Make Australia Stop Killing Aussies

The Australian Government’s criminal negligence in the design and administration of its medical cannabis access scheme killed hundreds of older Australians last year. It is killing hundreds more this year. It will continue killing Australians until Australia’s voters compel Australia’s politicians, bureaucrats, and government agencies to make it easy for every Australian GP to prescribe medical cannabis, every Australian pharmacist to stock it, and every suffering Australian to get it.

The Disease: Chronic Pain

According to The Cost of Pain in Australia (Deloitte & Pain Australia, April 2019), 3.24 million Australians just like you suffer from chronic pain (see Figure 1, below).

Figure 1: The distribution of Australians who suffer from chronic pain, by age and gender. Image from Deloitte’s report, “The Cost of Pain in Australia,” April 2019.

The Treatment: Deadly Opioids

According to the above-cited Cost of Pain study, the most common prescription for the treatment of chronic pain is opioid painkillers, such as codeine, oxycodone, and methadone.

Unfortunately, this treatment is worse than the disease. These opioid medications, prescribed by Australia’s Medicare system, are killing Australians like flies, as shown in Figure 2 below.

Figure 1 (above): “Fatal opioid overdoses are on the rise, and most involve prescription drugs,” ABC Chart of the Day, 28 Aug 2018.

According to the Cost of Pain report, 823 Australian chronic pain sufferers died of prescription opioid overdoses in 2018.

Surely, most of these were immoral, criminal “druggies,” who deserved to die, right? Wrong. According to the experts cited in the ABC’s 2017 article “Everyday Aussies, not ‘doctor shoppers’, at heart of crisis, experts say,” Australians just like you are likely to be prescribed opioids “after having surgery, and… for injuries suffered through sport or at work.”

With opioids, the margin for error is tiny. One pill too many, and you’re dead. Your father. Your son. Your mother. Your daughter. Your granny. Dead.

The Alternative: Medical Cannabis

In 2018, Pain Australia conducted a survey of its members regarding medical cannabis. According to Pain Australia’s summary of the survey’s findings, “Many respondents explained they would prefer to use medicinal cannabis over prescription pain medications such as opioids, which carry side-effects and risk of death.”

  • Are the respondents correct that cannabis poses no risk of fatal overdose? Yes.
    • According to a 2017 meta-study by the USA’s National Academy of Sciences, Engineering, and Medicine: “Overall, the committee identified no study in which cannabis was determined to be the direct cause of overdose death” (p. 235). That is: there is no scientific evidence that anyone, anywhere, at any time, has suffered an “overdose death” from cannabis.
    • An Australian study (Zahra 2020) claimed to identify 559 “cannabis-related” deaths in Australia between 2000 and 2018. However, by that study’s definition of a “cannabis-related death,” had any of the Australians killed by the 2002 Bali bombings recently smoked a joint, their deaths would have been counted as “cannabis-related,” despite their deaths having be caused by terrorism, not by cannabis. Does that make the study worthless? No. But it does call the entire study into question.
  • Are the respondents correct that cannabis is effective? Yes.
    • The same US meta-study concluded (p. 90) that there was:
      • “Substantial evidence that cannabis is effective for the treatment for chronic pain” and
      • “Moderate evidence that cannabinoids… are an effective treatment to improve [insomnia] associated with… chronic pain.”
    • In January 2019, the World Health Organization officially recommended rescheduling cannabis to be more widely available, and clarified that cannabidiol (CBD) — a cannabinoid found in cannabis — was not restricted internationally and should not be restricted nationally.
    • In February 2019, the European Parliament passed a resolution “calling on Member States to allow doctors to make free use of their professional judgement in prescribing regulatory-approved cannabis-based medicines to patients with relevant conditions, and to allow pharmacists to lawfully honour those prescriptions.”
    • The scientific evidence that cannabis can effectively and safely treat chronic pain keeps mounting: Russo (2013); Habib (2018); Cooper (2019); Lavie-Ajayi 2019; Boehnke 2019.

