’re treating a wide spectrum of New Zealanders – from elderly patients who use THC drops for arthritis pain and cancer patients who use drops to ease chemotherapy side effects to women suffering from endometriosis who use THC flower products to treat period pain. 

It’s time to update our drug laws so medicinal cannabis users aren’t unfairly penalised.  

 Clare Halford is medical director at the Cannabis Clinic

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