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House of Assembly - Fifty-Fifth Parliament, First Session (55-1)
2023-08-30 Daily Xml
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Motions

Medicinal Cannabis

Mr BELL (Mount Gambier) (11:01): I move:

That this house—

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

(b) supports expanded research and clinical trials into the treatment of conditions, including endometriosis, Alzheimer's, Parkinson's and chronic pain; and

(c) streamlines access to locally manufactured products for South Australian residents.

I honestly believe that South Australian people deserve access to the highest quality, modern and affordable health care available to them. For a growing number of South Australians, this includes treatment with medical cannabis. Whatever your thoughts about medical cannabis, there is growing evidence showing success where other conventional treatments have failed. There is also evidence that medicinal cannabis should be a legitimate first-line treatment for some conditions, rather than be considered an alternative or last-resort treatment. Chronic pain is now the leading indication for its prescription, with more than 100,000 scripts being written for chronic pain in Australia in 2022, followed by sleep and anxiety disorders.

The Therapeutic Goods Administration has approved the use of medical cannabis for more than 130 conditions, including epilepsy, multiple sclerosis, spasticity and palliative care, although these are often considered on a case-by-case basis. Although patient access has improved slightly over the last few years, there are still many barriers to accessing medical cannabis in our state. According to research conducted by the South Australian parliamentary library in 2020:

Research into cannabis medicines is limited and disparate, restricting medical establishments, understanding and treatable conditions and appropriate medicines;

Many doctors do not feel confident or comfortable in using the available access schemes;

Regulations are complex and difficult do navigate;

Illegal use for self medication is persistent, complicating clinical trials.

Three years following the publication of that research, I will argue that very little has changed. Is it any wonder our doctors are reluctant to prescribe medical cannabis? In 2020, a federal Senate inquiry exploring current barriers to patient access to medical cannabis in Australia heard from more than 30 experts and stakeholders in various fields. The report makes for very interesting reading.

A survey conducted by the Lambert Initiative for Cannabinoid Therapeutics, through Sydney University, showed just 3 per cent of medical cannabis users are accessing it through legal means. That is an estimated 600,000 Australians accessing medical cannabis illegally. More than 90 per cent of the survey respondents thought the current regulatory framework did not work well, and more than 60 per cent said the cost was prohibitive and expensive. Almost 90 per cent said the current access model was extremely difficult for patients to navigate.

If a desperate patient cannot access the products legally, they will access it illegally. Illegal medical cannabis accessed on the green market is completely unregulated, and the patient has no idea where the product has been produced, what they are ingesting and the levels of active compounds. Misinformation and self-medication are a very dangerous combination. Not only does this put people's safety at risk but it undermines the legal industry—all the more reason to support patient access to legal and regulated products.

In order to be an effective medicine, cannabis must be produced consistently under controlled circumstances by professionals. It is also important to point out the affordability issue I made earlier. Many of the parents who have contacted my office have spoken about the incredible cost of continued treatment for their children and having to reduce doses or, even worse, stop treatment altogether. As South Australians buckle under increased cost-of-living pressures, the last thing we want them to do is cut corners on health care.

I have spoken many times about two young children in my electorate whose parents battled for years to get them access to affordable medical cannabis to treat juvenile epilepsy. One local parent, Katherine Height, has put forward her experience in a submission to the recently formed Joint Committee on the Legislation of Medicinal Cannabis. I see this committee as an important step for all sides of politics to work together to further medicinal cannabis treatment options for our state.

I encourage the committee to pay careful attention to the submissions put forward by everyday South Australians who are already having to negotiate a complex and difficult patient access system. Katherine's submission highlights the battle these parents face in finding a medication that finally gets results but is too expensive for them to continue on a regular basis. I will read a section of Katherine's submission now:

At every Neurology appointment I ask the same question about funding for CBD and does Ella—

that is her daughter—

qualify, and I get the same answer. No.

