Reti ShaneDr SHANE RETI (National—Whangarei): Thank you Madam Assistant Speaker. It's a pleasure to speak to this bill a bill that clearly has public interest and a bill that we will support but that we do have some issues with. Certainly I'd like to start off by saying I do not believe this cannabis reform is the second or even the first most important issue for the New Zealand health system. I think there are much more important issues to be dealing with than cannabis reform. So I want to lead off with that.There are three parts to this bill that I want to talk to. The first is cannabidiol—that's what I'll call it—which is the non-psychoactive component. It is something that probably counteracts the THC component and it may well do. It is not readily available and has been used for addiction treatment as an anti-inflammatory and for some neuropathic pain resolution as well. We agree that this should be moved to a different schedule and be more readily available. In fact we did that in 2017. We did that so that it no longer requires Ministry of Health approval and we had people like the New Zealand Medical Association chair Dr Kate Baddock who were very supportive of that move—so no issue with the cannabidiol.The cannabis framework—the second part to this—we do want to talk to for a moment because we're hearing for the first time the issue that loose-leaf cannabis may be part of this scheme. That's probably an important thing to put in the bill Minister but to bring it up here for the first time is kind of a bit late. But that's OK we can work that through select committee because what we're hearing—and we're happy to have the dialogue. Don't get me wrong. It is a dialogue that New Zealanders want to have and that we want to have too: what place what role might cannabis have in pain relief and routine prescribing medicines? We're ready to have that dialogue but we'll need a lot more filling out as to what it looks like in this bill.So what we're hearing is that there'll be domestically cultivated and manufactured cannabis. That would presume that it's also leaf cannabis. But one of the interesting questions is: where do you source it from? Well if we go to a statement in the Taranaki Daily News it tells us: Eventually patients with a prescription would be able to access medicinal cannabis products at a pharmacy." That's kind of interesting—at a pharmacy. So if you're going to be able to cultivate cannabis pharmacies are going to be dispensing loose-leaf cannabis. That's going to need a lot of thought. I'll come to those who weren't consulted but if that is in the vision I think you should've consulted with pharmacists as well. I'll go to the list of people you didn't consult—we can see who you did—but surprisingly if pharmacists are a key here they weren't consulted.If it is loose-leaf and if it is going to be smoked let's look at that. How is that going to work with our smoke-free New Zealand goals? What's that going to look like—yeah? How is that going to align with those goals? How is it going to recognise that cannabis when it's smoked is often mixed with tobacco—ASSISTANT SPEAKER (Poto Williams): I'm sorry to interrupt the member. The time has come for me to leave the Chair for the dinner break.Sitting suspended from 6 p.m. to 7.30 p.m.Dr SHANE RETI: Thank you Mr Assistant Speaker. It's a pleasure to return and continue the narrative on this bill which I've broken down into three parts.First of all the very first part the cannabidiol I'd already explained that it has our support. In fact we did most of the heavy lifting—we think anyway previously—so completely happy with that. We understand that there are very few preparations on the market but hopefully they will eventually come to market—so yes no trouble there.I was then discussing the second part which was the cannabis framework. We were hearing for the first time in the Minister's narrative that potentially this could also include loose-leaf marijuana and I was recalling an article from the Taranaki Daily News saying that yes the medicinal scheme will have marijuana dispensed by pharmacists. I was making that case OK that's kind of interesting. So pharmacists could be dispensing loose-leaf marijuana. Where that took me to was if that marijuana is then going to be smoked what are the implications for the Smoke-free Environments Act what are the implications for second-hand smoking? There's a whole lot of depth to this whole discussion that isn't at all apparent in the bill. I do understand that the select committee fills this out and fleshes it out but I would've thought important statements like that that maybe loose-leaf marijuana is part of the medicinal scheme should be included up front. If pharmacists are going to be dispensing they should be consulted you'd have thought.So let's then move on to compassionate cannabis. In a very general sense let's talk about who wasn't consulted in this area. Compassionate cannabis—that's what I'll call it—introduces more cannabis into the community and we can talk about how that might be but regardless there potentially is more cannabis in the community. You'd have thought corrections might be worth speaking to; that's one agency you might've wanted to talk to. Maybe WorkSafe and the Occupational Safety and Health Service might've been worth speaking to maybe transport; a lot of terminal care patients are still able to drive. Maybe transport should've been spoken with and certainly pharmacies as I said.Let's break out the compassionate cannabis discussion a little bit more. So for terminal care patients terminal in the last 12 months of their life—probably doable; other jurisdictions have but challenging. As a doc I'm telling you it's challenging to say you'd take a guess as to how long people might be able to live but not insurmountable. Other jurisdictions have figured it out; I'm sure we can too generally coming up with a list of conditions that might lead into that sort of discussion.Now then consideration of compassionate cannabis: again a very strong indication that it's going to allow cultivated leaf. That's going to create some of the issues that we talked about before. Again where would you source it? Would it be from a marijuana clinic or from a pharmacist? Do you grow it yourself? What's that going to look like? These should've been at least put up there for discussion points in the initial regulations.I've already mentioned some of the issues of smoke-free New Zealand. I also wanted to consider for a moment if you just picture the logistics let's say it's dispensed from a pharmacist. So you go to the pharmacist you meet the criteria terminal care it's dispensed from a pharmacist you pick it up you go to pay for it you hand across your credit card. No you don't because those of you who know the American system know they don't accept credit cards. Credit card companies won't touch this with a barge pole. It's a cash-only economy. But that's OK because you've spoken with the Minister of Commerce and Consumer Affairs and the Minister of Revenue. Oh wait you haven't. That's right this is news to you. This is the first time you're hearing that it's cash-only in the US because the credit card companies won't touch it. That's kind of interesting. You'd have thought if you consulted further you'd have found out those sorts of things.I think what's also interesting in your medicinal cannabis scheme is that one of the criteria is that it's beneficial to the patient. What are the criteria we have for compassionate cannabis? That they are terminal in 12 months. Do I hear or see any indication that it might be beneficial? Zero. This would be the only jurisdiction in the world where there is no requirement for a doctor or any registered medical practitioner to also say "The patient is likely to benefit." Do we really want that prize? Do we really want to be the only jurisdiction in the world that says "Nah the only criteria you have to have is that you've got 12 months' life expectancy." That doesn't make sense. That would've been an easy thing to put up front because almost certainly that is something that the select committee will come to.I think in summary this just shows this bill's been hurried clearly to meet the 100-day requirements and the 100-day targets that they're looking to reach. I've pointed out a number of things. In summary we support the cannabidiol. Personally the cannabis framework we'll also support and I support it too.I just want to give you an indication of how I'm thinking of it: it's just a drug. Cannabis is just a drug like any other medicine. It's just a drug. It's just a medicine. Therefore it needs a half-life it needs a metabolic profile. Show me how much you take what it does in your bloodstream. It's just another medicine. On that basis I'm happy to support it through. As it initially looked in the legislation it's all around quality standards it's all around a quality product. Well show me a quality medicine and absolutely you have our support.Compassionate cannabis the third part to this—I understand the principle to it a lot of work needs to go into this. It's way too vague at the moment. There are things we're hearing today that are new to us that we'll need to think on. That's going to need a lot of work to have my support to this and for our support but we're certainly ready to have the dialogue in this whole discussion. We're not afraid of the dialogue and the discussion around medicinal cannabis but it needs a lot of work. Thank you."