Hard News: A dramatic and unremarkable decision
49 Responses
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Alfie, in reply to
Why do you think it’s politically difficult for pollititions to allow the use of CBD as a medication?
As cannabis has a successful 5,000 year history as a medication, I'd have to say our politicians are more influenced by an outdated US policy designed to halt the flow of Mexicans into the states in the 1930s. Wouldn't you?
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Russell Brown, in reply to
Dunne Speaks
I think it would been more helpful if he hadn't, tbh.
He actually didn't need to go charging around with a firehose.
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Sofie Bribiesca, in reply to
He actually didn't need to go charging around with a firehose.
But, he's a politician.
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Alfie, in reply to
Dunne Speaks
I think it would been more helpful if he hadn't, tbh.He appears to make his view on those who call for decriminalisation pretty clear... they're best ignored.
Some have hailed this week’s decision as the start of a “sensible” discussion of drug policy. I am deeply suspicious of that pejorative approbation – those making that call are invariably cannabis legalisation advocates, best ignored as just one more vested interest.
While some people undoubtably take a "single issue" approach to drug reform, it's sad that Mr Dunne blithely dismisses their ability to show compassion when it comes to a treatment of last resort for a sick child.
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Alfie, in reply to
Because, bad communication about the science.
Agreed.
I believe access to medical cannabis would benefit a lot of people -- those who suffer from crohn's disease, glaucoma, etc. For that reason I can't help but see Dunne's decision having a positive influence on public perception towards medical MJ in general.
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BenWilson, in reply to
. I believe that people should be alowed access to cannabis for medicinal use.
Me too, there's an even stronger argument for that than the already very strong argument that cannabis should be allowed for non-medicinal use. It's already being used in a massive way in this country, and those who want to use it medicinally instead of getting stoned should have the option not to have to break the law and get stoned as well, just to get access to the medicinal properties. My poor old great-aunt that recently died of cancer used for the first time in her life to help get through the shocking pain. It seemed a bit silly that she had to go through all the bullshit of making a connection, surreptitiously hiding her baggies and toking it up through a bong when a damned pill could have been prescribed.
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Kay, in reply to
Hi Sofie, sorry I'm a bit late in on this thread. Re your question about them being able to operate to remove the part of the brain that's causing his seizures:
Surgery is only an option for a very small group of people with uncontrolled epilepsy. The seizures have to be proven by very intense testing to be originating from a specific part of the brain, and even then that's got to be a part of the brain that can be cut out without causing severe damage to senses/mobility etc. In NZ all the testing and surgery in done at Auckland Hospital so if that were an option for Alex I suspect by now it would've been investigated. If the seizures are generalised, ie they start with and affect the whole brain then surgery is never an option.
I hope that helps with your question. -
Here's one for Steven Crawford to ponder.
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Rich of Observationz, in reply to
And if a doctor prescribed ‘cannabis’ to someone when they where in a comma…
Well, better that than in the colon..
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Russell Brown, in reply to
I hope that helps with your question.
Thanks for that, Kay.
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Russell Brown, in reply to
My poor old great-aunt that recently died of cancer used for the first time in her life to help get through the shocking pain. It seemed a bit silly that she had to go through all the bullshit of making a connection, surreptitiously hiding her baggies and toking it up through a bong when a damned pill could have been prescribed.
If I'm ever in her position, I hope the law is more sensible by then. I'm not sure if it needs to be a pill even. One of the benefits of legalisation in Colorado (and of California's less-well-regulated medpot scene) has been the availability of does-exactly-what-it-says-on-the-label strains of marijuana. There'd have been one for her – ideally as an edible.
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Sofie Bribiesca, in reply to
Thank you Kay. I had read about the surgery somewhere and know that all options would be considered. It will be fantastic if Alex has some help from Elixinol though. I would suggest now ,if that is not helpful, his family could seek other derivatives from Dunne.
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Some positive news through this morning - Alex has opened his eyes and is responding to voices! The Elixinol is supposed to be arriving today too.
http://www.stuff.co.nz/national/health/69333788/Teenager-in-coma-opens-eyes-responds-to-voices
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There are some interesting ethical issues with interventions for people in a coma. Sometimes they can give retrospective consent after they recover. So it is not just the treatment that is controversial, but also the fact that the patient is not competent to consent.
