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Medicinal cannabis is legal in Australia, but people like Grace are still turning to the black market

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After Grace* was diagnosed with cancer earlier this year, she turned to medicinal cannabis.

But accessing it through legal medical channels was a challenge: she faced long waiting times and substantial paperwork.

“I was offered through an illegal source where I could get it very quickly, and because my tumours were aggressive and time is of the essence, I decided to opt for the non-medical option,” she tells ABC RN’s Life Matters.

Grace started to get cannabidiol (CBD) oil sent to her in the post, in an olive oil bottle.

But concerns about the illegalities of the drug started to weigh on her conscience, and she worried about the chemical composition of the CBD oil she was taking.

“If you’re obtaining it through a medical source and it’s been approved, there’s stringent procedures and processes in order to create that oil. Whereas if I’m getting it off an illegal source, it’s hard to actually know exactly what I’m taking,” she says.

A scientific dope dive

Does medicinal cannabis work? Take a look at the evidence for different conditions.

She decided to “have another look at obtaining it through the medical channels” — but in the end, she opted to “stick with the illegal source”.

“It just seemed like the most easiest, cost effective option for me,” Grace says.

Navigating the system

Nicholas Lintzeris, an addiction medicine specialist at the University of Sydney, says Grace’s experience is not uncommon.

“The legal system we’ve had available now has been in place for about four years, and in the early days for the first couple of years we had a very clunky system,” he says.

Professor Lintzeris was the lead researcher in a study on how Australians use medicinal cannabis — for everything from chronic pain to mental health conditions.

The online survey of more than 1,300 people found that while cannabis is used widely for medicinal reasons, the vast majority of respondents don’t get it from their doctor.

“It was very difficult for patients to be able to find doctors who were knowledgeable and interested, the products were quite expensive, the legal hoops were quite pronounced. There were lots of hurdles, paperwork and so forth,” Professor Lintzeris says.

“Most of our respondents were working. They were people who were holding down jobs, mums and dads with kids. So engaging with illicit activities such as that was a concern.”

Life Matters listeners shared stories of similar hurdles:

“I have a well noted and long-term chronic pain condition, which has proven relief with CBD. Yet I have been constantly stymied in my attempts to get it prescribed. Thus I am forced to go through the black market with all its problems.”

“My husband was prescribed medicinal cannabis for his cancer pain — incredibly expensive — around $350 for a very small bottle that may last a couple of months only. It was very helpful but we just couldn’t afford to keep buying it.”

“I’d rather be using medical cannabis than opium products any day. But it is so expensive to access legally and yet opium products are subsidised by the government. The addiction story for opioids is horrendous. Cognitive dissonance [is] the right word for our culture.”

Access to legal medicinal cannabis is granted under the Special Access Scheme. It’s managed by the Therapeutic Goods Administration, and you need a restricted prescription for it.

The application needs to be done by a doctor on your behalf, and it must show you have a medical reason for accessing cannabis.

Between the start of 2020 and May 31, more than 18,000 applications for medical cannabis were approved by the TGA.

Professor Lintzeris says the system has adapted and improved since medical cannabis was legalised at the federal level in 2016.

Initially people would face wait times of up to two months for approval, he says, but now that’s more like two to four weeks — and that’s not the only change.

“I think we’re seeing some changes in the development of the marketplace, as more doctors take up this option and get better educated around what medical cannabis is, as the price of products is reducing and as more products come onto the market, and there’s more and more consumers who are getting experienced with legal supplies,” Professor Lintzeris says.

An ‘anachronism’ around drug driving laws

But he argues that some areas of the law are still lagging behind.

Driving with THC in your system is a criminal offence, even if you’ve been prescribed medical cannabis.

Drug driving laws ‘grossly unfair’

The standard advice for cannabis patients is to wait five days before driving, or risk a fine or a suspended licence, but there is ongoing debate about how much impairment THC actually causes.

“There’s this inconsistency in Australia where we have a group of drug driving laws that really reflect what made sense for illicit cannabis or drug use,” Professor Lintzeris says.

“Unfortunately, a THC-based medicine gets caught up in that drug driving. We have this anachronism in Australia where no other medication that’s legally prescribed is subject to the same drug driving issues as medical cannabis.”

It’s something that proved a huge worry for Grace.

“My biggest concern was that if I was to get pulled over while driving, if I registered for THC in a random drug test, I could lose my licence,” she says.

THC and CBD

  • Tetrahydrocannabinol (THC) is used to treat symptoms including pain, nausea and muscle spasticity
  • It is associated with some of the intoxicating effects of cannabis
  • CBD is used to treat epilepsy and inflammatory disorders, and relieve pain
  • It does not produce any intoxicating effects
  • The TGA warns that THC is not appropriate for people with a history of psychosis, or a current mood or anxiety disorder

Concerns surrounding ‘quality control’

Like Grace, Professor Lintzeris also points out that that if you’re self-medicating rather than going through a doctor, there are risks.

“There’s no capacity of standardisation of product or quality control, both in terms of what’s in this batch, how much THC or CBD in this batch compared to the batch from last month,” he says.

Despite the legalisation of medicinal cannabis in Australia, group bodies such as the Royal Australian College of General Practitioners (RACGP) continue to take a cautious stance on prescribing medicinal cannabis patients, calling for more high-quality research into the safety and effectiveness of it.

The RACGP pointed Life Matters to a statement, which said it doesn’t “recommend the use of cannabis products”, but does “recognise that a specialist GP may offer to prescribe it to a limited number of patients”.

