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House of Assembly - Fifty-Fifth Parliament, First Session (55-1)
2022-10-19 Daily Xml
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Medicinal Cannabis

Mrs HURN (Schubert) (12:05): In the absence of the member for Mount Gambier, he has asked that I rise to move this motion on his behalf, and I am very pleased to do so. I move:

That this house—

(a) recognises the growing importance of medicinal cannabis and cannabidiol (CBD) as an alternative treatment option to South Australians;

(b) moves to implement research and trials into the effects of cannabidiol (CBD) on patients with juvenile epilepsy, endometriosis and chronic pain; and

(c) puts South Australia at the forefront of medicinal cannabis research and treatment.

I rise to put my remarks forward as I would have done if I had not moved the motion on behalf of the member for Mount Gambier. I was pleased to move it because I am certainly in support of this motion. Patients right across South Australia can access medicinal cannabis medicines as a result of federal legislative changes that came into effect in November 2016. Nearly six years have passed since then, and research and opportunities continue to expand and present themselves in this space.

I do not like to speak on behalf of everyone in this chamber, but on this occasion I think I can: no-one likes to see South Australians suffer, especially young families and young children. That is exactly why the former state government explored the use of medicinal cannabis for children, in particular, with epilepsy and compassionate access for these very unwell children who simply are not responding to other treatments.

I just cannot imagine the pain and the stress caused to a community or a family when little ones simply are not responding to other treatment. I think that opening up this access has really revolutionised the way in which some of our most vulnerable youngest South Australians can cope with the consequences of their insidious illnesses. Since that time, there have been some important changes in national access to CBD medicines following assessment through the national medicines assessment and funding pathways.

From 1 May 2001, Australia's first ever registered CBD medicine became subsidised under the PBS for adjunctive treatment in patients diagnosed with severe myoclonic epilepsy of infancy, also known as Dravet syndrome, which is a very rare and very severe treatment-resistant epilepsy in children. That provided a real glimmer of hope for those little ones who were suffering, and it really opened up the door to all those people who had engaged with their clinicians about using this as part of their treatment plan. They were able to explore this as an option, and it gave them that glimmer of hope they needed.

Clinical evidence to support doctors in making decisions about prescribing medicinal cannabis continues to evolve, and ongoing research continues to seek to better understand its role in clinical use across a range of several medical conditions that have not responded to more established treatments.

The Australian Centre for Cannabinoid Clinical and Research Excellence (ACRE) is funded by the National Health and Medical Research Council. The TGA and ACRE clinical reference guidance resources published on their websites include a helpful overview that addresses the evidence base for medicinal cannabis therapy as well as specific guidance about medical use in the treatment of various conditions, which I am sure in some way, shape or form really does touch and affect us all in this place: palliative care, epilepsy, chemotherapy-induced nausea and vomiting, multiple sclerosis, chronic pain and dementia, just to name a few.

In summary, as I have already outlined, medicinal cannabis offers hope. It offers hope for a number of conditions that are otherwise really difficult and beyond stubborn to treat. That is why it is so important that we continue to strive in research, to improve our understanding of its benefits, so that we can keep building this evidence base for targeted investment that really is focused on improving health outcomes for South Australians.

On that note, I would like to thank the member for Mount Gambier for putting forward this motion. I am sorry that he is absent today and cannot speak to it, but I would like to support this motion.

Ms HUTCHESSON (Waite) (12:11): The government supports the motion moved by the member for Schubert on behalf of the member for Mount Gambier. I thank the member for Schubert for her comments and the member for Mount Gambier for his dedication and advocacy on this matter.

I acknowledge the ongoing need to ensure consumers have access to a range of treatments to improve treatment outcomes for South Australians experiencing chronic pain, juvenile epilepsy, and endometriosis. The decision to consider medicinal cannabis as a treatment option is a matter for discussion between a patient and their practitioner about the patient's specific clinical needs and the safety and efficacy of medicinal cannabis in the particular condition to be treated.

I have made no secret of the fact that I, like one in nine other women in Australia, suffer from the debilitating disease known as endometriosis. Women across the country suffer in silence and often have to resort to taking heavy opioids to manage the pain. Having other options available to them allows the patient to work with their practitioner to determine the best way forward.

Since November 2016, cannabis medicines can be prescribed by medical practitioners and dispensed by pharmacists in line with the commonwealth and South Australian legal framework for medicines and controlled drugs. The commonwealth's Therapeutic Goods Administration is responsible for the assessment, registration approval and determination of use of medicines via the national Poisons Standard. CBD medicines registered by the TGA may be considered by the expert advisory committee on medicines, the Pharmaceutical Benefits Advisory Committee, which makes recommendations on treatments and subsidies.