Australia’s people appear to know more about the safety and efficacy of cannabis than Australia’s experts. How can this be true? I suspect that it is related to the adage about a fox chasing a rabbit: the fox is running for its dinner, but the rabbit is running for its life. Chronic pain patients are, like the rabbit, highly motivated to find a safe and effective alternative to save their own lives. While the motivation of Australia’s health care professionals is high and admirable, it cannot be compared to that of the life-or-death motivation of the patients themselves.

In addition, many scientific studies take an oddly-narrow view of cannabis’ “effectiveness” in treating the suffering of chronic pain patients, in that they don’t measure the suffering, but only the pain. Consider van de Donk (2018), which tested the effect of cannabis on reducing reported pain levels in the same tests used to measure the effectiveness of opioids. It reported that “none of the treatments had an effect greater than placebo on spontaneous or electrical pain responses.” What such tests ignore is that cannabis appears to reduce suffering in a different way than opioids: patients’ sensation of pain isn’t decreased much, but patients’ ability to get beyond their pain is increased, which decreases their suffering (Lavie-Ajayi 2019; Boehnke 2019; Wallace 2020). Focusing narrowly on the pain, rather than the suffering, is like measuring the ability of a vehicle to fly based solely on the extent to which it was lighter than air. That metric would have worked perfectly for the earliest airships—hot-air and helium balloons—but would have failed miserably when applied to airplanes & helicopters.

There’s another thing that Australia’s experts seem not to know: medical cannabis saves lives.

The Crux: Medical Cannabis Saves Lives

In 2014, a scientific paper Bachhuber et al., “Medical Cannabis Laws and Opioid Analgesic Overdose Mortality in the United States, 1999-2010,” revealed a strong correlation between the legal availability of medical marijuana and a sharp reduction in opiate overdose deaths. The paper concluded:

Although the present study provides evidence that medical cannabis laws are associated with reductions in opioid analgesic overdose mortality on a population level, proposed mechanisms for this association are speculative and rely on indirect evidence. Further rigorous evaluation of medical cannabis policies, including provisions that vary among states, is required before their wide adoption can be recommended. If the relationship between medical cannabis laws and opioid analgesic overdose mortality is substantiated in further work, enactment of laws to allow for use of medical cannabis may be advocated as part of a comprehensive package of policies to reduce the population risk of opioid analgesics.”

That “further rigorous evaluation” was begun immediately, and its results were published in February 2018 in the scientific paper “Do medical marijuana laws reduce addictions and deaths related to pain killers?” by Powell, Pacula, & Jacobson, in the Journal of Health Economics 58 (2018) 29–42. It firmly established that easy access to legal medical cannabis reduced the overdose death rate by 25-40%.

As the authors wrote:

Using data from just the early period of these laws 1999–2010 [when medical cannabis dispensaries were unregulated, maximizing “easy access”], dispensaries reduce opioid mortality rates by about 40%, above and beyond the reduction from marijuana laws alone. The total effect is estimated to be even larger. When we consider the full time period (1999–2013) [including the later period of tighter regulation, reducing “easy access”], the estimates imply that dispensaries reduce opioid mortality rates by about 20% while the main effect of having a law is relatively small in magnitude, implying declines of about 5%, and not statistically distinguishable from zero. Importantly, together – a marijuana law with a legal, operational dispensary provision – the estimates imply a statistically significant (at the 5% level) decline in overdose death rates of about 25%.”

(Powell 2018)

[Update 11th October 2019: The paper “A Pilot Study of a Medical Cannabis – Opioid Reduction Program” by Dr. Kevin Rod was published on 20th September, 2019. In its study of 600 patients taking opioids for chronic pain,

Six months after beginning [Rod’s study],

* 156 patients (26%) had stopped using opioids altogether. An additional
* 329 patients (55%) had reduced their opioid use by an average of 30%. Cannabis use among these patients ranged from 1-3g per day. There was no change in the opioid use of
* 114 patients (19%) – neither reduction nor escalation in opioid dose.
* 1 patient with poorly controlled pain and an aggravated pain condition increased opioid intake.

With that one exception, all patients expressed satisfaction with their pain control, sleep and quality of life. No opioid withdrawal symptoms were noted in follow-up appointments.”