This is the sort of topic which will be discussed by ethics nerds at the upcoming Australasian Association for Bioethics and Health Law conference in Wellington.
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Angela Hart, in reply to
It would be nice if they would also consider what constitutes genuine informed consent. I have been in the situation where my daughter was seriously unwell such that she was not thinking straight and was unable to retain what she was told, in a hospital HDU. She was taken to have given informed consent for various medications and treatments including a change of cardiologist and I was not informed except in terms of her telling me what little she could remember having been told. ( I was excluded from Doctors rounds because of privacy issues in a several bed HDU)This was lip service to informed consent and yet was taken as totally acceptable by the medical staff. I don't think Doctors necessarily understand what informed consent actually is. It's sometimes quite convenient to try out some stuff without having to go into the pros and cons-- but also extremely risky for the patient. I won't be excluded from an HDU or an ICU ever again without security being called.
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Russell Brown, in reply to
There are some interesting ethical issues with interventions for people in a coma. Sometimes they can give retrospective consent after they recover. So it is not just the treatment that is controversial, but also the fact that the patient is not competent to consent.
The irony in this case is that Alex Renton was given some very heavy drugs without his knowledge, but heaven and earth had to move in order to give him one whose risks, if any, are extremely low.
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The Herald's editorial this morning. I can't really work out what's going on here, but it seems angry. Is this voicing a National Party swipe at Dunne? I can't tell.
Understandably enough, the Renton family have been doing all they can to get the best possible treatment for their teenage son, Alex, who is in an induced coma in Wellington Hospital.
After more than 20 standard medications failed to cure his ongoing seizures, they set their sights on a cannabis-derived medication, Elixinol. Protests staged by the family and their supporters to try to get the Government to approve its use gained widespread media coverage. Finally, this week, they got their wish.
Associate Health Minister Peter Dunne has gone where, earlier, the Rentons' Nelson MP, Nick Smith, refused to. Dr Smith said he would need clear evidence that Elixinol would work before he took up the issue. That cannot be forthcoming for the simple reason that it has never been tested in clinical trials. As Mr Dunne conceded, there is no compelling evidence it will work. The best that specialists can come up with is that it might be worth a try.
For that reason, Mr Dunne was keen to stress that his approval should not be construed as setting a wider precedent. But how can it not be? What will happen if there are further cases where this or another untested cannabis-derived medication represents a final chance? If the ailing patient's family succeeds in attracting publicity, will Mr Dunne also accede to their wishes? He says the protests organised by the Renton family did more harm than good. Like his claim that this was not a precedent-setting case, that should be treated with a strong degree of scepticism. -
Well, this is pretty big. A $34 million grant to the University of Sydney for cannabinoid research.
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Here's how the Medicines Act allows for consent for unapproved medicines, unapproved indications for approved medicines, etc.
It's actually quite permissive. The precedent here is getting past the cannabis bugaboo, not the consent for an unapproved medicine. That's not uncommon.
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And now this from Dunne in NZ Doctors......sigh
While I am speaking about drugs, let me make two additional comments. The National Drug Policy is currently being reviewed and I am expecting to release the revised policy shortly.It will largely build on what is already in place, and will demonstrate a coherent, and integrated approach to the health issues associated with illicit drug use. The issue of medicinal cannabis has also been in the news of recent days.
Let me reiterate that my recent decision to authorise the use of a particular product in a particular case has no greater implications than that. There has been no change in policy, nor opening of the floodgates, and those who assume a new precedent has been established are mistaken.
This case proceeded according to the long standing procedures which enable clinicians to seek approval for the prescription of certain otherwise restricted products in specific circumstances. There has been no change to that procedure, and any future cases that arise will be treated strictly on their individual merits, with no assumptions of an automatic favourable outcome.
I have received anecdotal reports of clinicians refusing to apply for permission to prescribe Sativex, due to the stigma associated with it being a cannabinoid-based product. I hope these reports are mistaken.
It is my expectation that clinicians will act in the best interests of their patients, regardless of any associated stigma that may exist.
