The medicinal cannabis scheme has enhanced access and reduced prices - but inequities remain. Illustration / Andrew Louis
The medicinal cannabis scheme has enhanced access and reduced prices - but inequities remain. Illustration / Andrew Louis
A new study says the medicinal cannabis scheme in New Zealand has greatly enhanced access and reduced prices for legal products since it started four and a half years ago, though inequities remain.
The increasing prevalence of potent THC products is also a concern. This trend overseas has led to psychosis, addiction and chronic vomiting among teenagers, though THC potency in those markets is four times higher than anything in New Zealand.
The medicinal cannabis market is finally becoming what was envisaged, with more affordable and accessible products providing relief for some of the hundreds of thousands of users – but a new research paper sounds an ominous warning.
“My fear is that it will look increasingly like a recreationalmarket, and that’s already happening,” says the paper’s co-author Dr Marta Rychert, a senior researcher at Massey University.
“Right now, you can get access to a high-THC (the psychoactive element of cannabis) flower product from a private clinic, as long as you’re willing to pay for the clinician (consultation fees range from $50-$100). You can get that for any wellbeing reason.
“My hope is that cannabis clinicians prescribe responsibly. Obviously, there are checks and balances. They’re registered doctors and need to practise standards required of medical professionals. But generally, it is very easy to get those products from those clinics.”
Rychert is referring to specific trends in data that she and Associate Professor Chris Wilkins assessed for their paper, published today in the NZ Medical Journal: Implementation of the Medicinal Cannabis Scheme in New Zealand: six emerging trends.
While most users still use the black market, 160,000 prescriptions were handed out in 2023/24, with prices comparable to the illegal market. A snapshot from earlier this year reveals 15 times more medicinal cannabis “product packs” were available than when the scheme started.
But two trends feed Rychert’s fear: the increasing prevalence of products high in THC, and the rise of private cannabis clinics.
The medicinal cannabis market is trending away from CBD oils towards THC-dominant flower, a new research paper says
Specialist clinics offering ‘just that one product’
It’s not a new thing for people to seek prescriptions from doctors they know will be more likely to prescribe, for example, an opiate for pain relief. But there aren’t any opiate-specialist clinics in New Zealand which, like cannabis clinics, would be less likely to offer a range of treatments.
“It’s very different from standard medicine where you’re supposed to consider a whole range of options,” Rychert told the Herald.
“Here it’s just that one product, and it’s really patient-driven. They can prescribe it to you for the stresses of daily life. We don’t have a list of conditions or symptoms that qualify for prescriptions. It’s entirely left to the clinician.”
Rychert concedes her fear is speculative, and there is no data to show this is happening in New Zealand.
But the Herald has heard anecdotal stories of people experiencing adverse reactions after they were given a prescription without being asked their medical history. Profit-before-care warnings are also being sounded in Australia.
The highest THC potency Rychert came across in her research was 25-26%, while most of the dried flower products were at least 20% THC.
This is well below the near-100% THC products causing problems in the US (in legal recreational markets), but is still considered high (15% and over). A UK study found that using 15%+ THC products resulted in a three-times increased risk of psychosis, jumping to five times if the use was daily.
“THC has recognised analgesic, anti-inflammatory and anti-emetic properties, and many patients prefer THC formulations to CBD-only products,” the paper said.
Dr Marta Rychert, senior research officer at Massey University. Photo / Supplied
“However, high potency THC cannabis also increases the risk of negative side effects, including impacts on cognition, memory, consumers’ ability to complete daily activities (e.g., driving, work, parenting), risks of developing psychosis and cannabis dependency (cannabis use disorder).”
Rychert added that there was no limit to THC potency in the New Zealand market.
“In theory, the Ministry of Health could approve such a product [near-100% THC], and there’s no age limit, so it can be prescribed to teenagers and kids,” Rychert said.
“So that’s where there is a huge responsibility on prescribers.”
Much better than what we had
The current scheme was launched amid a flurry of media stories about people in pain who were able to get relief by using cannabis but risked being criminalised.
That meant almost all cannabis for medicinal purposes was procured from the black market, with zero quality assurance; an ESR study in 2021 found that such products “contain a wide range of cannabinoid concentrations., and the claim that a product was high in CBD was often not correct”.
The number of available product packs has gone from about 5000 to 75,000 since the current scheme started. This huge jump is the first of six trends in the paper.