(Rod 2019)

That is, (26% + 55% =) 81% of patients in the study reduced their opioid intake by at least 30%, thus significantly reducing their risk of opioid overdose. A corresponding 81% decrease in opioid overdose deaths would have saved (823 * .81 =) 666 Australian lives in 2018. Even reducing the overdose mortality rate by 26% — that being the percentage of patients that stopped using opioids completely — would have saved (823 * .26 =) 213 Australian lives. End of update.]

Unsurprisingly, given the above, it has been found that those US states in which medical cannabis is legal have lower opioid prescribing rates (Wen 2019). Further evidence for the efficacy of medical cannabis in reducing opioid use among chronic pain patients abounds (Ishida 2019; Lucas 2019; Lake 2019; Capano 2019; Hutchinson 2019; Flexon 2019; O’Connell 2019; Takakuwa 2020; McMichael 2020; Donovan 2020; Boehnke 2020).

You would expect that, faced with such a demonstrably-effective tool in saving hundreds of lives each year, Australia’s politicians, bureaucrats, and agencies would have rushed — rushed! — to implement policies, laws, and regulations that gave Australia’s chronic pain sufferers “easy access” to medical cannabis.

Yet, Australia’s federal and state government have made medical cannabis so hard to get that only 30,000 Australians — fewer than 1% of Australia’s chronic pain sufferers — are predicted to be active medical cannabis patients by the end of 2020. The remaining 99% do not have legal access to medical cannabis legally, due to complex rules, extensive paperwork requirements, and high costs.

Why aren’t Australian politicians and bureaucrats doing everything they can to save Australian lives?

Because they are afraid that cannabis will drive its users insane.

The Fear: Cannabis Causes Schizophrenia

This fear, simply put, is bollocks unfounded. Despite nearly 100 research papers being published per year since 2012 on the relationship between cannabis and schizophrenia, all that has been proven is a correlation. This research has established that one of the three statements below is true, but not which one:

  • Cannabis use increases the odds of developing schizophrenia.
  • Latent schizophrenia increases the odds of cannabis use.
  • Some underlying condition increases the odds of developing both cannabis use and schizophrenia.

The latter is entirely possible. Consider this study from 2015 which showed that smoking cigarettes was correlated with later development of schizophrenia: the more tobacco a person smoked, the higher the risk. Many factors are correlated with the later development of schizophrenia, each confusing the potential impact of the others.

Schizophrenia is no joke. According to the Australian Bureau of Statistics’ Causes of Death, Australia, 2017 (the most recent year for which data is available) “Schizophrenia, schizotypal and delusional disorders” killed 63 Australians in 2017 — Australians with families, friends, and futures just like the rest of us. Still, that number is ((63/823)*100=) 8% of the Australian deaths from opioid overdoses. Alternatively put, (823/63=) 13 Australians die of opioid overdoses for every Australian who dies of schizophrenia.

Killing 13 Australians for certain because you think 1 Australian might get schizophrenia is so willfully misguided as to be criminally negligent.

Furthermore, what little evidence there is to support the “cannabis causes schizophrenia” claim requires that the cannabis user be young. Most of Australia’s chronic pain sufferers are not young (see Figure 1, above). Australia’s GPs are quite capable of being extra-careful about prescribing cannabis to young patients, while prescribing it “easily” to chronic pain sufferers who are not young.

Conclusion: The scientific literature does NOT prove that anyone, anywhere, ever, developed schizophrenia from consuming cannabis.

[Update (19 Oct 2019): People who suffer from chronic pain are often also prescribed benzodiazepines (such Valium and Xanax). Benzodiazepines help patients sleep despite their pain, and to treat the anxiety that often arises from having a chronic, painful illness for which they must take potentially-fatal and highly-addictive opioids. In the 2019 study Reduction of Benzodiazepine Use in Patients Prescribed Medical Cannabis, Purcel et al. concluded that:

Within a cohort of 146 patients initiated on medical cannabis therapy, 45.2% patients successfully discontinued their pre-existing benzodiazepine therapy. This observation merits further investigation into the risks and benefits of the therapeutic use of medical cannabis and its role relating to benzodiazepine use.

