03 Aug Cannabis As Palliative Care.

The highest priority for CLEAR is that doctors should be able to prescribe medicinal cannabis. The government continues to insist that cannabis has no medicinal value despite the huge amount of evidence that it provides real relief for a range of physical conditions. CLEAR has produced a summary of the evidence for cannabis as a medicine.

The ability of cannabis to treat physical symptoms is the essence of campaigning for medicinal cannabis, it has nothing to do with getting stoned or enjoying the intoxicating effects of cannabis. Indeed, medicinal users often go to great lengths to explain they don’t seek the recreational effects of cannabis, their purely medicinal use is all about treating the symptoms of the illness and the psychoactive properties of cannabis are considered to be unwanted side effects.

This is not, however, the end of the story. The value of cannabis as a medicine for some people goes further than reducing physical symptoms and this, perhaps, is where things get a bit messy.

In the course of being involved in the cannabis law reform effort for the past 20 years I have met many medicinal users who have said much the same thing: “Cannabis doesn’t cure me, but it helps me deal with the illness”. Less a medicine for physical symptoms, more a psychological aid in some cases.

At the recent CLEAR Exec meeting in July, I had the pleasure of meeting George Hutchings, veteran and stalwart of the Medicinal Users Panel. George suffers from Charcot-Marie-Tooth disease (CMT), a progressive wasting illness for which there is no cure. He sat down in front of my camera and gave this powerful short account of his condition and he explained why he uses cannabis.

There are a great many people in the sort of situation George finds himself. There is no drug available to cure the condition, all that can be done with pharmaceutical drugs is to reduce the symptoms and to dull the pain. Sometimes the drugs can work well, but often, as with George, there are problems with side-effects which outweigh the positive benefits. He describes in the video how the cocktail of drugs he was prescribed caused problems of addiction and left him little more than a zombie. Cannabis provides the physical relief without the terrible side effects for him, it really does act as a medicine in the physical sense of reducing the symptoms.

The thing is though, cannabis does something else that the pharmaceutical products can’t do for George, it makes him feel better and more able to enjoy life, to function as a normal human being. This is cannabis as a palliative medication and that is something hard to measure.

Palliative care can be explained as

Physicians sometimes use the term palliative care in a sense meaning palliative therapies without curative intent, when no cure can be expected

Cannabis fits this description for a great number of people. It cheers them up, contextualises the pain and allows the person to “put their problems in a box” and get on with life. This doesn’t mean people like George get hammered and forget the world, but it is the psychoactive effects – the “drug high” if you like – that bring this relief. In other words, George very much benefits from the supposed “unwanted side effects” of cannabis, this is recreational drug use in a medicinal context.

Strange as it may seem, this isn’t really news, the palliative effects of cannabis have been known about for some time, especially in respect of cancer sufferers: Cannabis use in palliative care – an examination of the evidence and the implications for nurses (Journal of Clinical Nursing 2010):

The literature on the use of cannabis in health care repeatedly refers to changes for users that may be equated with improvement in quality of life as an outcome of its use. This has led to increased use of cannabis by these service users. However, the cannabis used is usually obtained illegally and can have consequences for those who choose to use it for its therapeutic value and for nurses who are providing care.

This is the problem, what would normally count as recreational use is medicinal use for some people, cannabis can be a medicine that is in effect, enjoyable to use. This of course is illegal and In the eyes of the moralists it debases the claims of the medicinal value of cannabis.

There is an assumed quasi-moral mindset at work here along the lines of medicines should taste nasty. Anything that’s enjoyable must lead to “abuse” and therefore must be bad. Indeed, one of the main justifications for making cannabis illegal is this “high potential for abuse”. So is palliative care through cannabis really no more than drug abuse with a medicinal excuse?

A term which is seldom if ever questioned has been used here: ‘drug abuse’. This is a term that is bandied around as if it were universally accepted and with long established social norms, everyone is assumed to know what drug abuse means and it forms the bedrock of our attitudes to them and underpins our current laws. So much so in fact that it comes as a surprise to learn its origins.

In fact the term “Drug Abuse” has only been in use for the past 50 years. It was a term invented in the early 1960’s under the presidency of John Kennedy. It’s explained in some detail in ‘The Death of Marilyn Monroe and the Birth of “Drug Abuse“‘ by Matthew June:

In preparation for the upcoming White House Conference on Narcotics, Kennedy asked his Science Advisory Committee to write a preliminary “progress report.” That report rejected the use of “addict” and “addiction.” Seeking a new terminology that was not synonymous with illegality, Kennedy’s advisors suggested a concept that has become ubiquitous in the parlance of our own times – drug abuse.

Hence the language of the drug war was created and that is how the use of drugs for the sake of experiencing their psychoactive effects became “abuse”. Nixon would later say as he launched the War on Drugs in 1971 – “To declare all out war on pubic enemy #1: Drug Abuse”.

One of the rather weak arguments sometimes heard from some cannabis law reform campaigners to justify recreational use is that “all use is medicinal”. This is glib, untrue, undermines the genuine case people like George have and seems based on trying to comply with the faux morality implied by “abuse”.

Fact is some people labelled as drug abusers do just enjoy using cannabis for pleasure, with no medicinal ‘justification’ and they always will. The vast majority of such people do so without causing themselves or anyone else a problem. The concept of guilt associated with enjoyment implied by the term “drug abuse” has been so powerfully used to support the prohibition agenda very few people have ever thought to challenge the whole concept.

So we have a problem: How do we justify cannabis as a palliative medicine without being seen as a ‘backdoor’ argument for legitimising drug abuse? My feeling is we shouldn’t try. The real issue here is to debunk the false values of the prohibition morals; simply not all use is abuse even if it is just for enjoyment. The term ‘drug abuse’ and the set of quasi moral values it promotes is one we should reject entirely. Promoting palliative care for ill people is indeed promoting recreational use for ill people, it’s the same thing and there is nothing wrong with so doing.

The thing is, although I would reject the idea that “all use is medicinal”, quite possibly a fair bit is. There is no reason why the concept of palliative medicine should be restricted to those with an incurable illness. It isn’t about curing anything, it’s about dealing with life. It is entirely reasonable to conclude that cannabis is capable of helping a wide range of people cope with the problems life throws at them. Is it really accurate to describe someone who uses cannabis to unwind from a stressful day at work as a “recreational user” when what they are doing is using cannabis to contextualise the days issues?

This isn’t to claim cannabis use can never cause problems incidentally, because for a small number of users it clearly can. But such problematic use should be called what it is: “Problematic use” and dealt with as such, it isn’t a term that applies to most cannabis users.

None of this detracts from the CLEAR aim of achieving access to medicinal cannabis on prescription under the guidance of a doctor for those who need it. A huge number of very deserving people would benefit from this and are desperate for it, correctly this remains our primary aim.

But somewhere in all this is a new agenda for the recreational cannabis law reform campaign. The problem is unless we can see our way through this imposed moral maze where the pleasurable effects of cannabis are regarded as no more than unwanted side effects at best, or “abuse” at worst, people like George will remain criminals.

Derek Williams

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