2016-03-24
Colleen Hartland - Speech in Parliament: I would like to start off by congratulating the Victorian government on bringing forward this legislation but also by acknowledging that this has been very much a policy that has been supported by multiple parties not just in Victoria but around Australia. I think that we should all acknowledge too the incredible work of the parents of children with intractable epilepsy who have really highlighted the need for change in this area and have put themselves at risk of arrest in getting the kinds of medicine they needed for their children. I also particularly want to thank the minister’s office for the multiple briefings that I have received and, in the last two days, for the multiple meetings and phone calls that I have had to get additional information as has been required. I found that extraordinarily helpful.
As I have said, the Greens, like other parties, understand the need for and benefits of medical cannabis. We strongly support reform to make medical cannabis safe and legal, in such a way as opioid medications such as morphine and codeine are. For too long the medical constraints of the stigma associated with cannabis being an illicit drug has meant that children with epilepsy or people suffering from the impacts of cancer or cancer treatment have had to go on suffering unnecessarily, or alternatively they have been forced to purchase cannabis tinctures or oils via the black market, not always knowing exactly what product they have actually received. These black market products are unregulated and unprescribed, so the quality of the product and the optimum dose to treat the condition cannot be assured. Further, and I think quite tragically, some of these sick people or their families have even been legally prosecuted or been questioned by child protection officers for seeking this treatment to ease the suffering of their children.
The Greens have always supported a compassionate and evidence-based approach to medical cannabis. We are very pleased that MPs across the political spectrum have shared this view. We do, as I started off, congratulate the government for moving ahead with this legislation and not delaying. Without leadership this reform would have been tied up in legal and administrative hurdles. I think it was very important that the state government moved ahead even before the federal government did, because it needed that push along.
This piece of legislation has been devised after an extensive review by the Victorian Law Reform Commission (VLRC). We very much welcome the approach taken by the government, and we believe that this is an approach that has meant the development of a sound piece of legislation and a sound approach to the rollout of this class of medication. As usual, the law reform commission has written a report that is easily accessible and easy to understand on its first reading. We hope that this will provide relief for people suffering from a range of conditions.
Appropriately this bill will prioritise access to children with severe epilepsy, for whom there is no alternative treatment and who are in significant need. We look forward to the government expanding access to medical cannabis for other conditions as production comes online and there is an evidence base, which I actually believe is already there and will grow. Ms Patten has brought forward a number of amendments on this bill. I will be asking a range of questions of the government regarding when othercohorts of patients will be able to be brought into the scheme. I personally would like to see that happen as quickly as possible. We are also pleased that there is an allowance for authorisation in exceptional circumstances, and this might enable access for someone with a specific condition for which the specific research is not yet definitive or if it is likely to help. It is a sensible approach, and because of the medical oversight it will help progress our understanding of the potential treatment applications of medical cannabis.
The Greens welcome the government’s approach to the product, and we believe it will consolidate medical cannabis as a legitimate, reliable and appropriate medication for mainstream Victorians. It will be processed to ensure quality, consistency and reliability of effective agents in the medication and to minimise any psychotropic agents that are otherwise available in the raw product.
I had the opportunity to go to an international drug policy meeting last year, and the thing that came across very clearly was we do not want to go down the road of what has happened in America, where you will see billboards outside doctors offices which say, ‘If you have one of these 40 conditions, we will authorise you to be able to purchase cannabis’, but then it is smoked. There is no dosage. It takes away the whole medical basis of why we would want to legalise this. Medical cannabis will have to be prescribed by specialist doctors in appropriate doses for particular conditions, it will have to be purchased through pharmacies and the use will be overseen by a GP. I believe all of this is essential to ensure that medical cannabis is treated like any other medication that is prescribed when scientifically proven that it will treat those conditions.
We are also pleased that the government has ruled out the medical use of the raw product for smoking. I know that there are amendments coming on that particular issue, so I will speak about that when we get to those amendments. Further, smoking cannabis would remove the ability to properly refine the product to extract specific elements for specific conditions and to properly control the dosage. This is an issue on which we look forward to this approach being established by regulations. We do understand that those regulations are yet to be written, and we would hope that they would be available in the next few months. While the Greens believe we need a conversation about our approach to recreational cannabis use, we see that as a quite separate issue to providing access to medical treatment. Products such as these must not blur the line between medical and recreational use.
