Medical cannabis is a multibillion-dollar global industry that New Zealand is on the verge of breaking into.
The passing of the Misuse of Drugs (Medicinal Cannabis) Amendment Act, which came into effect in December means some products containing cannabidiol are now able to be prescribed.
Kiwis will also vote during a referendum on legalising cannabis for personal use in 2020.
But many have been using the drug to ease the symptoms of aches and pains - and much more serious illnesses - for years.
Dr Shaun Holt, a medical doctor and adjunct professor at Victoria University of Wellington, spoke to Kiwis who have used cannabis illegally as part of his new book Medical Cannabis: A Brief Guide for New Zealanders, written with his niece and researcher Emma Dalton.
Benefit vs devastating effect
Woman, 59 with breast cancer
Seven years ago, BR was diagnosed with stage IV breast cancer. At first, she thought the symptoms were due to insect bites but as the symptoms did not heal, she went to a doctor.
BR vividly recalls how the locum doctor took one look at her breast and burst into tears, knowing exactly what the diagnosis was. She was quickly treated with extensive surgery, including removal of lymph nodes from the armpit, followed by chemotherapy and radiotherapy. The latter caused third-degree burns.
A friend suggested she try cannabis. BR found it was very effective for controlling the side effects of the treatments. She tried both eating and smoking cannabis and found each method was useful for different issues. Eating cannabis, in her case literally eating chunks of the plant, was helpful for reducing pain, nausea and stress, but it took a while to be effective.
Smoking cannabis was much quicker, working almost straight away and it was particularly good for helping with sleep.
BR had also suffered from back pain for decades due to degenerative arthritis. As usual for people with chronic debilitating pain, she was prescribed many different medicines over the years.
When using the cannabis for the breast cancer treatment symptoms, she realised it was also helping with these symptoms and so continued to use cannabis after the breast cancer had been successfully treated. She was able to reduce the number of other medicines she was taking.
Overall, she says she would give cannabis a 5 out of 5 rating as it gives her a lot of relief from her symptoms and has few side effects. She has a trusted supplier – she has tried to grow her own but it can be technically challenging with limited success. An ounce costs her around $300 and lasts for around nine months.
BR is very concerned that she is breaking the law and says she will be much happier when medical cannabis is legalised. She knows that with the small amounts she uses and it being for medical purposes, she would be a low priority for prosecution, but still feels annoyed this would be at the discretion of the police and she could be one of the unlucky ones they choose to prosecute.
Her husband always knew about her use of cannabis, but she's sure her son didn't. A few years ago he left home and went to university. He began mixing with people who were using cannabis recreationally and began using it himself. Quite quickly he developed paranoid schizophrenia, a condition he will likely suffer from for the rest of his life. There is no history of schizophrenia in the family and it has been an enormous shock and stress for the family.
It is highly likely that cannabis use triggered the schizophrenia, but we will never know if he would have developed it anyhow. His main symptom was an overwhelming sense of worthlessness and a belief that everyone hated him. Thankfully he has responded well to medications.
His girlfriend makes sure that he takes them and now, five years later, he is able to hold down a good job.
This is an interesting case study of both the predictable benefits of cannabis when used medically in an older person, and unpredictable, devastating effects of recreational cannabis in a teenager, in the same family.
Cannabis in the NutriBullet
Woman, 46, with chronic back pain and multiple sclerosis
KW was diagnosed with MS 10 years ago, although the symptoms began about eight years prior to this. Around the time of the first symptoms, she had a bad fall and damaged her spine, leading to ongoing problems with pain.
Around two years ago a friend sent her some links to websites in California that were discussing the benefits of using cannabis for people with MS. She asked her neurologist about it, who said he could seek approval to prescribe Sativex (an oral spray delivering a cannabis extract with THC and CBD) but that it would cost her around $1200 every month.
Instead, having never used cannabis previously, she sought out a local supplier, bought a bag of empty capsules, ground up the plant material and stuffed it into the capsules (her words) to make her own cannabis medical product. And it worked.
Without causing any feelings of being high or stoned she experienced big improvements with most of the symptoms. The pain in her back, which had plagued her for nearly two decades, decreased substantially, she slept better, had fewer problems such as restless legs and burning feet, and fewer and less severe muscle spasms.
KW is in no doubt the cannabis helps enormously, also demonstrated by the fact that if she does not take it for a few days, the symptoms become worse rapidly. She usually has two of her homemade capsules in the morning and two at night.
After two years of using it, she has learnt that it takes around three days to build up in her system and give her the maximum benefits and it takes around three days to come out of her system. If the pain is really bad, such as having a severe spasm, especially if it is in the evening, on rare occasions she will smoke the cannabis instead. This leads to almost instantaneous relief, but does leave her feeling stoned.
However, it is a comfort to know there is something she can do that will help if symptoms get really bad. Before discovering cannabis, there was nothing that could do this.
