Painful joints: Medicinal cannabis in demand with older people and chronic pain sufferers

Medicinal cannabis is becoming more popular among older age groups in New Zealand. Photo / NZME

The medicinal cannabis industry is growing with an increasing number of patients over 60 seeking prescriptions for the drug. The Cannabis Clinic says medicinal cannabis could help New Zealand’s ageing population and more people needing treatment for pain conditions. But the Royal New Zealand College of General Practitioners says there is not enough evidence to support the drug being made more widely available as a medicine. Eva de Jong reports.

Andrew Fleming became a paraplegic in October 2000 after being thrown off a quad bike on his family farm.

Since then Fleming, who lives in Pātea, South Taranaki, has continued to experience debilitating pain in his paralysed legs that he describes as a “burning sensation” as if he is lying in a bath that is too hot.

Despite his determination, the pain made it impossible for him to return to work on his parents’ farm and often its severity would keep him up during the night.

“It felt like my legs were being dragged through gravel with really bad pins and needles,” Fleming said.

“That sort of pain is there 24/7 but the worst pain I would get is electric shocks. It feels like someone is jabbing an electric probe into my thighs.”

Pātea resident Andrew Fleming uses medicinal cannabis to manage his pain condition, saying "It works better than anything I’ve ever had in the past”.

When he was admitted to Burwood Hospital in 2020, a patient in his ward suggested he “consider marijuana”.

After consulting his Pātea GP, Fleming has been on a regular prescription of medicinal cannabis for more than two years.

He said the drug had brought him immense relief and was the most effective pain management medicine he had taken.

“My pain levels are just so low compared to what they used to be. I would say rather than burning pain in my legs, it feels more like annoying sensations, like insects running around on my skin.”

Earlier this year, data released to the NZME showed that across all age groups the number of medicinal cannabis prescriptions had grown each year for the past four years. The highest number of prescriptions was in the 30-39 age group at 27,028.

In the 60-69 age group, prescriptions rose to 13,236 in 2023. In April to December 2020, when the scheme first came into effect, there were just 1294 prescriptions for this age group.

Dr Waseem Alzaher, who opened The Cannabis Clinic in 2020, said patients mainly accessed his service for chronic pain, insomnia or mental health issues such as anxiety, and they came from “all walks of life”.

Cannabis Clinic chief executive Dr Waseem Alzaher says medicinal cannabis offers life-changing benefits to some patients. Photo / Supplied

Alzaher said medicinal cannabis could provide relief for common ageing issues such as osteoarthritis, which led to wear and tear in the joints, or rheumatoid arthritis, which caused inflammation in the joints.

It could also help with common sleeping issues in older people, he said.

Recently, Alzaher treated a client who, after regularly taking medicinal cannabis for one month, was able to return to playing lawn bowls.

“There’s a lot of education to be done because older generations hold so much stigma and judgment about cannabis, and usually they have to be open-minded to try it,” Alzaher said.

Older patients who visited his clinic had fears about developing an addiction to medicinal cannabis, or that other people in their rest homes would be able to “smell it on them”.

College of GPs medical director Dr Luke Bradford said there needed to be more research into the safety and effects of medicinal cannabis.

“Our concern with it being regulated as a medicine is any other medicine has to go through clinical trials and we know how much to use, what type to use and for what purpose,” Bradford said.

“If you have high blood pressure, I know exactly what medicines and what doses there are for it, but it’s not the same for medicinal cannabis.”

He said there needed to be “real numbers and real data” with clearer, consistent products before medicinal cannabis could be considered being used in mainstream general practice, but that did not detract from the fact many patients found it “makes them feel better”.

Alzaher said part of the resistance to medicinal cannabis came from within the medical community and, because it was an unapproved medicine, many prescribers felt unsupported by the College of GPs.

Bradford said he was concerned that cannabis clinics were often owned by growers, which could create a commercial incentive to prescribe.

“There are clear conflicts in the way they are structured to dispense the medicines that they also prescribe.”

Fleming said over the past 20 years, he had been prescribed other pain relief medication such as oxycodone, clonazepam and gabapentin, but he had to deal with adverse effects such as feeling “wiped out” and unable to get out of bed.

“A lot of people told me it’ll [oxycodone] kill you if you stay on it.”

Bradford said he felt the combination of an ageing population and decreased access to surgeries meant there needed to be more investment in chronic pain services.

“The alternatives aren’t great; anti-inflammatories have side-effects and opioids are addictive.

“It’s certainly something that is undercooked within the health system as pain management is so pervasive.”

Fleming would like medicinal cannabis to become a more widely-known and available treatment for patients, as he felt it could have saved him the misery of being put through strenuous trials on other medications.

“There’s a line where doctors need to be careful about what they do ... but I think they need to be listening more to clients like me who know so much about it.

“How does anyone else understand what my pain is like?”

He had spoken to other paraplegic people who were not using legal cannabis products because they were concerned about the stigma associated with the drug.

There was an ongoing perception that being on medicinal cannabis had the same impact as “being wasted or drunk”, he said.

Fleming said it did not make him feel high and he was able to do activities such as adaptive skiing with total control and little pain.

“It works better than anything I’ve ever had in the past.”

In April 2020, when the Medicinal Cannabis Scheme was established, a Medicinal Cannabis Agency was set up and made responsible for verifying that medicinal cannabis products available for New Zealand patients met the minimum quality standard.

A Ministry of Health spokesperson said it was up to the individual company to decide whether it wanted to seek verification for its product and apply to the Medicinal Cannabis Agency for assessment and verification.

“To date, the agency has verified a total of 58 products against the minimum quality standard and 50 of those products are listed on our website.

“A further 19 applications for new products have been accepted for assessment and are in the process of being verified against the minimum quality standard.”

In a written statement, Associate Minister of Health David Seymour responded to a question about whether more medicinal cannabis products should be approved by Medsafe.

“It’s not for politicians to pick what Medsafe should and should not approve.

“As the Minister responsible for Medsafe I am committed to ensuring that red tape isn’t unreasonably holding back access to medicines so Kiwis can live happier, healthier lives.”

Labour’s health spokeswoman Dr Ayesha Verrall declined to comment.

Bradford said for doctors the evidence was not there for them to be able to confidently prescribe medicinal cannabis.

“That’s not to say it doesn’t work, it’s just that it doesn’t have a clear evidence base behind it,” he said.

Eva de Jong is a reporter for the Whanganui Chronicle covering health stories and general news. She began as a reporter in 2023. You can contact Eva at eva.dejong@nzme.co.nz