I have accepted that Ella will never be seizure free [but] there are so many rites of passage she cannot engage in, for example getting a licence, but I refuse to accept a quality of life any less than what she deserves based on political red tape.

I am a proud South Australian but to put it simply, I feel my state [has] let me down, and is letting my daughter down.

I shouldn't have had to travel interstate to access a clinical trial, I shouldn't have had to make a choice between paying for life changing medication or electricity, I shouldn't have to accept a quality of life for Ella that results in her having hundreds of daily seizures because she doesn't fall under the Dravet or LGS banner.

In our case we have exhausted all other options and are currently on a combination of four anti-epileptic medications and the ketogenic diet.

I am terrified for the day when the funds run out and I have to stop the CBD once again.

I am terrified to see the regression in Ella and I fear for her safety and mental health.

Katherine's submission also highlights the extra problems regional people face in accessing treatment. In capital cities, it is far more likely you will find a GP or a specialist willing to prescribe medical cannabis for you; whereas in regional areas, where GPs are thin on the ground already, it is far less likely this will occur. The more we can better support and understand this industry, the more training we provide our medical professionals, the more evidence-based trials, the better the outcomes for South Australian people.

I congratulate my parliamentary colleagues on their work on this issue, in particular Greens MLC Tammy Franks, who introduced the Road Traffic (Medicinal Cannabis) Amendment Bill 2021. This bill aims to ensure people driving with THC in their system would be exempt from police action if they have a valid prescription.

Earlier this year, new drug-driving laws came into effect in South Australia, which means that drivers who test positive for MDMA as well as THC will face an immediate loss of licence. This does not take into account people who have been legally prescribed medical cannabis containing THC, even if it is trace elements.

In Victoria, the state government was working on an Australian-first select trial for a small number of medical cannabis users to drive if they are not impaired. In Western Australia, there has been legislation introduced to grant exemptions for those with a legitimate prescription. Nationally, the Drive Change campaign has been started to create awareness of this issue and drive law reform across Australia.

Tammy Franks also shares my view on increasing access to legal medicinal cannabis products for South Australian patients. If a desperate patient cannot access the product legally, they will access it illegally. Illegal medical cannabis accessed on the green market is completely unregulated, and the patient has no idea what they are ingesting and what the levels of active compounds are. Not only does this put people's safety at risk but it undermines the legal industry—all the more reason to support patient access to legal and regulated products.

It is estimated that by 2030 approximately 670,000 patients will be seeking access to medical cannabis in Australia. A particular focus of mine over the last few years is the tremendous opportunity this industry could provide for our regions. It is my belief that regional South Australia, including the city of Mount Gambier, has a big role to play in the production and manufacturing space. But if South Australians are being forced to illegally access medical cannabis, South Australian doctors are reluctant to prescribe it, and South Australians are having to travel over the border to access clinical trials, it is clear we have some large hurdles ahead of us.

This is an industry that needs regulation and controls and a unified approach from both the state and federal governments. What we need is a regulated framework that aligns with other states and the commonwealth and legislative change to support this. We need to fill the knowledge gap and encourage education and training campaigns for both the general public and, most importantly, our medical fraternity. We also need to subsidise costs and streamline access pathways. We need to curb the flow of misinformation and conduct more research and long-term studies into the effects of this drug over multiple conditions.

I look forward to reading the Joint Committee on the Legislation of Medical Cannabis report and I look forward to some real change occurring in this sector. I see this as an opportunity for our state to lead and drive change. Importantly, we need South Australians to have access to the very best health care and treatment options available to them.

Ms PRATT (Frome) (11:13): I rise to speak to the motion introduced by the member for Mount Gambier. I thank him for bringing this back to the house for further inspection and debate, and for the touching anecdotes that are the very fabric of our work as members of the lower house and as representatives of thousands of people. You never know what is going to walk in the door, but we are duty-bound to advocate where possible.

When it comes to recognising the growing importance of medicinal cannabis and cannabidiol (CBD) as an alternative treatment option for South Australians, I found myself going back to try to fully understand what it is. What is the product that we are needing to understand and possibly advocate for as an alternative treatment option?

