As support for the legalisation of recreational cannabis grows in Australia, Cannabiz editor-at-large Rhys Cohen analyses what it would mean for medical cannabis patients.

In 2013, the legalisation of recreational cannabis was supported by approximately 26% of Australians aged 14 years and older. Since then, that level of support has on average grown by roughly 2-3% every year. The most recent data from 2019 estimated popular support had reached 41%.

Given a long enough timeline, it seems likely that net support will hit and exceed 50%. And if support continues to grow at the same pace it has for the last decade or so, we might see majority support for the legalisation of recreational cannabis in Australia as soon as 2025.

Of course, this trajectory might slow, stall or go backwards. Although for a whole bunch of reasons – global and domestic – I don’t think that’s likely. And support is necessary, though not sufficient by itself, to affect policy change.

But eventually, at some point, I am confident that cannabis will be legalised for recreational consumption in Australia.

Depending on when and how this happens, recreational legalisation may have negative impacts on Australia’s medical cannabis framework. And I’ll get to that in a subsequent instalment. But I’ve been thinking – are there ways in which medical patients might actually benefit from recreational legalisation?

Ensuring quality medical care

In 2017, even dying of cancer wasn’t a good enough reason to get access to medical cannabis. Thankfully that is no longer the case – if you have the money (and you don’t live in Tasmania), you can now get a prescription.

Some clinics have started bulk billing visits and even offering free interstate telehealth consultations, reducing the costs associated with getting a prescription, while some product prices are approaching black-market levels.

This is great for affordability and access. But cheap and quick doesn’t always equal good, especially when it comes to the medical needs of complex care patients. As it gets quicker and easier for people who want cannabis to get a prescription for it, the more perfunctory these clinical services will become.

Which is fine for otherwise reasonably healthy patients, or the non-medical cannabis consumers looking for quality controlled products. But it has the potential to compromise the quality of medical care many patients need.

Cannabiz editor-at-large Rhys Cohen

I support the legalisation of recreational cannabis because prohibition causes more problems than it solves. But I have mixed feelings about recreational users accessing cannabis through the medical system.

I don’t want us to end up in a situation where the only clinics I can recommend to my ailing parents, who might benefit from medical cannabis, are ones that pro-actively call patients to recommend they try the newer, stronger strain that’s just hit the shelves. And yes, that actually happens.

Legalising recreational cannabis would help us keep some distance between medical and non-medical services, which is a good thing. All the enthusiastic, well-intentioned cowboys could turn their prescription mills into the businesses they always dreamed of – real, recreational cannabis companies.

Consumers could get the quality control and legal access they deserve without having to frame their use as clinically necessary.

And patients with complex needs could visit medical clinics which would no longer have to concern themselves with catering to increasing numbers of young men asking for flower prescriptions.

Prescription cannabis isn’t for everyone

Medical cannabis is a very broach church. Some patients are offended at the very suggestion that they should supplement their CBD isolate with small doses of THC. For whatever reason, the thought of becoming even mildly intoxicated from THC scares the hell out of some people who have spent the last decade on hardcore opiates and antipsychotics. These people are reasonably well served by the prescription cannabis model.

On the other end of the spectrum are those who would never in a million years consider taking a synthetically produced medicine of any kind. People who feel that modifying the cannabinoid content of plant extracts is not only medically pointless but barbaric, verging on unethical.

There are also those whose clinical needs are so challenging and particular that it is impractical or impossible for them to get satisfactory clinical outcomes from the current prescription cannabis framework. The Peek, Taylor, Cleaver, Carter and Lambert families spring to mind, but there are many more.

“It is not an exaggeration to say that many people have endured unnecessary pain and suffering because of the ways in which cannabis use is portrayed in Australian society.”

Not to mention those people who, through bad luck and circumstance, can’t afford prescription medicines if they’re not on the PBS.

Legalising the personal cultivation of cannabis may not be the best solution to all of these challenges. But it seems like one of the least-bad options.