As I said to the United Nations Commission on Narcotic Drugs meeting in Vienna earlier this year, I believe it is essential that we address the issue of medicinal cannabis on its merits, and as a global community. I have asked my officials to look into the evidence and efficacy for cannabis as a medicinal or therapeutic relief.
But I have to say that based on the evidence provided to me, I have grave reservations about the efficacy of cannabis for the vast majority of indications that it is being put forward for. My concerns do not stem from a personal antipathy towards the drug – despite the sneers of my many critics on this issue, I am quite agnostic.
Rather, they stem from the very real likelihood that many sufferers – and in many cases they are children, are being given false hope that cannabis use will significantly ameliorate their symptoms, their pain and their reduced quality of life.
We have to do better, and shut out all emotion or personal prejudice and concentrate purely on the reputable, proven facts, of which there as yet few, when reaching long-term decisions.
http://www.nzdoctor.co.nz/un-doctored/2015/june-2015/12/-NZMA-General-Practitioners-Conference-Speech.aspx -
[Update: I should have refreshed this thread before posting - Russell beat me to it]
Here's a good news CBD story out of Australia.
Katelyn Lambert, a little girl suffering from Dravet Syndrome was having a seizure every 15 seconds. Her parents heard about American girl Charlotte Figi -- she had the same condition and improved dramatically after treatment with CBD.
Watching his six-month-old daughter endlessly spasming in pain drove Michael Lambert beyond the bounds of Australian drug laws.
Three years later, Katelyn's recovery has prompted an unprecedented A$33.7 million (NZ$37.29m) donation to fund research into medicinal cannabis.
The three-year-old's grandparents made the staggering donation on Friday to scientists and the University of Sydney - the largest donation ever made to any Australian university.
That generous gift will encourage research into cannabis as treatment for a wide range of illnesses.
University of Sydney psychopharmacology professor Iain McGregor said the research will focus on 10 key cannabinoid compounds found in marijuana and their potential use to treat a range of illnesses, including childhood epilepsy.
"Only one [THC] is psychoactive," Professor McGregor said. "This gift will allow us to explore one of the most exciting questions in modern medicine.
"The new science of cannabinoids has incredible potential for relief of human suffering ... and to repair damaged bodies and brains."
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Today's Herald editorial: Dunne's assurances on cannabis mean little
Mr Dunne was keen to stress that his approval should not be construed as setting a wider precedent. But how can it not be? What will happen if there are further cases where this or another untested cannabis-derived medication represents a final chance? If the ailing patient's family succeeds in attracting publicity, will Mr Dunne also accede to their wishes? He says the protests organised by the Renton family did more harm than good. Like his claim that this was not a precedent-setting case, that should be treated with a strong degree of scepticism.
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From today's news:
"Alex grew up on homeopathic remedies and Rose knew he would not respond to conventional medication...After a month in the hospital, Rose applied for legal guardianship over Alex so she could refuse some of the medical treatments."
To me that article reframes the issue - from the right to access a medication which has links to prohibited substances to the right to abandon on someone else's behalf conventional treatments in favour of unproven ones. This seems more like an analogue to demands for intravenous Vitamin C or other fringe treatments that are somehow less "chemical" than conventional medicine.
After all, diacetylmorphine, otherwise known as heroin, is legally prescribable and conventional treatment for pain relief. Cocaine is also used medically as a local anaesthetic sometimes.
Anyway, roll on the research, it's always better to proceed from a position of good information.
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chris, in reply to
opiates certainly are and just need to be prescribed by a doctor and signed out the controlled drugs cupboard.
Or you just nip out to garden, pick some of the seed pods off your (legal to grow) Papaver somniferum, illegally cut them open and squeeze out the sap, dry that and chase the dragon to your hearts content. Personally I’d prefer the class C cannabis, but as this class B producer is legal to grow, beggars can’t be choosers.
Not a smoker? Wack those pods in the blender and whip up a pot, add lemon, a delicious opiate brew, or use the leaves to make a salad, just be sure not to ingest too much or you’ll die.
We absolutely do need to be debating these topics, the whole gamut.
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