Compared to the standard treatments she received from her doctor for the symptoms, she says that cannabis is better and with no side effects; so much so, she now only takes the medicines that are trying to slow the progression of MS.
She grows her own cannabis. It takes quite a bit of time but at least she knows what she is taking. It only costs around $100 a year for cannabis seeds and fertiliser. She simply uses a NutriBullet blender to chop the cannabis into a powder and then fills the capsules.
KW says she is not at all concerned about the law and prosecution, believing authorities would likely turn a blind eye to her cannabis use.
She says it would be cruel to prosecute someone with MS and chronic back pain who cannot walk on some days and who just grows a couple of plants for personal use.
She laughs when friends ask if she has considered using cannabis for her MS, but her neurologist knows and is happy about it.
Refugee mixes with 'unsavoury characters'
Man, 27 with PTSD
CG is a recent refugee immigrant to New Zealand. He was born and raised in a country where from a young age he and his family were exposed to very real threats of violence.
The government and gangs were responsible for extortion, threats and torture, and a number of people close to him were killed. He was constantly in fear of his life and of his
As a result of this trauma, severe mental health issues have recently been diagnosed as post-traumatic stress disorder. Symptoms include depression, thoughts of suicide, crippling anxiety, high stress levels, feelings of guilt, and insomnia.
In his native country, he did receive some medical care for these problems but it was not always easy to see a psychiatrist and he sometimes had to wait six months.
At one stage he was diagnosed with bipolar disorder, even though he had not experienced any episodes of mania or psychosis. He was prescribed medications including sleeping tablets, but they were not particularly effective and had significant side effects.
CG arrived in New Zealand three years ago.
He says "cannabis has saved my life". He was a recreational user when he was in his teens for around a year, but started using it for medical reasons around a year ago – initially for pain after suffering a badly twisted ankle.
It became apparent it was also helping with his anxiety, stress, depression and insomnia. Since then, has stopped using prescribed pharmaceutical treatments for the PTSD symptoms.
The formats he uses are smoking it about three times a day, applying a topical cannabis cream to help with the musculoskeletal pain and a CBD tincture (particularly effective for his anxiety and insomnia). He used an online calculator to work out the dose he needs based on his body weight.
The process to make the tincture involves cooking the cannabis flowers for six hours and adding coconut oil; he sometimes adds cannabis to his cooking.
The only negative effect he sometimes gets from cannabis is that he can be too sleepy in the mornings, so every now and then he takes a break for a few days and this problem goes away.
The big issue for him is that what he is doing is illegal, especially being an immigrant who could potentially be deported. Obviously, the stress and anxiety due to his illegal activity are not what a person with PTSD needs.
The law means he has to obtain products without knowing exactly what is in them; sometimes he has to mix with some unsavoury characters. On one occasion he was scammed by a black-market supplier on Facebook, further adding to his stress.
Numbing the pain
Woman, 28 with anxiety
TW is a university student and suffers from anxiety as a result of a brutal sexual assault when she was just 14. She describes her severe episodes of anxiety as rapid heart rate, having negative thoughts about herself and the events of the day, especially at night, and "freaking out" (panic attacks).
She has never been formally diagnosed with an anxiety disorder, but has received counselling and has been prescribed a number of antianxiety medicines.
TW doesn't take them often, as she doesn't like pharmaceutical products and they make her groggy in the mornings. She says she's tried to self-medicate with "large amounts" of cannabis and alcohol.
Being a cigarette smoker, she started taking her nicotine using a vaporiser. A year ago in a vape supplies shop, one of the staff told her that vaping CBD might be good for her symptoms. As it was not legal at the time he sold her a bottle under the counter.
Vaping CBD has been hugely beneficial for TW. It reduces all her symptoms and she has substantially reduced the amount of cannabis she smokes, and her alcohol intake. She no longer drinks lots of coffee.
The CBD also gives her a healthy appetite, whereas she used to skip meals and did not eat enough. When she feels her heart start to race and her anxiety levels rising, she now has two to three puffs of the CBD vape and the anxiety starts to reduce almost immediately.
Her sleep has improved, she has more confidence and less fear about her condition as she knows she can quickly find relief from her symptoms without, it appears, any
harmful side effects. The only problem she finds is that too many puffs of CBD can make her very drowsy and she needs to lie down for half an hour to recover. But this happens less now that she has learnt exactly how to use it.
TW does not suffer from being too groggy or being high. Her studies have improved as she can now concentrate much better, and compared to smoking cannabis, vaping is so subtle, it's possible for her to receive relief from symptoms during the day at university.
Her mother, who had never used cannabis, was diagnosed with breast cancer and TW baked her some cannabis cookies which she found very helpful.
Medical Cannabis: A Brief Guide for New Zealanders
By Dr Shaun Holt & Emma Dalton
Published by Potton & Burton
Available in bookshops nationwide/online.