The Greens are pleased that not only Victoria but also New South Wales and the ACT are investing in further trials of medical cannabis as a treatment for a range of conditions, and we hope this will add to the international evidence base about the efficiency of the product range and help expand its appropriate use over time for a range of conditions. These trials will also help us understand any negative side effects of the treatment and minimise them, as is done with other medications.
The Greens welcome the establishment of a medical advisory committee to guide the role of this drug to treat various conditions. While obviously the government cannot give us the names of the people who will be on that committee, one of the questions I will be asking during the committee stage will be about the range of specialities of doctors and other medical professionals and whether there will be a patient advocate on that committee as well. It is obviously important that the use of medical cannabis is backed up by rigorous science as it becomes available so that we can have the confidence of the community in it parallel to that in products derived from medical poppies. It is obviously critical that the medical community is part of this reform process and absolutely involved.
Having said that, the Greens do not want to see waiting for the results of long-term project trials getting in the way of sensible access to the product. We know that medical cannabis eases the suffering of certain conditions and has relatively modest side effects, if any. We trust that the medical community and the government will find the right balance in respect of this.
The Greens very much welcome the price control. I know that MsWooldridge brought this issue up, and it will be discussed in the committee of the whole. The Greens certainly want to see that the price of this product is kept at a range where, especially for families, it is affordable and so, as MsWooldridge said, people do not go to buy products on the black market that are substantially cheaper. Obviously that is a question that we will discuss during the committee of the whole.
There are a number of things that the Greens would like to highlight in regard to this bill. As this industry establishes itself, medical cannabis should become widely accessible. There are a number of aspects of the bill that would or could restrict that access somewhat, so we ask the government to closely monitor this, and I will be asking a range of questions on that later. For example, before a patient can obtain medical cannabis they must obtain authorisation from the Office of Medicinal Cannabis, then they must have that authorisation renewed yearly. If this office is not well resourced, there could be a backlog of applications. The legislation does not require the government to process the applications in a specific time frame, so there is a potential that someone could wait months to receive authorisation and thus an appropriate treatment. This of course is very critical in terms of someone who requires medical cannabis because of end-of-life issues. I reiterate that the government must ensure that the office is efficient and well resourced.
Further, pharmacies must also seek authorisation from the Office of Medicinal Cannabis before they can stock and sell the product. Given there will be price caps on this product, it appears that to some extent we will be relying on the goodwill of pharmacists to make the effort to go through the administration and practical hurdles to retail the products when someone comes to them requesting them. I think this is going to be a particularly important issue for rural and remote communities so that if they do need this product, they are not going to have to travel hundreds of kilometres to a chemist who will dispense it. Monitoring and ensuring access to this product needs to be an ongoing consideration of the government.
Next I will turn to the Victorian Law Reform Commission’s recommendations in relation to eligibility for the use of medical cannabis. Eligibility was recommended for people with severe muscle spasm or severe pain resulting from multiple sclerosis (MS); severe pain, nausea, vomiting or wasting resulting from cancer, HIV or AIDS or because of the treatment for these conditions; severe seizures resulting from epileptic conditions where other treatment options have not proved effective or have generated side effects that are intolerable to the patient; or severe chronic pain where, in the view of two specialists medical practitioners, medical cannabis may in all circumstances provide pain management that is superior to what can be provided by other options. The VLRC basis for these categories and the way they are formulated is the body of the research as to their efficacy, the compassionate circumstances attaching to the distressing circumstances of the categories of patients and the control of risks and options that may be addressed by the formulations proposed.
We are concerned that the government has not yet fully made its intentions clear in relation to this recommendation and the time frames for access. At this stage eligibility in respect of these and other conditions will be defined by the minister at a later stage—and hopefully that stage is not too far away—with guidance from the independent medical committee.
At this stage I also mention that a friend of mine, Belinda Rogers, sent me an email recently—she is someone who has MS—basically asking me and the Parliament to urgently look at the issue of the access to medical cannabis for other cohorts or groups. I would like to read out Belinda’s email because I think it goes very much to the issue of how this drug will benefit other people. She says:
My name is Belinda Rogers and I am a 51-year-old woman with secondary progressive MS. I have severe spasticity and although I am on oral baclofen to try and control it, the dose I am on is not enough to manage it. If I increase the dose I develop severe weakness in my legs which reduces my mobility even more. The pain is so bad from the spasticity that I am now needing to add valium and Endone into my daily medication regime to manage it and this is far from ideal as both these drugs are sedating and addictive.
