Five years ago, New Zealand introduced the Medicinal Cannabis Scheme which allows doctors to prescribe cannabis products to patients. But GPs have remained reluctant to prescribe it, with two thirds of doctors saying they would not prescribe it if a patient asked, according to research from Massey University.
Baz Macdonald looks into the medicinal cannabis sector for Re: Investigates. Watch it on TVNZ+
The number of medicinal cannabis prescriptions given out in New Zealand has risen exponentially, from around 6000 in the first year of the scheme to over 105,000 in 2023, according to Ministry of Health data.
This has gone hand-in-hand with the rise of cannabis clinics, which are specialised medical practices focused on medicinal cannabis.
An estimated 90% of consultations at cannabis clinics result in a prescription.
Using cannabis to alleviate cancer symptoms
Fabian Cook is a member of patient advocacy group Medicinal Cannabis Aotearoa New Zealand.
A few years ago, Cook’s grandfather-in-law Len Drager was diagnosed with stage four lung cancer.
He was rapidly losing weight because intense nausea left him unable to eat.
“The cancer was eating everything and I couldn’t eat. Just to drive downtown, I could smell a pie shop and it just about made me spew because of the smell,” Drager says.
He was so unwell, doctors told him chemotherapy and radiation weren’t options for him.
“He was told that there’s nothing that they could do. No radiation. No chemotherapy, even if he wanted it,” Cook says.
So Cook decided to offer him some cannabis to get Drager through his last six months of life.
“Fabian introduced me to CBD and THC. Since then, I’ve been taking quite high doses each day,” Drager says.
He had never taken cannabis before in his life. But, he says, “When you’ve got no hope, you’ve gotta hope. Because if I didn’t try it, it’s like going away and dying. So I might as well go away and die happy if it makes me high, or it saves my life.”
Drager and Cook say taking cannabis improved Drager’s nausea so much he was able to eat again and exercise.
He became strong enough for his doctors to try radiation therapy, and then immunotherapy, which worked so well that he’s now in remission.
Cannabis clinics ‘meet an unmet patient need’
Sally King is the executive director of the Medicinal Cannabis Council, overseeing the development of the medicinal cannabis sector in New Zealand.
She thinks GPs are hesitant to prescribe medicinal cannabis because they haven’t had the time to get educated on it.
Cannabis clinics have been able to fill that gap, King says.
She admits the 90% prescription in these clinics is high but thinks “they’re trying to meet an unmet patient need”.
“If GPs did [prescribe cannabis] then we wouldn’t have this focus on the cannabis clinics. It would be simply a part of a normal prescribing practice for a GP.
“The truth of the matter is they can’t, or they don’t. So that drives the patient community to the alternative.”
‘The rise is driven by demand’
Dr Waseem Alzaher is the co-founder and CEO of The Cannabis Clinic, New Zealand’s largest medical cannabis specialist service.
He says cannabis clinics are popular because “the rise is driven by demand — you can’t stop it”.
When it comes to the clinics’ high prescription rate, Alzaher says it’s “misleading and ignorant to look at the number only by itself because you’re taking away the clinical judgement of it”.
“This is a clinician who is sitting with the person, who is making an assessment of what is best for that person.
“If they feel in nine out of ten cases that is appropriate, by all means. That is what they are paid to do, and that is what the person in front of them is paying for — that service, that advice.”
A lack of evidence
Despite cannabis having been in use by humans for millennia, very few trials have been done to understand the medical effects and impacts of it.
An extensive review of medicinal cannabis research found no “firm conclusions on the effectiveness of medical cannabis” and that it was possible “harms may outweigh benefits”.
These harms ranged from minor effects like drowsiness and nausea, to rare but serious events like psychotic episodes and seizures.
Dr Luke Bradford is the medical director for the Royal New Zealand College of General Practitioners, the main organisation for GPs in New Zealand.
In 2023 the organisation told its members it doesn’t recommend or encourage the use of medicinal cannabis products.
The medicines watchdog says such behaviour risks running afoul of drug advertising laws. (Source: 1News)
“Traditional medicines that you would get from your doctor go through a very long and rigorous testing protocol. Medicinal cannabis doesn’t have any of that,” Bradford says.
“And when you take the fact that there is the ability for abuse and addiction, plus the fact that we don’t have the evidence of what it’s for, we recommend … that medicinal cannabis isn’t prescribed.”
Bradford says: “We’re not saying that people aren’t gaining some symptomatic improvement for some conditions with cannabis, or that they don’t find it helpful. What we’re saying is it shouldn’t have been classed as a medicine.”
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