News and opinion

‘Prohibition is failing’: Ex-AFP boss says criminalising cannabis use does more harm than good.

Former Australian Federal Police boss Mick Palmer has said the prohibition of cannabis use “is not just failing, it is causing real harm” as he described his journey from a hard-nosed policeman to a vocal advocate for cannabis law reform.

In a speech at Parliament House in Victoria on Wednesday afternoon, Palmer said that when he was a detective in the Northern Territory in the 1960s, he used to arrest people for possessing and using cannabis at parties.

Looking back, he said, his attitude then, along with most of his colleagues, was “you do the crime, you do the time” and “we don’t make the laws, we just enforce them”.

“The statistics make it very clear that criminal sanctions disproportionately impact Indigenous and minority communities, the homeless and disadvantaged, and persons suffering depression and other mental health problems,” Palmer said at the inaugural David Penington oration.

He said the widespread use of cannabis indicated fear of arrest was not working as a deterrent. In 2019, 37 per cent of Australians said they had used cannabis at least once.

However, for those unfortunate enough to be arrested for use and possession of cannabis, Palmer said, the outcome could be a “severe, whole-of-life” punishment, with convictions having the ability to wreck people’s careers.

Occupational and non-occupational factors associated with work-related injuries among construction workers in the USA

Xiuwen Sue Dong, Xuanwen Wang, and Julie A. Largay

“Many factors contribute to occupational injuries. However, these factors have been compartmentalized and isolated in most studies. [This study] examined the relationship between work-related injuries and multiple occupational and non-occupational factors among construction workers in the USA.… [Among non-occupational factors associated with workplace accidents, being] obese/overweight, smoking, and cocaine use were risk factors for work-related injuries; however, drinking and marijuana use were not significant [factors].

Results:

After controlling for demographic variables, occupational injuries were 18% (95% CI: 1.04–1.34) more likely in construction than in non-construction. Blue-collar occupations, job physical efforts, multiple jobs, and long working hours accounted for the escalated risk in construction. Smoking, obesity/overweight, and cocaine use significantly increased the risk of work-related injury when demographics and occupational factors were held constant.

Australian nurses and midwives are being urged to get behind Medicinal Cannabis Awareness Week, and lend their support to the hundreds of thousands of patients who are still battling stigma and ignorance.

‘It’s about being well, not about being high’ is the central theme of Australia’s first Medicinal Cannabis Awareness Week 20-26 February, marking the seventh anniversary of legalisation in Australia.

Victorian nurse practitioner (NP) and founding member of the Australian Cannabis Nurses Association (ACNA) Simone O’Brien said reducing stigma for people was paramount to increasing access to medicinal cannabis for people in need.

“People seek to use medicinal cannabis for a reason. There are so many potential populations that it helps.” It is thought that medicinal cannabis can treat various illnesses by acting on the endocannabinoid system, the largest receptor in the body.

Ms O’Brien is a NP who has spent over 30 years working in rural health across acute, emergency, aged and community care.  In 2019, she was diagnosed with a malignant melanoma and had surgery on her right leg. Six months later, she slipped and fractured her left leg requiring two surgeries and bone grafts, which resulted in six months off work.

It was while on bed rest for four months recovering and with chronic pain that Ms O’Brien did a ‘deep dive’ into medicinal cannabis – how it works, and legislation and access in Australia and around the world. She has since undertaken several courses in prescribing medicinal cannabis and is passionate about patient access to cannabis as medicine.

A new group is launching this week to plug the cannabis knowledge gap among nurses as interest grows around the medicine and the role it can play in patient care.

The Australian Cannabis Nurses Association (ACNA) will be led by nurse practitioner Simone O’Brien who has been working on the launch with the Australian Medicinal Cannabis Association (ACMA).

A website with membership details is expected to go live later this week.

O’Brien told Cannabiz that while prescribers and practitioners have resources they can turn to, little is provided by way of training for nurses, even though they are encountering cannabis on an increasingly regular basis and have an essential front-line role in patient care.

Among the resources will be a course developed with the Australian Nursing and Midwifery Federation, with the endocannabinoid system among the topics covered.

“We’ve been getting numerous emails and phone calls from nurses wanting support and avenues to get into the cannabis industry and to work as cannabis nurses,” O’Brien said.

“The body of our work will be targeting registered and enrolled nurses around their role in managing cannabis, whether that’s in a hospital or home environment.  

