75 Michael Ferguson, ‘Interim Report on Medicinal Cannabis’ (Media Release, 20 November 2014) < interim_report_on_medicinal_cannabis>. 76 Ibid. 77 Legislative Council Government Administration Committee ‘A’, Parliament of Tasmania, Final Report on Legalised Medicinal Cannabis (2015). 16 78 Ibid 1.
123 See Gary W Mathern, Laurie Beninig and Astrid Nehlig, ‘Fewer Specialists Support Using Medical Marijuana and CBS in Treating Epilepsy Patients Compared with Other Medical professionals and Patients: Results of Epilepsia’s Survey’ (2014) 56 Epilepsia 1. 124 Cochrane Reviews are systematic reviews of primary research in human health care and health policy, and are internationally recognised as the highest standard in evidence-based health care. They investigate the effects of interventions for prevention, treatment and rehabilitation. They also assess the accuracy of a diagnostic test for a given condition in a specific patient group and setting. They are published online in the Cochrane Library, and supported by the National Health and Medical Research Council of Australia. 125 Gloss, David and Barbara Vickrey, ‘Cannabinoids for Epilepsy: Review’ (2014) 3 Cochrane Database of Systematic Reviews <>. 35
183 Keith Green, ‘Marijuana Smoking vs Cannabinoids for Glaucoma Therapy’ (1998) 116 Archives of Opthalmology 1433. 184 A J Flach, ‘Delta-9-tetrahydrocannabinol (THC) in the Treatment of End-stage Open-angle Glaucoma’ (2002) 100 Transactions of the American Opthalmological Society 215. 185 See, eg, Keith Green, ‘Marijuana Smoking vs Cannabinoids for Glaucoma Therapy’ (1998) 116 Archives of Opthalmology 1433. 186 Keith Green, ‘Marijuana Smoking vs Cannabinoids for Glaucoma Therapy’ (1998) 116 Archives of Opthalmology 1433. The author refers to treatments such as once- or twice-a-day eye drops (blockers such as timolol maleate, or the prostaglandin agonist latanoprost). 187 Ibid. 188 I Tomida, R G Pertwee and A Azuara-Blanco, ‘Cannabinoids and Glaucoma’ (2004) 88 British Journal of Opthalmology 708, 711. 189 American Glaucoma Society, Position Statement on Marijuana and the Treatment of Glaucoma (10 August 2009) <americanglaucomasociety.net>. 43
48 Advisory committee (Meetings 1 and 3). 49 Australian and New Zealand College of Anaesthetists Faculty of Pain Medicine, ‘Statement on Patients’ Rights to Pain Management and Associated Responsibilities’ (Position Statement No 45, 2010) <>. 61
76 Faculty of Pain Medicine, Australian and New Zealand College of Anaesthetists, ‘Statement on “Medicinal Cannabis” with Particular Reference to its Use in the Management of Patients with Chronic Non-Cancer Pain’ (2015). 66 77 Ibid.
