Opinion: The young man outside the reggae club was trying my patience. On he droned, bragging about the great weed he was getting on prescription, and even about how many prescriptions he had had. All the top businesspeople were into cannabis, he reckoned, “and it’s all legal!”
He didn’t realise he was trying to impress someone who had once flown to Wellington to make a select committee submission on the Misuse of Drugs (Medicinal Cannabis) Amendment Bill 2018, which established the Medicinal Cannabis Scheme that facilitated his expensive hobby. Someone who recognised him as in some respects an archetypal medicinal cannabis patient in 2024.
I knew this because I’d had an early look at the data in a recent New Zealand Medical Journal article by Marta Rychert and Chris Wilkins of Massey University, which described “six emerging trends” in the scheme.
With some canny use of the Official Information Act, they were able to draw a picture of who is using the scheme. The demographic receiving most prescriptions – more than 35,000 – in the year to April was 30-39 years, and twice as many were men as women.
Several trends have a bearing on those figures. One is that dried cannabis flower products have now met the scheme’s “minimum quality standards” and constitute the majority of products available for prescription. Another is the rise of the specialist cannabis clinic.
The original legislation was a sincere attempt to place cannabis medicines within the existing prescribing framework. Product standards would be as high as those for any pharmaceutical medicine – to an extent that has made it difficult to impossible to produce compliant products – and discretion over prescribing would rest with doctors.
But most GPs have not been comfortable prescribing cannabis, so most scripts are written by doctors at specialist clinics. The authors characterise this as the “privatisation of prescribing”, which seems an odd description: GPs also operate privately. But no one goes to a cannabis clinic to discuss any other therapeutic option than cannabis.
Missing from this system are many of the elements of the hypercautious bill to legalise and regulate cannabis that narrowly failed to gain a majority in the 2020 referendum. There is no ban on vertical integration in the industry. Medicinal cannabis patients can consume in public. Prescription cannabis flower is typically 20-25% THC; the referendum bill would have limited potency to 15%. For all that, it is difficult to perceive any widespread negative effects of the scheme, on individuals or society.
I don’t doubt that medicinal cannabis users derive therapeutic benefit – I am one, and I genuinely do. But I also enjoy my medicine, somewhere on what the authors describe as the “blurred boundary between therapeutic and recreational cannabis use”. The problem, really, is that we have drifted into a two-tier system where one group has safe, legal access to cannabis and everyone else is a criminal.
Such inequities “disproportionately affect Māori and those on lower incomes”, say the authors, and they become particularly odious in a situation where a cancer patient who can’t afford to go to a clinic or buy a $700 vaporiser can be prosecuted for growing a couple of plants. The article proposes an extension of the “palliative exemption”, which provides a defence for someone with a life-limiting condition to use cannabis, so that friends and family who grow or provide it for them are not criminalised.
That would be a decent idea. But in the end, we will decide, as Canada did, that a properly-regulated cannabis market needs to extend beyond the pharmaceutical system to be fair. My annoying white-collar interlocutor outside the club should be able to spend his money as he wishes. We just shouldn’t privilege him.
