Reti ShaneWEDNESDAY 5 DECEMBER 2018(continued on Thursday 6 December 2018)MISUSE OF DRUGS (MEDICINAL CANNABIS) AMENDMENT BILLIn CommitteeNew clause 5A Section 8 amended (Exemptions from sections 6 and 7) (continued)Dr SHANE RETI (National—Whangarei): Thank you Mr Chair. It's a pleasure to speak to clause 5A of the bill this morning a clause that talks about certification primarily from a medical practitioner or a nurse practitioner around the definition of palliation" which we've discussed previously which clearly has some issues as well.Now it might seem easy to write into a bill "You will have a medical practitioner or a nurse practitioner certify." The workflow to that is complex and it's really important we understand the workflow in as much as if we look at the Australian scheme for example that's one of the reasons why the Australians have failed. They didn't do well on the workflow. Amongst other things they require two certifying medical practitioners and that's been a substantial hindrance to them. So understanding the workflow to certification is really important and we need a lot of detail around how that might happen. But again I think this clause is a really good example of what the media have framed as legislative laziness around this bill and the vacuum—the void—that sits in the lack of detail.So we're saying that medical practitioners and nurse practitioners will certify whether a person has palliation. How does that actually work? Well probably a good starting point would be to go and ask GPs and nurse practitioners and say "How might we do this?" So in written question No. 29033 (2018) a few weeks ago I posed this to the Minister: "What communications if any has the Minister or his Ministry had with the Royal New Zealand College of General Practitioners … around certification requirements for the terminal exception and statutory defence under the Misuse of Drugs (Medicinal Cannabis) Amendment Bill …?" His reply was "I am advised that no communications on this subject have occurred between myself and the Royal New Zealand College of General Practitioners or the Ministry … and the Royal New Zealand College of General Practitioners." How hard could that have been to go to those people who were actually doing the certification and say "Here's what I've got in my head. How might we do that? What hurdles could befall us?"You know the same is going to be for the Minister of Police because we have this issue around how we're going to monitor how we're going to exercise discretion or due judgment or whatever we are going to do for people who are pulled over by police and demonstrate that they believe they have a defence under the terminal exception and statutory defence. We had police tell us this was going to be challenging for them. So again you'd think "Well why don't we ask police what works for them? What certification might fit into the scheme?"So written question No. 29032 a few weeks ago to the Minister of Police the Hon Stuart Nash asked: "What communications if any has the Minister or his Ministry had with the Royal New Zealand College of General Practitioners … around certification requirements for the terminal exception and statutory defence under the Misuse of Drugs (Medicinal Cannabis) Amendment Bill …?" Here's the reply from the Minister of Police: "Neither I nor Police have had any communications with the Royal New Zealand College of General Practitioners … around certification requirements for the terminal exception and statutory defence". You'd think you'd have that discussion. The workflow is hard. Get the workflow right. Things would be a lot easier just to reach out to the two main certifying bodies. "How is this going to work?" would be very useful.Now what we know because we've done a lot of detail on the scheme—we can describe how it might actually work and then what I want to come to in a moment is talk about how we could navigate all of this with a medicinal cannabis card. So what I want to talk to first of all is we know because we've done a lot of work on it that we can make this easy for GPs particularly to certify. How you'd do that is this: there's a mechanism on every GP's desktop where if you want to do what's called a special authority you enter the patient's name all their details are lifted out of the file you enter whatever you're requiring and it automatically goes to the ministry. It's called a special authority. This would work well for a medicinal cannabis scheme. This would work well for certification. It would achieve a lot of our goals and it just demonstrates the workflow. When you think about it GPs could do this. I've spoken with them; their hurdle is like the Australians had: if it's too cumbersome in its compliance they just won't do it. So we've thought through the workflow that would make certification happy.What we've also thought through and I want to come to the topic now is a medicinal cannabis card because it gets past the issues we're talking about around certification around what sort of certificate you're actually going to produce. We produced a Supplementary Order Paper. That isn't sitting on the Table as it was indicated to us that there may be other mechanisms to discuss this. Our thinking is to have a medicinal cannabis card which a large number of jurisdictions have—a large number of jurisdictions have. What happens here and it partly draws on some of the work that member Swarbrick brought to the Table several months ago—certainly earlier this year—around the issue of the complexity of GPs deciding what's in or out. In our hands what we decided was a GP on the advice of a specialist panel would decide eligibility. A GP is actually just saying a person is eligible or not; they don't actually have to say "Yes I'm going to give you medicinal cannabis. Here's the dose—whatever whatever." and that was part of what member Swarbrick brought in her bill to sort of help GPs get over some of the hurdles they have around medicinal cannabis. Certainly all the feedback we've had is that that would work.I just want to go over that again. Eligibility criteria for the scheme decided by experts—we've already had this discussion with the Minister previously. We shouldn't be here in the Chamber defining what the criteria are and all we ask is of the certifying GP or nurse practitioner as this clause is requesting is they're just saying that yes this person is eligible not actually prescribing the dose form or anything else. We think this would substantively help the certification process. What we also discuss around a medicinal cannabis card is that the details then go to the ministry who issue a card. That card can then be presented to a dispensing pharmacy. It can then be presented to police if you should be pulled over. Furthermore we also talk about a carer card recognising those people who may be too frail to travel.Now there is a huge appetite for a medicinal cannabis card in the population in as much as an omnibus survey that's been conducted by Horizon Research soon to be published asked exactly this question. What the preliminary results show is that the card is well supported by New Zealanders: well over 50 percent are in support and agreement of a medicinal cannabis card that would resolve the certification issues that we're talking about here in clause 5A—a medicinal cannabis card instead of some nebulous sort of paper that the Minister is suggesting that we don't know and that he's had no discussion on with any of the actual certifying bodies. If you ask who might be opposed to that well the survey also showed that only 17.9 percent said "No a medicinal cannabis card wouldn't work for us."So we have a solution. So what we're saying is the certification as it stands in the Minister's hands as it's written in clause 5A has a lot of flaws and the workflow in particular may be enough to bring the whole scheme down both the terminal exception and the medicinal cannabis scheme—again I'd use the example of poor workflow in the Australian scheme. We created a solution. Our solution was a medicinal cannabis card. The access to that was through the special authority software mechanism that GPs have and we have run this past the sector and have some agreement and feedback with them. What I'm also presenting is evidence that the New Zealand public is in support of a medicinal cannabis card.So the challenge I'd put to the Minister is: why have there been no discussions with the main certifiers? Clause 5A talks about certification. Why have there been no discussions? Is he concerned that the workflow may be so much of a hurdle that the scheme falls over? Will he consider other certification mechanisms such as special authority through GP software and a medicinal cannabis card? I think if we could have some answer to that that would be most enlightening. Again it stands to our underlying platform that there's just not enough detail in this bill. Thank you."