As members may be aware, Australia's first cannabidiol or CBD medicine was registered by the commonwealth's Therapeutic Goods Administration in 2020 and subsequently subsidised in 2021 under the Pharmaceutical Benefits Scheme to treat patients diagnosed with severe epilepsy. The particular form of epilepsy subsidised under the PBS is Dravet syndrome, a severe myoclonic epilepsy that occurs in infancy. The treatment is subsidised for patients who have not responded with adequate seizure control with other anti-epileptic medicines.

I understand that more recently, in fact last month, an application for the medicine to be subsidised for another form of paediatric epilepsy, Lennox-Gastaut syndrome, was supported by the PBAC. This provides for further improved access for children with severe epilepsy and their families at an affordable cost, with eligible patients now paying the PBS co-payment of up to $6.80 for concession cardholders and $42.50 for general patients for a supply.

It was announced in 2020 that a pilot to trial the use of medicinal cannabis for children with epilepsy would be established. This pilot program, proposed by the former Marshall government, did not proceed on the basis of national changes to CBD medicine accessibility. The clinical evidence to support doctors in making decisions about prescribing medicinal cannabis is evolving, and there are currently 52 trials registered in Australia. Ongoing research continues to seek to better understand its role in clinical use across a range of severe medical conditions that have not responded to more established treatments.

In 2021, the University of Adelaide received $1.5 million in funding from the commonwealth government to assist with research. The Medical Research Future Fund investment was targeted towards research in cancer therapy and improving the wellbeing of patients through management of symptoms of gut distress following mucosal injury as well as reducing the impacts of treatment side effects, including sleep, appetite, pain and fatigue-related impediments. The Malinauskas government will continue to review and expand capabilities for patients to receive the most appropriate care.

We certainly will be considering all available treatment options, following clinical guidance from medical practitioners and the commonwealth guidelines. Our government understands the importance of improving and aligning research practices to benefit the health and wellbeing of South Australians and has recently begun stakeholder consultation on South Australia's first health and medical research strategy.

We acknowledge the need to continue to assess and improve treatment practices in line with emerging research outcomes and changes in subsidies by the commonwealth. I appreciate the member for Mount Gambier's advocacy, and I look forward to working with him over the coming years.

Mr PEDERICK (Hammond) (12:16): I rise to support the motion from the member for Mount Gambier:

That this house—

(a) recognises the growing importance of medicinal cannabis and cannabidiol (CBD) as an alternative treatment option to South Australians;

(b) moves to implement research and trials into the effects of cannabidiol (CBD) on patients with juvenile epilepsy, endometriosis and chronic pain; and

(c) puts South Australia at the forefront of medicinal cannabis research and treatment.

It is interesting that in this state, since the federal legislation medicinal cannabis has been able to be prescribed since November 2016, but the experience I have had through talking to constituents in my electorate office is that it has been very difficult to obtain a prescription. I believe it will get better over time.

There has been some hesitancy from doctors to take up the case of something when not a lot of clinical trial work has been done. More work is being done as time goes on. A lot of doctors are hesitant because they want to see more clinical trials. The simple fact is that people are crying out for access to medicinal cannabis. It has been legalised for just short of six years, and we need to be able to assist people with their access.

We need to get doctors to be more confident in prescribing medicinal cannabis for all sorts of ills that may be affecting patients, whether they be people who have back injuries or spinal injuries that they cannot seem to find relief for, whether they be people with epilepsy or women suffering from endometriosis, as we have just heard. There are a whole range of things for which, reportedly, medicinal cannabis can really come into play and give some relief.

A constituent I worked with a few years ago has tried to get access to it, and we helped him. He had to go through a doctor in Melbourne in the end. It became difficult and expensive, and I would like to see more doctors being prepared to prescribe medicinal cannabis to make it easier for people to access. The simple fact is that people will use other options. They might use illegal options, or they might be importing stuff from overseas. We have the legal structures in place, and I think we need to make sure that we can connect people with chronic conditions with a health network that will support them if this is what they are seeking.

I had a recent cry for help from a friend of mine whose wife was dying—and she was a very good friend of mine as well—and he wanted to know if he could get hold of medicinal cannabis, and I said that it was just not that easy. It just does not happen. I did what I could but, sadly, my constituent and my friend was in the very late stages. This was coming from a loving husband and partner who was trying to do all he could for his wife in her last weeks to have all the options available, just in case the pain relief did not come. In the end the other pain relief did come and helped her on her sad journey with her terminal illness.