“We don’t feel that nurses and care workers – who are working with patients in their homes and in hospitals and who are encountering medical cannabis – have sufficient knowledge. Often they tell us, ‘we don’t know what CBD is, we don’t know what THC

Australian Cannabis Nurses Association launches to educate, advocate for medicinal cannabis

A newly formed group with a vision to offer medicinal cannabis education, advocacy and peer support to nurses has launched this week.

Nurse practitioner and medicinal cannabis prescriber, Simone O'Brien, will lead the Australian Cannabis Nurses Association (ACNA) alongside co-founders Deb Ranson and Jodie Davis.

"There's misinformation about cannabis with clinicians," Ms O'Brien said.

The group wants education about the endocannabinoid system included in undergraduate nursing degrees.

This week marks seven years since the Federal Parliament passed legislation to legalise medicinal cannabis in Australia.

Most cannabis medications are classified as unapproved therapies, which means permission is required from the Commonwealth Therapeutic Goods Administration (TGA) before a prescription is issued.

Since 2016, the number of prescriptions has skyrocketed from just a handful to well over 100,000 last year.

Ms O'Brien first became interested in medicinal cannabis after an accident in 2019 left her with a "really nasty break" in her leg.

During months off work and in rehab, she looked into whether medicinal cannabis could work for her.

Simplified process for DVA funding of medicinal cannabis 

Under the updated Department of Veterans’ Affairs (DVA) Medicinal Cannabis Framework (the Framework), general practitioners (GPs) can now seek approval of funding for medicinal cannabis without the need for a non-GP specialist’s assessment in many circumstances. Applications may be made over the phone by calling the Veterans' Affairs Pharmaceutical Advisory Centre on 1800 552 580

Changes to the Framework include a new tier-based approvals approach, which considers the active ingredients, dose parameters and regulatory factors in decision making. Each application will continue to be considered on a case by case basis.

The prescribing practitioner is still required to report why medicinal cannabis is clinically indicated, and confirm that the potential for an adverse event or contraindication for the person has been assessed.

DVA has a duty of care to veterans and their families to fund treatments that are proven to be effective, safe and comply with legislation. The updated Medicinal Cannabis Framework provides greater flexibility to enable DVA to adapt and fund more health conditions in the future, as clinical evidence emerges.

Commissioners deliver the Interim Report to the Governor-General 

At 9:00am, the Commissioners, Nick Kaldas APM (Chair), The Hon James Douglas QC and Dr Peggy Brown AO presented the Interim Report of the Royal Commission into Defence and Veteran Suicide to the Governor-General, His Excellency, General the Honourable David Hurley AC DSC (Retd).

Delivering the interim report is required by the Letters Patent that established the Royal Commission into Defence and Veteran Suicide. The Commissioners will continue their inquiries until June 2024, when they will share the Royal Commission's final report and recommendations.

The interim report includes some urgent recommendations as well as preliminary observations, which will now be considered by the Government.

It is anticipated that the Government will make the report available publicly as soon as possible after it is delivered to the Governor-General. Once the interim report has been made public, the Royal Commission will publish it in hard copy and digital editions. 

AMCA welcomes this interim report and looks forward to the delivery of the final report next year. AMCA will be making a submission to the Royal Commission before that time.

AMCA response to the TGA final decision on down-scheduling of cannabidiol

AMCA supports the decision by the Scheduling Delegate to down-schedule CBD from a Schedule 4 medicine to a Schedule 3 medicine when administered at a dose of up to 150 milligrams per day.

AMCA notes, however, that the down-scheduling only applies to products administering 150 mg or less of CBD/day that are registered in the Australian Register of Therapeutic Goods (ARTG). 

With that restriction in place, it is evident that any product containing CBD in a concentration of 150 milligrams per day or less that is a unapproved therapeutic good (whether it is a compounded therapeutic good or a therapeutic good that is imported or manufactured domestically in a GMP-accredited facility and supplied under the unapproved access schemes) remains a Schedule 4 medicine and cannot be supplied as a Schedule 3 medicine. 

We note, further, that Epidyolex, which is a CBD-containing product that is currently registered in the ARTG, contains cannabidiol in a concentration of 100 mg/ml but with a stated dosage recommendation of 2.5 milligrams per kilogram as a starting dose taken twice daily (i.e. 5.0 mg/kg/day), which would amount to a dose of 300-350 milligrams per day for a 60-70 kilogram adult. That being the case, Epidyolex remains a schedule 4 medicine at its starting dose or higher, and patients will not be able to access that product as a schedule 3 medicine. 