Cannabis, a marijuana plant, exists in multiple forms and can contain more than 540 chemical substances. These include over 100 active chemicals, known as the cannabinoids. We know that two of the most common ones are referred to as CBD or THC and, I think, when we condense those scientific terms we risk losing the relevance of the treatment itself. Obviously, there are limitations and impediments to accessing this treatment, and the member's motion challenges the parliament to expand on some of those limitations.

In Australia, medical marijuana, including CBD, is a scheduled medication, and patients should discuss any possible treatment with their doctor, but it does seem that on a national scale South Australian doctors are the least likely to prescribe, and our debate today will touch on why there may be some of those hesitations. The member for Mount Gambier reminds us that the regulations are complex, and it is possible that doctors are lacking in confidence either to navigate those regulations, or perhaps just lacking in confidence to recommend a treatment that is still subject to clinical trials and research.

Currently, medicinal cannabis can be accessed by the Therapeutic Goods Administration approval via the Special Access Scheme Category B pathway. As I referenced, this becomes a technical process for our very busy and overworked doctors. We know that applications have been approved across Australia for a wide range of clinical indications, with over 115,000 of these for chronic pain. We cannot remind ourselves too often, as the member for Mount Gambier pointed out, that we are seeing a prevalence in chronic pain management.

Recognising that there is science, research and an understanding of the benefits of this kind of treatment, it still is a medicine of last resort and seems to be the only option when all other options have been exhausted. To reflect on some of the anecdotes raised by the member from the South-East, families are looking for any and every avenue to reduce pain and suffering that their loved ones might be experiencing. It is important for us to question whether this is the best outcome for patients when we are denying or impeding their access to this treatment and it only becomes an option of last resort.

Within the member's motion we are being asked to examine the necessity for further research and for clinical trials to understand the treatment of particularly common conditions, which include, but are not limited to, endometriosis, Alzheimer's, Parkinson's and, as we constantly talk about, chronic pain. For women, endometriosis is of particular interest as it affects one in nine of us. More than 830,000 Australian women will seek a diagnosis and will be affected by it. It is certainly associated with a variety of symptoms, including chronic pelvic pain and fatigue.

A study from the NICM Health Research Institute shows that the use of medicinal cannabis in the treatment of chronic non-cancer pain and inflammation has a ready been well established. Not only does medicinal cannabis help with pain management for patients with endometriosis, it also reduces uterus cell tissue growth and survival, making it quite a suitable alternative treatment for many women.

Past research has demonstrated that certain compounds within cannabis, known as cannabinoids, exert an analgesic and anti-inflammatory activity. That research sought to determine the prevalence, tolerability and self-reported effectiveness of cannabis in women with endometriosis.

Although the study showed promising results for the use of cannabis for endo symptoms, research fellow at the Australian medicinal cannabis research centre Justin Sinclair did caution that cannabis use was not without risk. He also reported that the rates of adverse effects were low in their study, with some undesirable effects such as drowsiness, rapid heartbeat or increased anxiety being reported by women in that study test.

While there is emerging evidence to show that medicinal cannabis can help manage a number of conditions associated with endo, such as chronic pain, anxiety and depression, research on the use of medicinal cannabis for this is still in its infancy. Despite the limited evidence, it overwhelmingly demonstrates that reducing pain relief following the use of medicinal cannabis in women with endometriosis is desirable.

In turning my mind to how governments and researchers may streamline access to locally manufactured products, it is certainly a sobering reflection to understand that there is a very active illegal supply, an unregulated and black market supply. Throughout Australia it does remain illegal to cultivate cannabis or manufacture those products. The only exception will be where cultivation and manufacturing are done under a licence or a permit granted by the commonwealth licensing scheme for that particular medicinal use.