Read more from Life Matters:

  • The mum on a mission to help kids embrace their bodies
  • Chunk the groundhog’s lessons for vegetable growers
  • How important is it to eat and sleep at the same time each day?

After four months using CBD oil through an illicit producer, Grace is willing to accept the risks.

“I do find that there is little to no side-effects of using the cannabis oil — which was a concern initially — and it’s a cost-effective option,” she says.

“When I went down that [medical] channel, what I found was that there were a lot of hoops I had to jump through, a lot of paperwork, and a lot of people who had to be involved.

“And even then if I was deemed worthy of the CBD oil, I was going to be sent this particular oil every six weeks.

“But the illegal CBD oil I got straight away, it was very easy to access and cost effective. So I opted to stay using the illegal source.”

*Name changed to protect the person’s identity.

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After Grace was diagnosed with cancer, she turned to medicinal cannabis. But getting it legally was a challenge, so she's sticking with the black market — and experts say her experience is common.

Canberra’s cannabis laws do not address supply problem, meaning buying the drug will remain illegal

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Cannabis will be legal in the ACT come the end of the month, but those hoping to light up might have to break the law to do so.

Key points:

  • Buying, selling and trading cannabis after January 31 will remain illegal in the ACT
  • Academics are worried potential pot purchasers will go to drug dealers
  • Calls for “cannabis social clubs” have been rejected by the ACT Government

The controversial new laws legalise growing, possessing and smoking small quantities of cannabis.

If you are over 18 you can grow the plant, collect up to 50 grams of dried bud, and smoke it as you like within your own home (provided there are no children around).

But the laws do not offer any guidance at all on how it is supposed to be acquired.

There will not be any cannabis shops opening up, as buying and selling the drug remains strictly illegal.

It also cannot be gifted from one person to another.

Cultivating two plants — to a limit of four per household — is perfectly legal but buying cannabis seeds is not.

Professor Simon Lenton from Curtin University’s National Drug Research Institute argued the laws left people looking to use cannabis with few options outside of drug dealers.

“Either they’re going to go to the illegal market or they’re going to miss out,” he said.

“It really is a problem for how the majority of people in the ACT who smoke cannabis are going to access the cannabis.”

The ACT Government is quite clear on the matter, arguing its approach is around “harm minimisation”, not opening doors to cannabis for potential users.

“This approach seeks to ensure that adults who are in possession of cannabis do not have to face the prospect of criminal penalty for possession and are more easily able to seek help for addiction or treatment for the adverse effects of cannabis,” a spokesperson said.

“It is not the Government’s intention to legalise the gifting of cannabis between individuals, other acts of supply, or the commercial sale of cannabis.”

Could weed shops work?

New Zealand is currently weighing up its options on legalising cannabis, ahead of a referendum on the question in late 2020.

The current plan suggests a tightly regulated commercial model, with cannabis sold in licensed shops.

It would not be advertised, or sold to anyone under 20 and the potency of cannabis sold will be restricted.

Like the ACT, the New Zealand Government is also pitching legalisation as a harm minimisation measure.

“The primary objective of the legislation is to reduce overall cannabis use and limit the ability of young people to access cannabis,” New Zealand Justice Minister Andrew Little said.

Anyone who wants to smoke it can do so at home, and in licensed venues — but not where alcohol is being sold.

It raises the possibility of cannabis cafes, like those found in parts of Europe.

“You might be able to enjoy a cup of coffee or tea with your cannabis product, but not alcohol,” Mr Little said.

Some ACT MLAs have indicated they could be supportive of commercialisation down the track, arguing it would help cut criminal gangs out of the cannabis business.

But it will not be an option for the foreseeable future, due to federal regulations that cannot be overcome.

Professor Lenton said going by the experience in North America, adding profit to the mix did not necessarily work out.

He argued it encouraged the consumption of ever-stronger strains of cannabis.

“What we’ve heard about in North America is very much commercially driven, profit-driven markets, where industry is really in the market trying to maximize its profit,” he said.

“And then we get the very serious problems that we’ve seen associated with alcohol and tobacco use and a lot of the problems that are emerging now look like the worst of that.”

‘Social clubs’ floated as possible solution

An ACT parliamentary inquiry considered many of these issues while the legislation was still being drafted, and made a range of recommendations.

One was allowing cannabis ‘social clubs’ of up to 10 people to be formed, as a way of getting around some of the supply issues.

Social clubs would essentially allow users to pool their plants — growing plants together at one single property.

Membership would be restricted and registered, and plants would be grown on behalf of members, who could then access their cannabis free of charge.

Professor Lenton said, having surveyed the models in place around the world, social clubs appeared to offer the best legal middle ground.

He argued it provided an easy option for people unable or unwilling to grow their own plants.

“It’s a way of providing cannabis in a restricted market without the problems of widespread availability, rampant commercialisation and profit-driven advertising to people who are regular cannabis users,” he said.

“Rather than having them go to the illicit market.”

The ACT Government rejected the recommendation, suggesting it went beyond the intention of the legislation and would have made it difficult for police to distinguish between cannabis clubs and illegal grow houses.

Whether or not supply becomes a problem for users — and the ACT Government — will become apparent in just a matter of weeks when the legislation comes into effect.

A public information campaign is planned to roll out before the laws come into force, which might give some indication that the Government expects users to put the new laws into practice.

There is still one big unanswered question about Canberra's new cannabis laws — if supplying the drug remains illegal, how is anyone meant to acquire it?