This means that based on the requirement for ARTG registration, no CBD medicine is currently available on the market which could be supplied a Schedule 3 medicine, i.e. there are no CBD medicines registered in the ARTG that have dosages of CBD of 150 mg/day or less.

Ultimately, Schedule 3 CBD medicines will only be available if companies invest in generating the comprehensive data packages of quality, safety and efficacy that would be required to support registration in the ARTG. In the meantime, we anticipate that patients will continue to access CBD as a Schedule 4 medicine in the short- to medium-term, while the industry waits to see whether any companies have any interest in working towards ARTG registration..

Department of Health considers making imported medical cannabis meet GMP standards

In response to a Cannabiz report that the Department of Health is considering taking steps to require all imported medical cannabis products to be manufactured according to Good Manufacturing Practice (GMP) quality standards (https://www.cannabiz.com.au/exclusive-department-of-health-considers-making-imported-medical-cannabis-meet-gmp-standards/), 

AMCA is cautiously optimistic that this could be the first significant step towards finally seeing fair treatment for Australian products vs imported products which currently only have to meet quality standard TGO 93, not production in a GMP-licensed facility.

We look forward to participating in consultations with the Department on behalf of our members and hope that the expected timeline of end-20 for such consultations is met.  

TGA interim decision on down-scheduling of CBD

AMCA supports any government measures which legitimately facilitate access to medicinal cannabis. However, its view is that the interim decision of the Scheduling Delegate to down-schedule low-dose CBD (cannabidiol) will not lead to better access. 
AMCA notes that the Medicines Scheduling Committee (Committee) did not support any down-scheduling of CBD but the Scheduling Delegate proposed, in an interim decision, to down-schedule CBD to schedule 3 on the following provisos (among others): 
1.  That CBD be limited to no more than 60 mg/day in oral dosage forms; 2.  That the quantity supply be limited to a 30-day supply;3.   That the supply be restricted only to CBD medicines which have been entered in the Australian Register of Therapeutic Goods (ARTG).   The Scheduling Delegate has indicated that further advice will be sought from the Committee at the November meeting on whether the proposed addition to Appendix M of the Poisons Standard to restrict the supply of CBD as a Schedule 3 medicines only to medicines entered into CBD will sufficiently mitigate the concerns raised by the Committee about the safety of CBD.   However, the proposed addition to Appendix M will effectively negate any facilitated access that down-scheduling was intended to achieve. It means that pharmacists will be prohibited from compounding CBD as a Schedule 3, or from obtaining products which are not entered in the ARTG (but which nevertheless must meet certain quality standards), access pathways which are currently available for CBD as a Schedule 4 medicine and for all other Schedule 8 medicines (subject to approval under the Authorised Prescriber Scheme or Special Access Scheme).   AMCA does not agree that pharmacists would only be able to make “informed decisions” in relation to Schedule 3 CBD products that are ARTG-registered.  Pharmacists have professional obligations in their practice of pharmacy, which include an obligation to satisfy themselves that the supply of any medicine to a patient is clinically appropriate.     The interim decision suggests that pharmacists are not sufficiently equipped to make decisions about the supply of CBD as an over-the-counter medicine unless that medicine is ARTG-registered.     AMCA strongly disagrees with that proposition; pharmacists who dispense medicinal cannabis products are knowledgeable on their quality, safety and the types of conditions for which they may be suitable. The other proposed measures that have been imposed on supply (60 mg/day dosing, not more than 30 days supply, adult use only, inclusion of mandatory warning statements and supply in child-resistant packaging) are more than sufficient to address any perceived safety concerns.   The requirement that all products need to first be registered in the ARTG, for specific indications, even at such a low dose, is also detrimental to the still-developing Australian industry. There is a paucity of sufficient data to demonstrate the efficacy of the 60mg/day dose proposed by the interim decision, and therefore to meet ARTG registration requirements, large and costly clinical studies would need to be conducted. This is neither feasible nor indicative of an approach intended to facilitate access.  
AMCA encourages stakeholders to respond to the interim decision and provide further information to the Committee and Scheduling Delegate so that any further deliberations can refine the interim decision towards a final decision that actually does facilitate access.