On its own website, the South Australian government states that it is committed to ensuring South Australian consumers have access to the optimal range of safe and effective treatments and services to promote better health outcomes. That includes where South Australia has adopted the commonwealth scheduling since November 2016, where medical practitioners can legally prescribe medicinal cannabis products with the required commonwealth approvals.

As we explore the concept of streamlining access or providing pathways following consultation, the state government released a patient access pathway to clarify that access for South Australians. I think with our reflections this morning, what we are understanding is the complexity of those regulations and how difficult it can be to navigate those pathways, particularly when South Australian doctors are still reluctant to prescribe.

From October 2018, South Australian medical practitioners have had access to a single online application system for unregistered medicinal cannabis products, and medical practitioners can also apply for that product through a single application process. The signs are there that pathways are being developed to ease access to streamline that access and to improve the user experience. It is well understood that in our community cannabis is recognised as an addictive drug, so I want to recognise why there may be a cautionary approach in our community, but I think we certainly should be pursuing a more modern, affordable and accessible treatment option.

Chronic pain is a rising occurrence for patients, which is unfortunate, and as we reflect on people who are facing end-of-life and palliative care options, those patients certainly deserve access to more options. So I would call for research and trials which are an essential part of that advancement in medicinal cannabis and I support the motion.

Mr McBRIDE (MacKillop) (11:23): I rise today to speak to the motion moved by the member for Mount Gambier in support of the growing importance of medicinal cannabis or cannabidiol (CBD) as an alternative treatment option for South Australians. In his motion, the member for Mount Gambier has identified the need to streamline access to locally manufactured products for South Australian residents.

The motion also highlights the objective of putting South Australia at the forefront of medicinal cannabis, research and treatment. I support the motion and thank the member for Mount Gambier for raising this and bringing it to the 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 thanks to federal legislation that came into effect in November 2016. Patients access medicinal cannabis on prescription from their authorised medical practitioner. The cannabis is dispensed by a pharmacist, with the benefits of access to this drug becoming increasingly better understood by medical practitioners.

I acknowledge previous support from the Hon. Steven Marshall MP and the previous South Australian Minister for Health and Wellbeing, the Hon. Stephen Wade, who jointly endorsed the delivery of the Australian Medicinal Cannabis Course. The course is provided by the Australian Medicinal Cannabis Observatory through the Australian National University. I also acknowledge the current government's commitment with the establishment of the Joint Committee on the Legislation of Medicinal Cannabis. It illustrates the motivation from both sides of government to explore the potential importance of medicinal cannabis and cannabidiol (CBD) as an alternative treatment option for South Australians.

It is very clear that many general practitioners are increasingly being asked about medicinal cannabis as a treatment option for patients, particularly when other treatments have failed. In many cases, practitioners feel ill-equipped to answer questions regarding medicinal cannabis and are nervous about committing to either prescribing or non-prescribing. I have spoken to medical practitioners in my electorate who have raised such issues.

One of the biggest obstacles for GPs is the arduous nature of prescribing medicinal cannabis. In the first instance, the GP has to become a TGA-approved authorised prescriber and obtain three different permits. After a GP has become a TGA-approved prescriber, they have to also apply to South Australia Health's Drugs of Dependence Unit (DDU). The first question the DDU may ask the GP is 'What dosage is recommended?', which is often followed by, 'Well, I am unsure.' This is because the research around THC dosages, when related to specific conditions, is largely unknown until it is prescribed.

It is literally trial and error due to the lack of trial data. This needs to change. More independent trials need to be funded. GPs need to know they are supported with research and the backing of government before they can participate in more widespread prescription of medicinal cannabis. Once medication is given to a patient, if it is found that a higher THC dose is required the GP needs to go through an online application process to the state government pharmacist to change the prescription. This process applies to any adjustment in the patient's prescription around medicinal cannabis. This increases the paperwork for our already stressed GPs.