The others are:
most products are now THC- rather than CBD-dominant
an increasing share of the market is dried cannabis flower – typically consumed as a tea, in a vapouriser, or smoked – rather than oral liquids/oils
prices have fallen to be comparable to the black market
inequities still persist due to expense, and disproportionately affect Māori and those on lower incomes.
specialised private cannabis clinics have expanded patient access
THC is the psychoactive element in cannabis, and it has become the primary ingredient in medicinal cannabis products in the past year and a quarter. Source: NZ Medical Journal
“The evidence from double-blind, placebo-controlled trials simply doesn’t exist for most conditions that people want cannabis to be prescribed,” Rychert said.
“It puts health professionals in a difficult position when there’s a product that doesn’t really have strong scientific evidence behind most cases that people ask about.”
There is clinical evidence about its efficacy in treating epilepsy, including in children but people use cannabis for a variety of other medical or therapeutic reasons including nausea, stress, migraines, chronic pain, or simply trying to sleep better.
Unlike standard medicines and prescribed pharmaceuticals, medicinal cannabis products do not need to undergo clinical trials to prove efficacy and safety. Instead they need approval from the Medicinal Cannabis Agency, which ensures product quality (free of contaminants, for example), stability and consistency.
The paper said private clinics are now established in most major cities as well as smaller centres including in Nelson and Hastings. Several clinics offer telehealth services and run their own dispensaries including delivery.
“There is a risk that financial conflicts of interests may blur the clinical judgement of doctors employed in cannabis clinics, due to their focus on a single treatment option,” the paper said.
“In Australia, where cannabis clinics have also become a feature of the medicinal cannabis scheme, the Australian Health Practitioner Regulation Agency recently released a statement that such business models focused on a single medicine ‘may take advantage of consumer demand’ and ‘may be putting profit ahead of patient welfare’.”
Cannabis use in New Zealand has remained relatively stable, though falling for the 15-24 age group. Source: NZ Drug Foundation
Relatively stable in use in New Zealand, drop among young adults
The explosion in usage there has not been mirrored in New Zealand so far. The Drug Foundation’s 2022/23 report on drug use said that 14.2% of adults (600,000 people) used cannabis in the past year, with usage declining the sharpest for those aged 15-24.
“These numbers have been relatively stable since 2018/19 and have decreased slightly compared to 2021/22,” the report said, though it noted an 80% rise since 2016/17 in the proportion of women who use it at least weekly.
The growing medicinal market has seen prices drop for legal products, while prices on the black market have remained relatively stable, Rychert said. Most users still shunned the legal market, however, with a 2022/2023 survey showing only 9% of users with a prescription.
“According to cannabis clinic pricing information, the cost of monthly medicinal cannabis therapy in New Zealand may range from $120 to $400, depending on the dosage and products prescribed,” the paper said.
“While the product price decreases over the past four years are welcomed by many patients, affordability remains an issue for those on lower incomes.”
That could exacerbate existing inequities, the paper said.
“Māori have higher prevalence of using cannabis for medicinal purposes, yet they are less likely to transition to the legal prescription scheme. This is possibly due to stigma, income inadequacy, and systemic barriers in access to healthcare, for example living in a rural area with poor access to a doctor.
The paper suggested ways to reduce inequities, such as allowing some home-grown cannabis for medicinal use.
More men than women are getting prescriptions for medicinal cannabis, as are those aged 30 to 49. Source: NZ Medical Journal
‘At a crossroads’
The paper also suggested an exemption for those with medicinal cannabis prescriptions from the incoming roadside drug-testing regime.
“They can test positive for THC, even when the impairment effect has passed. Exemption from legal sanctions for drivers who test positive for THC but who can prove they were prescribed medicinal cannabis and demonstrate that they are not impaired at the time of driving is a much-needed amendment.”
Rychert said policymakers might also want to consider the trend towards privatisation, and whether it aligns with the original aims of affordable access to quality products that improve people’s lives.
“Now we are kind of at the crossroads with this scheme. It’s going towards the easy, privatised access to high-THC flower. The question is whether we follow this route, and my prediction is it will essentially morph into recreational legalisation some time in the future. That’s what other countries have gone through,” she said.
“Or we narrow it down. We push it back a little bit, and regulate those clinics maybe a bit better. That’s something that policymakers may want to look at.”
Derek Cheng is a senior journalist who started at the Herald in 2004. He has worked several stints in the Press Gallery team and is a former deputy political editor.