Certainly, there is lots of evidence out there—some would say it is anecdotal evidence—around the support medicinal cannabis gives people with chronic pain and epilepsy and other conditions. I think we need to do all we can to make sure that people can get access to medicinal cannabis. I know there are various companies around the state that have looked at producing it and whether it is the whole supply and demand issue that is the issue—I know of one that was potentially going happen in my electorate that has not happened.

The beauty of medicinal cannabis is that it would be grown in a controlled area, controlled growing conditions, so that they can get oil levels stable, the THC level, because that is what you have to have in regard to medicinal cannabis. It would be good if we could get one of these projects going in South Australia. It has to work alongside a regime where the product can be prescribed, where it can be made more readily available through people going to their doctors with chronic pain and making sure that we can get the right forces in place to make it available for the public.

I commend the motion by the member for Mount Gambier and I just wish that we can assist people moving forward through the medical fraternity, through our doctors, so that those people with conditions and also those parents trying to look after their children with chronic conditions can get better access to medicinal cannabis into the future.

Mr WHETSTONE (Chaffey) (12:23): I, too, rise to support this motion. Many of us as MPs have had constituents who have visited us through the course of the journey with the request about speeding up the process of trials on the benefits of medicinal marijuana, or medicinal cannabis I should say, and for many reasons.

I think there is an underlying issue that there is some level of uncertainty out there where people have the belief that it is all the same. I can assure you that it is not. There are a number of businesses that are trialling medical cannabis at the moment, but the make-up of the medical capabilities and properties that it has are quite different.

While I was a former Minister for Primary Industries, we saw significant trials for hemp in South Australia at government research centres. Confusion has overlaid the properties within industrial hemp, which does not have the same compounds that the other two groups do. There is the CBD product, which that comes from medicinal cannabis, but there is also the THC. The CBD is a cannabidiol, and it is there to treat medical conditions primarily. It has no more than 0.3 of THC, which is the stimulant that gives us the high, if you like. THC has quite a technical name of tetrahydrocannabinol and, as I said, it is the compound that gives the high.

The CBD is the product being used in a lot of the medical research, a lot of the trials at the moment, to help people with a number of medical issues that have been deemed appropriate for the use of these products, and we talk about mood disorders, chronic pain, inflammatory diseases, neurodegenerative diseases, Alzheimer's, Parkinson's. As the member for Mount Gambier touched on, he has a constituent whose daughter has been suffering seizures and epilepsy. Through trialling the CBD, they have had great success. I know that some of those trials continue. Currently, if you are South Australian, you have to have legal access by a registered doctor to give you a prescription of those products.

While I was visiting my son in the US recently—he lives in California—I was able to travel to a dispensary out of curiosity when I was suffering a few old sporting injuries. My son had said to me, 'Give a couple of these products a try,' which I did. I used a CBD cream on some of my joints (pardon the pun) and straightaway there was a reduction in swelling and the inflammatory issues I was having with my knee—whether caused by the plane flight over there or whether it was just wear and tear at a certain point in time I do not know—and I can genuinely say that I did have relief.

I guess along the course of the journey it is about understanding what this product means in the medical world. Some of the cynical conversations are that the big pharmas are not looking to support the release of this into mainstream medical use because it competes directly with their products.

I can say that a number of Australians and South Australians have used it. In 2019, about 2½ million Australian aged from 14 and over had used cannabis in the previous 12 months, including the use for medical purposes prescribed by a doctor—2.7 per cent of the total population using cannabis for medical purposes, either always or sometimes. However, only 3.9 per cent of those who said they used cannabis for medical purposes obtained it by a prescription. What that is showing us is that there is a lot of this product potentially in the black market. As these trials continue, we will see progress in developing these products and in the way they are administered and accepted. I think that is a lot of the issue at the moment.

I have a very sophisticated and advanced trial business in Chaffey that is currently having great results, and it has grown a number of different strains. Many of them are all gauged by the potency, whether it is the CBD or whether it is the THC. It does have a level of sophistication about how it is grown, the tissue culture types that are used and how the benefits are targeted to specific medical conditions. Some of the heavy opioids and other addictive substances have been proven to be unnecessary, and they are very, very addictive.

What we are seeing through these trials is that CBD particularly, the cannabidiol, does not have a level of dependency when you are using it on an ongoing basis to treat some of those medical conditions. In cases of juvenile epilepsy, it can often be dangerous to introduce children to these types of substances at an early age but, as I said, CBD has been classed as not being addictive or habit-forming in itself. Taking CBD oil is the safest course to get some of those benefits, particularly with young children suffering seizures and epilepsy.