I hear that the most potential for streamlining access to medicinal cannabis is in the area of palliative care. Sadly, in many palliative care cases we often see patients bedbound and medicated at a level that leaves them in a highly sedated state. If medicinal cannabis were an option for GPs for palliative care patients, it is my belief it could potentially provide an elevated quality of life in their final days. It could be the medication that provides the important balance of adequate pain relief along with some cognitive function at the end of their life.

How can we as a parliament assist in making this option of medication more streamlined for our GPs to prescribe without fear of litigation? No-one wants to see patients access medicinal cannabis illegally. I appreciate the complexities and barriers that are currently inhibiting progress in both legislation and more mainstream application of medicinal cannabis. This includes the time it takes to locate and see an authorised doctor to prescribe medicinal cannabis. There is also the high cost of medicinal cannabis currently not on the PBS, along with providing unbiased training for GPs in medicinal cannabis administration.

Our police also have warranted concerns around people who have consumed medically acquired cannabis and then drive a vehicle. They are a risk to both themselves and other road users. I hope that the current joint committee can provide some recommendations to navigate a pathway forward for more mainstream medicinal cannabis use.

I share the member for Mount Gambier's 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 up 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 and as an alternative where modern medicines have failed.

I again thank the member for Mount Gambier for bringing this to the parliament's attention. I also thank the member for Frome for her speech prior to mine, and I commend the member for Mount Gambier's motion to the parliament.

Mr PEDERICK (Hammond) (11:30): I rise to make a contribution to this motion from the member for Mount Gambier in regard to support for medicinal cannabis. I think that it is a very worthy motion and that more work needs to be done because medicinal cannabis is being used as an alternative medicine and it has been hard for people to get access to it. I have had some constituents who have had trouble getting prescriptions and had to go to specialists in Victoria, which makes it difficult.

I am hoping that over time—and I think it is over time, opening them up—more doctors will be willing to prescribe medicinal cannabis. From my understanding, it goes against their culture, a bit of using traditional medicine. However, there are people looking at ways to get past that, whether it is for chronic pain, epilepsy or a whole range of issues which confront people in their day-to-day lives and for which they need to find support.

It is a fact that some people use illegal cannabis, and I would like to see access to medicinal cannabis made easier so that people could go down that path. I understand that people find all sorts of ways to access medicinal cannabis on the black market, so we want to rule that out as well. We want to make it affordable and ethical for people to access this product. It is grown in a highly regulated way.

One of these operations was going to be set up in my electorate, ringed with barbed wire and security cameras. It did not get off the ground, but that was going to be the program, and one featured on Landline the other day. There are a lot of costs involved to get it going, and I certainly do not think anyone is getting rich real quick real soon. I think the issue is bigger than that; I think it is about providing an alternative for people for pain relief or for whatever medical condition they may have.

I commend the motion. Let's hope that more research is ongoing because I know that the medical profession love to have a long time line for research, but they also need to look at the physical evidence in front of them and talk to the people who are getting relief, and significant relief at times, from the use of medicinal cannabis.

Mr HUGHES (Giles) (11:33): I rise also to support this important motion and commend the member for Mount Gambier for bringing it forward. It is an important issue, and there is some complexity around it, but that can be worked through. In a lot of ways, our state is behind some of the other states—not far behind—and Australia as a whole is behind, and well behind, some nations overseas when it comes to the use of medicinal cannabis. We do need to address the barriers, and part of that is simplifying the regulatory process and also when it comes to GPs. I fully accept that our GPs are under a lot of pressure when it comes to time, but GP education in this area is important, and needs to be ongoing.

The nature of the plant itself is complex, to say the least. We have already referred to over 450 compounds or thereabouts in the plant and to date only 100 of those compounds have been identified. One of the complexities around the compounds derived from cannabis is the way they also interact with each other. You have cannabinoids, terpenes and other compounds and the manner in which they interact can either repress or enhance effects of individual compounds, so there is a lot of complexity.