65 Pekka Hakkarainen et al, ‘Growing medicine: Small-scale cannabis cultivation for medical purposes in six different countries’ (2015) 26 66 Submission 59; Consultations 1, 9. 67 Advisory committee (Meeting 3). 68 Victorian Law Reform Commission, Medicinal Cannabis: Issues Paper (2015) [3.75] – [3.79]; Wayne Hall, ‘What Has Research Over The Past 69 Yu-Wei Luke Chu, ‘The Effects of Medical Marijuana Laws on Illegal Marijuana Use’ (2014) 38 Journal of Health Economics 43, 45. 70 Delsys, Final Report: Cost-Benefit Analysis of Regulatory Changes for Access to Marihuana for Medical Purposes (2012) 74–75. 71 Jeff Mapes, ‘Medical marijuana growers may see new limits as Oregon legislators move to curb black market’, The Oregonian (online), 20 March 2015 <>. 72 Submission 74. 73 Gerald Caplan, ‘Medical Marijuana: A Study of Unintended Consequences’ (2012) 43 McGeorge Law Review 127, 143– 4. r r E
161 John Ramsay & Associates, Review of the Tasmanian Poppy Industry Regulation: Report (July 2013) 26. 162 Philippe Lucas, ‘It Can’t Hurt to Ask; A Patient-Centred Quality of Service Assessment of Health Canada’s Medical Cannabis Policy and Program’, (2012) 9 Harm Reduction Journal 2. See also Amanda Reiman, ‘Cannabis Distribution: Coffee Shops to Dispensaries’, Handbook of Cannabis (Oxford University Press, 2014) 349. 163 Submission 63. Similar concerns were expressed at Consultation 8. 145
6.28 The way in which specific risks would be addressed under the proposed scheme is set out in the following table: Table 2: Risks associated with cultivation of medicinal cannabis and the regulatory responses proposed to control these risks Risk Regulatory response Diversion occurs because of criminal intervention by third parties (potentially causing risks to public safety) Risk management plan addresses facility security measures, location, secrecy, surveillance Diversion occurs because of criminal conduct by employees or contractors Risk management plan addresses assessment, training and supervision of employees and contractors Criminal record checks required for employees Licence conditions require destruction of unused cannabis Diversion occurs because of criminal conduct by managers/owners Fit and proper person test before licence is granted Chief Commissioner of Police has veto power Licence conditions require: • that all cannabis cultivated is delivered to a licensed manufacturer or destroyed • that all unused cannabis is destroyed Diversion occurs during transport Risk management plan addresses how transportation will be securely undertaken Cannabis grown is of poor quality Addressed through quality control regime 6.29 Controlling diversion to the illicit market is also a requirement of international law. The Single Convention on Narcotic Drugs requires states to ‘adopt such measures as may be necessary to prevent the misuse of, and illicit traffic in, the leaves of the cannabis plant’.30 6.30 As observed in consultations, the scheme must be designed to control the risk that cannabis will be diverted to the illicit market at ‘weak points’ in the supply chain.31 This requires careful assessment, properly resourced. It would be inappropriate merely to duplicate the policies associated with the alkaloid poppy scheme, because the risks associated with cultivating poppies are different from those associated with the cultivation of cannabis. For example: • Cannabis with significant THC content can readily be used illicitly, while alkaloid poppies require sophisticated processing, making cannabis a more attractive target for theft.32 • The waste products of medicinal cannabis production (the leaves) have value on the illicit market, if they have significant THC content, while poppy straw remnants do not. • Medicinal cannabis tends to be grown indoors, while alkaloid poppies are grown in the field, meaning the risk of theft of cannabis by third parties is lower. 154
112 Advisory committee (Meeting 2); Consultations 23 and 24. This risk exists even for non-smokable forms (discussed below at [7.79] – [7.83]: Consultation 23. 113 The gap between a prescribed dose of the drug and a lethal dose. 115 Subject to price controls imposed by the Victorian Government, discussed at [6.84]. 116 This may not be necessary given the much lower risk of overdose for cannabis medications. 117 Set out in the Drugs, Poisons and Controlled Substances Regulations 2006 (Vic) 35. That regulation requires, in essence, that such drugs be held in a lockable storage facility meeting minimum requirements, that the pharmacy take reasonable steps to ensure that it is locked at all times except when used, and that it is only used to store Schedule 8 and Schedule 9 poisons. More stringent security may be needed at the outset of the scheme because of the novelty of medicinal cannabis. 118 It appears that the sale, use and possession of such devices, which heat a liquid form of cannabis to a temperature at which the cannabinoids form a vapour which can be inhaled, is not currently prohibited in Victoria. The sale and display for sale of cannabis water pipes, hookahs and bong kits is prohibited by ss 80U–80X of the Drugs, Poisons and Controlled Substances Act 1981 (Vic), but the definition of ‘cannabis water pipe’, while it includes devices which allow the drawing of fumes from cannabis by heating, requires that this be done ‘through water or another liquid in the device’. This does not occur with a vaporiser. Nonetheless, it may be prudent to explicitly authorise their sale and display by pharmacists to ensure patients can continue to access them if restrictions are later introduced.
3 Cancer Council Australia and Clinical Oncology Society of Australia, Position Statement—Medical Use of Cannabis (21 May 2015) <>, 2. 4 Ethan Russo, ‘The Solution to the Medicinal Cannabis Problem’ in Michael Schatman, