My former home state in the US, New Hampshire, enacted legislation to legalise medical cannabis.
That law was passed in 2011 by the legislature and the governor. But bureaucrat opponents, by dragging their feet, and setting up onerous certification processes, ensured that the first time eligible patients received prescriptions for medical cannabis was late in 2016.
This week the medical society sent a survey to members to find out how things are going. They needn't have bothered, as among the several questions was one that hinted at the probable outcome.
It asked whether the practitioners had hesitated or refused to participate because of the onerous process for certification in order to prescribe medicinal cannabis.
What's quite clear is that despite the legislative will, in a very conservative state, to make medicinal cannabis available by prescription, the resistance to actualising the law is deep and entrenched and expressed by bureaucratic delay that subverts the process.
To fully appreciate the issues involved, it's important to know that deaths from opioids in New Hampshire are at an all-time high, making the state either number one or two in the nation in this dubious distinction.
Put that fact along with the public health studies demonstrating that those states which earlier legalised medical cannabis saw a reduction in opioid-related deaths of from 14 per cent to 28 per cent and the scale of malfeasance becomes obvious.
Cannabis, long slandered by its opponents as a gateway drug leading to "even more serious" drug use, is a means for closing the gate on opioid misuse and its potential for consequent concomitant accidental death.
A similar penchant for regulatory framework is used here in New Zealand by politicians opposed to medicinal cannabis. They're for it, but ... not until we've studied it and controlled it.
That mugwumpery lets them appeal to an electorate without actually taking a stand. Sadly enough, our current MP Harete Hipango is one whose non-stance is on both sides of the issue.
A regulatory framework sounds like a great idea. Don't we have such for the ordinary medications we are prescribed? Aren't they tested and certified before they get marketed to us, notably by the US agency, The Food and Drug Administration?
The facts may be disappointing and perhaps shocking.
New medications, even psychoactive ones like antidepressants, anti-anxiety medication or anti-psychotics receive only 90 days of testing in their stage III trials before release. Moreover the FDA, which once was a serious, scientifically based regulatory agency, has morphed into a pharmaceutical industry enabler.
The result can be seen in the studies 25 years after Prozac's introduction that find it and many other antidepressants no more effective than placebo. Or the recent findings of a withdrawal syndrome for people taking anti-depressants for a long time. Or the serious metabolic side-effects of many anti-psychotic meds, including extreme weight gain, movement disorders, diabetes type 2, that make the cure at least as disabling as the disease.
Mine is not a polemic against these drugs, which I've prescribed successfully, carefully. But the regulatory framework is a bad joke. And the pharmaceutical agencies touted the safety of these drugs, encouraging their prescription by general practitioners as well as psychiatrists.
My quarrel is not with GPs, nor with anyone, especially psychiatrists, forced by the exigencies of modern practice to prescribe meds and see patients for 12 minutes every two months. My opposition is directed at the pharmaceutical companies, their pre-eminent concern with profit, not patient benefit, and their regulatory enablers.
Cannabis has been around for 4000 years, long enough for its effects, positive and negative, to be known. My question for opponents who want effectively to stop medicinal cannabis through delay by the 1000 cuts of "regulation" is: Just how long are people with amenable conditions supposed to wait? And how many people misusing opioids for pain will have to die while waiting?
Jay Kuten is an American-trained forensic psychiatrist who emigrated to New Zealand for the fly fishing. He spent 40 years comforting the afflicted and intends to spend the rest afflicting the comfortable.