One of the important things is the need for far more scientific research. There is a lot going on around the world and in this country. There are a whole range of trials. When it comes to trials, the gold standard is double blind trials where there are placebos used. It is always interesting when you go back and look at the pharmaceutical industry—and I am not going to get into a big pharma thing—that often the results of trials are not fully released, and it is often the case that the trials that paint the more positive picture are the ones that are released. One of the other elements is that sometimes a whole range of pharmaceutical products can have effects over a long period of time. A lot of trials, by their nature, are relatively short.

Some people here might have seen the story on Four Corners last night on Prozac, which was very interesting when you look at the nature of trials and you do a meta-analysis of the trials and the sorts of results that come out. The area is obviously ripe for a lot more work, and it is clear, both from anecdotal information and more rigorous information, that the products of cannabis, whether it is THC or whether it is other products, can have a beneficial effect for a whole range of people.

Given the complexity of the plant and the compounds and the nature of our bodies, it has only been relatively recently that we have a whole endocannabinoid system in our body. We have receptors all through multiple organs and parts of our body, so it is no wonder that the products from cannabis can have wide impacts for both good and ill, and we just need to have some clarity about that.

As I said, a lot of work has been done overseas and some of that has been good quality work. We do not always need to reinvent the wheel. We do need to get to a point where we regularise the use of medicinal cannabis in the way that we do with a whole range of other pharmaceutical products. One of the issues—and it is a big issue and probably even more of an issue for people in regional communities, given the lack of alternative transport—has been the fact that THC in your system is enough over a very small level to rule you out of driving, yet we accept people driving around with prescription drugs that are far more powerful.

Some research has been done in the United States in the states where medicinal cannabis is available. There has been a reduction in road vehicle accidents because people have substituted a product derived from cannabis and used that instead of far more powerful prescription drugs. That is a positive and I think we need to take that on board.

We do need to normalise the use of medicinal cannabis and we do need to address regulatory barriers. When the efficacy and safety have been demonstrated for particular conditions, we need to ensure that people do then have access, and affordable access. Ultimately, some of the products need to be on the PBS system, and I fully acknowledge that getting drugs onto that system in Australia follows a rigorous process, as it should. You have to demonstrate efficacy and you have to demonstrate safety.

I have no doubt that some of the compounds that are derived from cannabis are going to prove to be medically very useful indeed, but there is a lot more research to be done. I spoke to a bunch of scientists in Brisbane recently, and the nature of the research that is being done is fascinating. I hope in the months and years to come we will see the results of some of that research.

South Australia should get on board. People have said there is an industrial opportunity here, and there is an industrial opportunity. Victoria has not done it all that well, so there are opportunities. You have to realise that we are competing with countries that are well ahead of us when it comes to the production of products, so we do need to get our act together.

Mr WHETSTONE (Chaffey) (11:40): I rise to support the member for Mount Gambier's motion. It is an important motion. Medical cannabis is playing a much more significant role in medical treatment of people on a day-to-day basis. We know that patients can legally access medical cannabis through prescription, and there are 600,000 Australians who are currently using cannabis for medical purposes; however, only 4 per cent is obtained by prescription.

It does tell you that the sooner we have it regulated, and the sooner that we get what is probably one of the most highly regulated medical aids out there for general consumption, it will help us not only expand the research and the trials but bring them into effect. It will provide treatment for those who are suffering from many medical conditions, such as endometriosis, Alzheimer's, Parkinson's and particularly for chronic pain, which medical cannabis is very good at treating.

I think my message to government would be: do not take away the opportunity for people to have alternative medical treatment through medical cannabis. We know that heavy opioids and other addictive substances can be deemed as unnecessary because of the nature of them. We know that CBD is not addictive or habit-forming in itself, and taking CBD oil is the safest course of getting medical treatment.

I will touch on a facility in the electorate of Chaffey, MedTEC. It is a newly built facility that is moving along quite nicely. It is the only active operation in South Australia. It is waiting for its final permit to bring it into commercial cultivation, one of 12 licences in Australia. It is commercially up and going and it will soon be in full operation, employing about 100 South Australians. It is just a great opportunity. To date, they have invested many millions into that facility, and it is currently working with PIRSA on research work and destroy, permit only.