For those capable of growing their own plants, it would be an immense relief to not lie awake at night dreading a knock on the door or a full-on raid and the confiscation of life-saving medicine.

And for those who lack the space, skill, mobility or inclination to grow, it would open the possibility of grower/buyer clubs and other compassionate, community-based, not-for-profit models of supply.  

Medical-only home-grow is theoretically possible, but I suspect legalising personal cultivation is unlikely to happen outside of some broader process of recreational cannabis legalisation. That’s because there’s no way to easily distinguish home-grown cannabis from illicit cannabis, unlike prescription cannabis which is easily verifiable (prescriptions, labelled containers etc).

If home-grow is legalised, recreational use would be legalised by default.

Normalisation

The other possible benefit to medical patients from the legalisation of recreational cannabis would be the normalisation of its existence and use. There are many out-and-proud prescribed medical cannabis patients. But there are many more who are embarrassed and anxious about what people might think of their medication.

And worse yet, those people who can’t bring themselves to even consider medical cannabis because of the social stigma.

It is not an exaggeration to say that many people have endured unnecessary pain and suffering because of the ways in which cannabis use is portrayed in Australian society.

Legalising cannabis for recreational purposes would force people to confront their prejudices, and might lead to a more informed and reasonable community understanding of cannabis use – both medical and non-medical.

Mitigating the drawbacks

Legalising recreational cannabis will be difficult, and whatever framework we end up with is guaranteed to be imperfect (if not borderline broken) from the start. Some of those issues will be about impacts to the medical system, and there are valid reasons for medical advocates to be concerned.

Assuming we are destined (at some point in the future) to legalise recreational cannabis, the time to start thinking about these issues is now.

Because the more front-of-mind these concerns are when the policy design process starts, the more likely it is we will be able to mitigate or even avoid some of them altogether.

In the next instalment, I will attempt to sketch out the key concerns as I see them, and suggest some ways in which we might design a fully legal cannabis framework that benefits consumers and patients.

  • Is Rhys right? Would legalising recreational cannabis have benefits for patients? Have your say in the comment box below.

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  1. As a patient of medical cannabis I feel that it would hurt the people that need it, not help, for so many reasons… One thing I would like people to know is that the price is already past what street prices are, but street cannabis isn’t even close to as good as medical. And to be honest the systems in place at the moment to get a script and product are really good and simple I feel… I just think it’s something that needs to be controlled to a point eg the approvals people need to take and be responsible for it… In saying this I’m all for it if things are done right and not just rushed through. Plus a lot more grow farms will be needed. And if anyone is interested I take three different types a day plus a 20:20 oil.

  2. It is interesting when you look at this debate and also when you consider the benefits of psychedelic medicine. I know there have been recent studies where cancer patients are using medicinal psychedelic to address facing death and to become more comfortable with it.

    How do we as a nation address the massive trauma issues caused by COVID, bushfires, tripling of domestic violence worldwide, bushfires etc without using these alternates?

    I have seen the benefits when applied to treatment of ptsd type issues.

  3. Yes, Rhys is spot on as usual.

    It’s a real shame to hear that some clinics (I say some as I am sure it’s not the norm) call patients to recommend specific products and strains. I would have thought this is a conflict of interest.

    Rhys I also learned recently that some clinics sell the patient to a cannabis company, have you ever heard of this, and is this even legal?

  4. First, the plain truth is that we could simply erase all references to cannabis in the criminal laws and it wouldn’t make a whole lot of difference. Any problem related to marijuana can already be addressed under other laws. California proved it with Prop. 215, in 1996.

    Only one person that I have ever met has been able to define the difference between “medical” use and “recreational” use. Authors who make claims or decisions about it never can.

    Unfortunately, no-one likes the explanation. Stoners don’t like it, and prohibitionists don’t like it. I will demonstrate.