(Purcell 2019)

This matters, because, according to the Australian Bureau of Statistics, benzodiazepine was found in 63.1% of the Australians who died of opioid overdose, and were the second most-common cause of overdose death (at 4.0 per 100,000 vs 4.6 per 100,000 for opioids).]

Some anti-cannabis fear-mongers muddy the waters by claiming that cannabis can cause “psychosis.” That’s a scary-sounding word! However, it is defined as “perceiv[ing] or interpret[ing] things differently.” The colloquial term for cannabis-induced temporary psychosis is “getting high.” (Many Australians are rumoured to enjoy this.) Similarly, alcohol-induced beer goggles can make one perceive or interpret a potential companion differently, meeting the technical definition of temporary “psychosis.” Even eating chocolate can cause temporary psychosis. Don’t let the fear-mongers scare you.

One reasonable concern is the possibility that chronic pain sufferers, high on prescribed cannabis, might cause more fatal traffic accidents. However, this concern is misplaced: chronic pain alone increases the risk of fatal traffic accidents, and taking opioid medications increases that risk even higher (Chihuri 2017; Cameron-Burr 2019; Chihuri 2019). The question is not whether medical cannabis would increase the rate of such accidents, but whether its increase is higher than or lower than the increase caused by untreated chronic pain or chronic pain treated with opioids, since those are the only available alternatives to treating chronic pain with medical cannabis.

The Crime: Wrongful Death from Criminal Negligence

To summarize: The Cost of Pain in Australia (Deloitte & Pain Australia, April 2019), 3.24 million Australians suffer from chronic pain, for which the most common prescription for the treatment of chronic pain is deadly opioids (often along with benzodiazepines), which killed 823 Australians in 2018.

“Easy access” to medical cannabis would have saved the lives of 25-to-40% of these 823 Australians. That’s 205-to-329 Australians just like you. Hundreds of Australians with families, friends, and futures, whose only “crime” was being injured, developing a painful illness, or growing old.

These hundreds of Australians died because the politicians, bureaucrats, and government agencies that are responsible for Australia’s medical cannabis scheme’s policies, laws, and regulations failed in their duty of care. They have been too afraid of the potential side-effects of medical cannabis to pay sufficient attention to its actual life-saving properties. They should have known about medical cannabis’ life-saving properties. They should have done everything within their power to make medical cannabis as “easily accessible” as deadly opioids. They did not do so. Every opioid overdose death in Australia since at least February 2018 (when Powell et al.‘s paper proved that “easy access” to medical cannabis reduced opioid overdose death rates) was a wrongful death caused by the criminal negligence of these individual politicians, bureaucrats, and government agencies.

Hundreds of Australians just like you suffered these wrongful deaths last year, in 2018. Hundreds more are suffering such wrongful deaths this year, in 2019. Hundreds more will suffer such wrongful deaths next year, in 2020, and in every year to come until Australia’s criminally negligent medical cannabis policies are changed to make medical cannabis “easily accessible” to chronic pain sufferers.

The Analogy: Antiseptics

Ignaz Semmelweis discovered in 1847 that antiseptic procedures reduced to near-zero the rate at which women died of childbed fever after giving birth. The “experts” of his day — highly educated medical professionals — resisted his procedures for decades. Hundreds of thousands of women could have been saved from premature and painful deaths during this time. Nuland (2003) argues that Semmelweis could have saved more lives if he had communicated his findings more effectively.

The Solution: Vote for “easy access”!

The solution to this problem is in the voting booth. Ask every candidate if they will support a bill that would stop killing Aussies by “making it easy for every Australian GP to prescribe medical cannabis, every Australian pharmacist to stock it, and every suffering Australian to get it.” If not, vote for someone who will stop killing Aussies. This is the best way for you to “communicate your findings more effectively.”

The Motivation

Patricia Shaw “Patti” Plamondon (above, at upper left, in 1991, aged 35), to whom I had the honor of being married for 25 years, died of an overdose of an opioid (methadone) prescribed for her chronic pain, in 2012, at the age of 56. Look into her eyes! Every one of the 823 Australians who died of opioid overdoses in 2018 was a real human being, just like Patti, who loved, and was loved by, family and friends. Lest we forget.