They are growing the CBD, the THC and industrial hemp for the betterment of those trials. I have been up and had a look, had a visit, and it is quite an eye-opener. The trials are in conjunction with PIRSA, and also the nursery trials that have a licence for cultivation of the THC product. I guess the threshold for the THC is that if it does breach the 1 per cent content of THC it is deemed as a hot product and destroyed straightaway. Of the strains that are being developed in a facility like MedTEC at Renmark, there are 1,800 strains of the CBD or the THC products.

In Australia, 85 per cent of the products that are sold here are imported, mostly from Canada, and so that tells you that there is an opportunity here in South Australia, in particular, to grow something in our own backyard instead of having to import. If you want to be an importer, it takes six to eight weeks to get that importer's licence and import the product to put it on shelves, put it into chemists or put it into what will be dispensaries.

Through my trips internationally, I have visited a number of R&D facilities in Israel. They really are quite an advanced operation. Also, on my most recent trip to the US, I visited a number of dispensaries in California. The amount of marketing and advancement over there really does open the eyes right up to understanding just how progressive this industry is and also what it is doing to provide a non-addictive form of medication. I think in today's world that is becoming very much more needed.

What I would like to say to any government is that it is a highly regulated commodity. There is a significant amount of red tape, but the speculators have been and gone. As I said, MedTEC here in South Australia is a great facility. It is a great opportunity for our economy when it comes to medical cannabis. I would urge that we support an industry that is a great medical breakthrough. It is also a great opportunity for economic advancement in South Australia.

I commend the motion. I commend the opportunities that particularly a medical facility in my electorate is going to advance to South Australia. I must say that, as a partner with Waite and as a partner with SAHMRI, the MedTEC facility will be one of the first and most advanced facilities in Australia. I am really looking forward to that permit being given and understanding what it will mean for South Australia's economy.

The Hon. D.G. PISONI (Unley) (11:46): I, too, stand to support the motion. In doing so, I think I should take the opportunity to discuss what is medical cannabis because there is a very broad understanding around the world, or a very broad perception around the world, as to what is medical cannabis.

I am comfortable with the language here—I am not going to move an amendment or anything like that—but the member for Mount Gambier has used the term 'alternative treatment'. Medicines are not alternative treatments: medicines are developed to treat something. Ozempic, for example, when it was developed was not marketed as an alternative medicine for diabetes. I am not quite sure that using the term 'alternative' does the product any good.

It might want to be considered that what we are about here in this place is this actually being a treatment available, not alternative treatment but a treatment available as specified or prescribed by a medical practitioner like every other drug, every other pharmaceutical that is available, a product that is available to be provided through the PBS on a subsidy, for example. We have heard contributions about the cost of medical cannabis that is available in Australia at the moment. Only two medical cannabis products are actually on the PBS, yet hundreds are available. They are all imported, of course, because we do not have a medical cannabis industry here.

We certainly do not want the medical cannabis industry that was the forerunner to recreational cannabis use in Canada, in particular, and in many of the states in America, where franchises were set up to sell marijuana weed as medical cannabis. In Vancouver, you could walk into a cannabis pharmacy, and you would see samples of cannabis weed on display with the grower's name and the reputation that grower had. It would have a description of why you should consider that weed over the one being displayed next to it. It was almost like you were at a wine tasting event.

You needed a prescription to access it, but you could get a prescription from a herbalist. Fortuitously, the shop had a herbalist on hand, so you could walk in off the street and say, 'I like what I'm reading about John Williams' marijuana. It says I can take it all day and still get up and do the gardening when I'm finished,' or perhaps, 'Today, I feel like a real day off, so I'm going to take the weed that's grown by Peter Smith. He's got a reputation of knocking you out on the first puff.' That herbalist would be able to prescribe that particular brand of weed sold as medical marijuana for you there and then, and you could use that prescription instantly and purchase it.

