To Civis, the ethical conflict is stark. Doctors, in such a position — no matter their integrity — have a clear perceived and actual self-interest.
Cannabis clinics have become big business in the five years since such prescribing was allowed. Doctors, for good reason, cannot own pharmacies. They don’t earn money from prescriptions — even if their drug-company-sponsored conferences have raised questions in the past.
Even if — and this is a matter of debate — medicinal cannabis has a significant place in treating pain and illness, the conflict of interest is alarming.
To some, the clinics fulfil an unmet need. Many people swear by the properties of cannabis to relieve pain and aid healing. But anecdotes do not a medicine make. Cannabis has not passed the trials that medicines require to make the grade.
A review of medicinal cannabis research found no "firm conclusions on the effectiveness of medical cannabis" and that it was possible "harms may outweigh benefits".
While it could well be that medicinal cannabis does help for some conditions, New Zealand’s Medsafe has only agreed that it can be classed as a medicine for multiple sclerosis and certain forms of seizure. All other uses remain "unapproved" as medicines.
It could be said that "medicinal" cannabis is a misnomer. Perhaps it fits better under a health supplement category. Whatever the rights and wrongs of the efficacy and safety of medicinal cannabis, the underlying conflict remains. The prescriber is supplying directly to the patient.
Medical Council chairwoman Rachelle Love last week told RNZ that concerns and formal complaints had been received about doctors and medicinal cannabis prescribing. There were concerns that full assessments were not being conducted, alternative treatments were not being offered and patients were not being fully informed.
There had also been communications issues where prescribing doctors were not sending back information to a patient’s GP, psychiatrist or other members of the treating team. There were also complaints about insufficient information on side effects and ongoing costs.
Any doctor may prescribe medicinal cannabis, although it has been reported that two-thirds of GPs decline when asked by patients. About 90% of patients going to cannabis clinics are prescribed a form of medicinal cannabis.
In 2023, the Royal New Zealand College of General Practitioners advised members that it did not recommend or encourage the use of medicinal cannabis products. The college’s medical director last year raised concerns about clinics pursuing commercial interests over the medical needs of patients.
This is more than just the medical establishment protecting its turf. Regulation should require ownership separation, as the medical council’s Dr Love said.
While Civis is no proponent of over-regulation, a regulatory gap remains — one that the Ministry of Health and the government need to address.
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Dr Love, in her RNZ interview, said that good medicine should include taking a "fulsome" patient history. A few days later, Civis heard at a funeral that someone had lived a "fulsome" life.
Civis once thought fulsome’s correct meaning was overdone or excessive flattery, a decidedly negative word. Not any more, it seems. Fulsome was a synonym for "full" in those uses last week.
The Merriam-Webster online dictionary says the word first appeared in the 14th century with the meaning of "copious". It morphed into a form of disparagement in the 17th century. But the meanings of abundance or generosity gained ascendancy during the last century.
The problem now is ambiguity. Is "fulsome praise" abundant or obsequious?
It is one of those words best used with care — or avoided altogether.