I do not have firsthand experience with my children, but I do have friends whose children have had conditions involving seizures and epilepsy. They have taken traditional medicines and there have been significant side effects. It is quite concerning to see a young child having a seizure, and it is very concerning knowing that that child has epilepsy or a condition that could easily be treated by medical cannabis through the CBD format.

It is a worthy motion that has come to this house, allowing us to engage in the conversation. I urge governments, both federal and state, to give support to some of these alternative medicines. They have been proven to be very worthwhile, and have been proven to be non-addictive and have much fewer side effects when treating children, in particular.

It shows us that there is a level of use that is not prescribed, and there is a lot of use particularly for adults, and adults suffering advanced chronic pain, particularly back and joint pain. They have used the THC form of cannabis, but I think that as we progress through the trials the CBD, the cannabidiol, will play a much more significant role in treating some of those ailments and medical conditions.

More importantly, it is about not having the side effects, not having the medical impact, particularly on our children. It is very, very sad when we see medical intervention that comes at a price. With no further ado, I support the motion and hope it will be supported by both sides of this chamber.

Mr McBRIDE (MacKillop) (12:33): I rise today to speak briefly to the motion moved by the member for Schubert, on behalf of the member for Mount Gambier, in support of the importance of the use of medicinal cannabis and cannabidiol as an alternative treatment for South Australians.

In his motion, the member for Mount Gambier has identified the need to implement research and trials for patients with juvenile epilepsy, endometriosis and chronic pain. The motion also highlights the objective of putting South Australia at the forefront of medical cannabis research and treatment. I support the motion, and thank the member for Mount Gambier for raising this and bringing it to this parliament's attention.

In South Australia, the South Australian Controlled Substances Act 1984 regulates the supply of medicinal cannabis products. South Australian patients have been able to access medicinal cannabis, as enabled through federal legislation that came into effect in November 2016. Patients are able to access medicinal cannabis on prescription from their authorised medical practitioner, which is dispensed by a pharmacist, with the benefits of access to this drug becoming better understood by medical practitioners.

Certainly, those in our community who are searching for treatment options or complementary treatments where medicinal cannabis has benefits are seeking it out and embracing its use. Medicinal cannabis is used for a wide range of conditions, including the management of chronic pain, anxiety and insomnia. I have recently spoken with one of my constituents, Mrs Meredith Pomery. With her permission, I will share part of her story.

Meredith was open to me sharing part of her story and is keen to see the profile and value of medicinal cannabis raised with the hope of helping others to understand the benefits of its use in improving legal and practical access to it as a medication. Meredith was diagnosed with bowel cancer in 2017. She proceeded with treatment, which included surgery and radiotherapy. For some time, the treatment was successful, and she thought she was clear of the cancer. Unfortunately, the cancer returned, impacting her lung and stomach, and is now a condition that she is seeking to manage. She is focused on ensuring that she can have the best life she can with her family. She is a strong woman who is staying strong for her family.

Meredith has explained that in the last 10 months the pain associated with the cancer has increased to levels that require careful management. She said that she has good days and days that are not so good. When it became evident that more pain management was needed, Meredith used traditional pain control, but started to seek out medicinal cannabis to support her treatment. Meredith explained that it took some time to locate a doctor to prescribe medicinal cannabis. She found that there was what seemed to be a lack of connection and information about the option to be prescribed the medication by medical practitioners she consulted. She had to really search to find a doctor to prescribe the treatment. Ultimately, she found a doctor in another state.

Meredith now uses prescribed medicinal cannabis in conjunction with traditional pain relief approaches. It is her desire for others who need pain relief that the profile of medicinal cannabis continue to be raised and used as a treatment by more medical practitioners. It is a treatment that works. She also highlighted the high cost of the medicinal cannabis as a matter that needs to be addressed.

I take this opportunity to thank Meredith for sharing her story. I share her desire to see the profile of medicinal cannabis continue to be raised and for it to become more of a mainstream treatment for pain relief. We need to continue to take opportunities to research and promote the use of medicinal cannabis for a range of conditions.

I do hope that this parliament and the state embrace medicinal cannabis for medical treatment. I hope that the medical treatment is widely accepted, and I hope that the research then follows to back it up and make it even more widely accepted as its true value is found in the way that it can address issues and health issues, as I have already highlighted, that perhaps modern medicines are struggling to cope with today. As our population ages and we find more means to survive the elements that health throws at our population, I think a wider variety of health options will only reinforce and add to the quality of life that we all strive for and want to live as long as we possibly can.

I again thank the member for Mount Gambier for bringing this to the parliament's attention. I commend the member for Mount Gambier's motion. I thank the member for Schubert for bringing it to the house and I support the motion.

Motion carried.

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