When I asked about age limits for access to medical marijuana pharmacies in Vancouver, when I was there in 2015 looking at this process, I was told, 'No, we're very strict about people having to be over the age of 18 to be clients.' When I walked past that very same dispensary a few hours later, I saw two boys in there, who were obviously well under the age of 18, buying their medical cannabis over the counter.

What I also learnt on that trip was that there is a particular brand of coffee chain in Canada—everywhere you go you bump into it; I cannot remember the name off the top of my head, but it is very prominent, like Starbucks is in America, for example—and the largest medical cannabis franchise in Vancouver had more outlets than that particular coffee franchise.

The investment in that type of medical cannabis came from cigarette companies, who were big shareholders, as were bikie groups, who were also very big shareholders and owners of franchises in that area. I know that is not the type of medical cannabis the member for Mount Gambier has brought to this place, and I know that no-one in this place has been speaking about that type of medical cannabis program, but it is important to raise it in this place.

We did have an instance back in 2019 when Jenny Hallam was charged with producing cannabis oil. Pharmaceuticals are not produced in the backyard: pharmaceuticals are produced by pharmaceutical companies with years and years of testing and proven outcomes for their use. That is what we are talking about when we are talking about supporting medical cannabis, and that is why I do not think we should be using the term 'alternative treatment'. It is a treatment, supporting cannabis as a treatment, because we know there is evidence for medicines made from cannabis having benefits that other medicines cannot deliver.

That on its own, of course, makes it eligible—after testing—for that product to appear on the PBS. The PBS works in such a way that you cannot have two products receiving PBS support that deliver the same outcome. They have to be the best product to produce that outcome or they deliver something new. They deliver an outcome for that patient that is not available with another drug.

Sometimes, for that new drug—for example, if there was a commercial version of a cannabinoid drug that was able to support or minimise Alzheimer's disease or some other outcome—it may very well be that it would be made available on the PBS and a drug that did not work as effectively would be taken off. That is how the PBS works. If an improved drug comes along, it will quite often replace a drug that might make a similar claim but does not deliver as good an outcome as the new drug that has replaced it.

It is a massive opportunity for health outcomes in South Australia. It is a massive opportunity for industry. I am very pleased that my colleagues supported me for participating in the select committee that is set up to look at medical cannabis in South Australia. The issues, of course, are complex, particularly for those using it. We know that there are drugs that are prescribed that you get from your pharmacist, and they will come with a warning about driving and operating machinery. We know that is an issue with the THC that is used in some cannabis-based drugs.

One of the challenges for us is having some form of measurement as to what degree of THC actually causes impairment. We know that with alcohol it is .05 and that it is an offence to drive with that amount of alcohol in the blood, but we do not have a system where we are able to determine through a test whether the THC that is in your blood after using medication derived from cannabis has an effect on your impairment. There is a lot of work to do. I am very excited about being part of that, and I support this motion.

Mr BELL (Mount Gambier) (11:56): I want to thank all members who have contributed to this motion: the member for Frome, the member for MacKillop, the member for Hammond, the member for Giles, the member for Chaffey and the member for Unley. I also want to give special thanks to Tammy Franks MLC from the Greens for being a driving force in the establishment of the committee that is looking into this exact issue. It is an important issue.

Over my journey, a number of people have come and spoken to me about the benefits they receive from medicinal cannabis. A very good and dear friend of mine is undertaking quite serious cancer treatment. It is prescribed as an appetite stimulant and it has been able to increase this person's appetite, which has then given them more weight gain and certainly made them stronger in their ability to withstand the chemotherapy, combined with pain relief.

Most prevalent in my mind is juvenile epilepsy and the number of parents who come into my office and make the observation that they are no expert in this field but that this works. It is the only drug that has reduced the number of seizures. It improves the quality of life for their children. It is extremely important, in my mind, and again I think there is a great opportunity for our state to lead in this field. With those words, I thank members who have made a contribution and I commend the motion to the house.

Motion carried.

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