My neurologist is now recommending that I have a baclofen intrathecal pump implanted to better control the spasticity. This involves fairly major invasive surgery. The pump is implanted under the skin of the abdomen and a catheter is threaded up to my spinal cord where it is then inserted into the epidural space to allow a continuous dose of baclofen to be released into the central nervous system. I’ll have to be admitted to hospital for the surgery and require constant trips to a specialist department for refills and monitoring. The pump itself protrudes through the skin and is obvious and unsightly which will involve a fair degree of psychological adjustment. For me that is… the hardest part to get my head around. I hate the thought of a box sticking out of my stomach. I have never been able to watch Aliens because the scene where the alien bursts forth from Sigourney Weaver’s stomach…
Belinda has a particularly bizarre sense of humour, which is one of the things I enjoy about her company. That scene gave her: …the absolute horrors and this box for me is somewhat reminiscent of that. That may sound neurotic and silly to some but for me it is a major emotional hurdle to overcome. I do not think it is silly at all. She continues: And I have a major phobia about epidural and lumbar puncture procedures and the thought of having a permanently placed epidural— very difficult— is also doing my head in. But the alternative is being in so much pain that I am basically bedridden for 80–90 per cent of my life. I am a single mother of a teenage daughter and I can’t afford to have my life so limited. It is impacting severely on not only my quality of life, but that of my daughter. She is now on antidepressants and under the care of the local adolescent mental health team due to adjustment disorders and associated depression and anxiety. She is on a carer’s allowance and is a recognised young carer because of the extra responsibilities she has to take on to assist me around the home and to get basic household necessities done. I need to add that Belinda has no relatives who live close by and is totally dependent on her daughter. This year her daughter is repeating year 11 because of all the problems at home, and Belinda’s MS is having such a negative impact on her child’s education and mental health, which has been absolutely devastating for her. Basically she is urging us to consider people with MS and to make sure that other people in this category are brought onto the list as soon as possible. I think Belinda’s statement is quite a powerful one, and it is ne that we need to take seriously.
Other concerns the Greens have with this bill include the lack of clarity around the circumstances in which access to the drug by a patient may be suspended by the government and the lack of rights specified in the legislation for a patient to have this decision reviewed. There may be a medical reason why the government might want to withdraw access to a particular medical cannabis product—for example, if it is found to cause substantial harm to certain patients in clinical trials. That is legitimate and clear cut. However, I can imagine a range of more grey, personal circumstances under which the individual’s authorisation may be revoked, and in such circumstances it seems appropriate that these people have some avenue to appeal the decision as there could be a range of circumstances to consider.
The final point I want to make—and, as I have indicated, we will have a very large range of questions that we will pose during the committee stage—is that we want to see that this legislation provides for the minister to set a wide range of regulations in relation to medical cannabis. At this stage we have limited information regarding the government’s intentions regarding the product range, labelling, packaging, advertising and a range of other aspects over which it has regulatory power. MsWooldridge did talk about the issue of the government not putting it in regulation 8. We are quite comfortable with the way the government is dealing with this. We actually think that this is quite an exceptional circumstance and it needs some flexibility.
It was very interesting when MsWooldridge was talking about how there could be a faster process for bringing these drugs on, because when Dr Richard Di Natali, the Greens leader, first started to investigate this, one of the reasons why he understood that he needed to bring forth legislation was that for it to go through all the proper processes we could be looking at a 15-year wait time. So we obviously need to be able to do this much, much quicker than that. To conclude, I would like to say that obviously the Greens are extremely pleased that this legislation is in the Parliament. It is good to hear that it is supported by, hopefully, all parties. We understand that the use of medicinal cannabis is a separate issue from the use of recreational cannabis. This is about giving access to medicinal cannabis to people who need this as a drug. It will be much less harmful, as Belinda has said, than having to be on a large amount of painkillers and sedatives that make her days extremely difficult. With those words, the Greens obviously will be supporting this bill. We will put a range of questions later.