    Let’s suppose we have two stoners sitting on the couch, hitting a bong. Both claim they are “medical”, but you know one is not. Give us the clear and objective criteria that you would use to decide that one is really “recreational”.

    Your answer must be clear enough to justify an actual distinction in the law.

    The first answer that comes up is: “They have to have a serious illness”. If you check the law, there is no definition of “illness” or “serious”, let alone “serious illness”. [Edited under our comment moderation policy].

    The second answer that comes up is: “They need a doctor’s approval”. In California, that costs $50, takes 15 minutes, and I have never heard of anyone who was refused, if they asked.

    Dr. Tom O’Connell did life histories on 5,000 medical marijuana patients in California. He wondered why so many people were claiming medical problems and wanted to see what the common denominators were.
    He found that, while many of them had a verifiable medical complaint for which marijuana might work, lots of them had already been smoking marijuana before they came down with the complaint.

    The common denominator was anxiety. Lots of them had [edited under our comment moderation policy] early diagnoses with things like ADD, ADHD, and PTSD. They were using marijuana to self-medicate anxiety.

    Everyone has anxiety from time to time, so when does anxiety become “medical”? In every other circumstance, anxiety becomes “medical” when it bothers the person [enough] that they go to the doctor and ask for some Valium.

    The doctor doesn’t have an anxiety meter they can hook up to the patient, so the doctor has to largely take the patient’s word for it. It is, in fact, the patient who determines when anxiety is “medical”. It is also the patient who is the only one who can determine what works best to relieve it.

    As Dr. O’Connell argued, the only dividing line that makes sense is this: If you accepted the doobie passed to you at the concert, that’s “recreational”. If you bought it for yourself, then you went to the trouble to seek it out, that’s “medical”.

    That is the only definition that matches our current rules with other anti-anxiety drugs.

    However, stoners don’t like that explanation because it implies they have anxiety problems. Guys generally don’t like admitting to anxiety problems.

    Prohibitionists don’t like it because it means anyone can be “medical” who wants to be. But it is the only explanation that survives even five minutes of analysis.

  5. There is still exorbitant amounts of dogma surrounding the idea of ‘illicit drugs’ for cannabis. Until this dogma is addressed, I don’t believe the industry can go forward.

    Any pharmaceutical formulation, by the nature of pharmacology itself, requires extraction from the plant material and isolation in order to be dosed correctly. These pharmaceutical formulations are, for the distribution to general public, almost always metabolic in their delivery system. This is because pharmaceutical medicines are attempting to induce the body’s natural metabolic systems to create the components required to balance the underlying endocannabinoid system.

    Cannabis, as the sole proprietor of cannabinoid synthesis genetics outside of humans, does not work the same way. Exogenous cannabinoids such as THC or CBD are handy for humans who have weak cannabinoid synthesis pathways. Fatty acid metabolism is poor in many modern humans due to glycemic diets and the delivery of cannabinoid lipids into the bloodstream via inhalation is a unique medicinal dosing mechanism; one which requires proper education of the individual doing the dosing in order to glean the full benefit of the cannabinoids.

    Absolutely no combustion or solvent extraction is required to take full advantage of all parts of the cannabis plant; however pharmaceutical companies have jumped directly to the extraction of psychoactive cannabinoids using solvents. Doctors are prescribing cannabis [Edited under our comment moderation policy]. [But] No education is being provided to the end user about how to use the plant as medicine, it is simply prescribed as a drug.

    Cannabis grown at home requires no solvents; it requires no dangerous chemicals, it is completely organic. Making any other pharmaceutically prescribed medicine at home requires solvents and dangerous chemicals and is not organic. This is the major difference between cannabis medicine and all others. It is a pure plant medicine.

    The real danger is that the public believe that the pharmaceutical companies know how to grow and use cannabis as a medicine. They may well do, but they certainly don’t create medicines from cannabis, they only create controlled substances, a.k.a drugs. It is up to the end-user to use the substances as a medicine.

    The poison is in the dose, not the substance. Education is key.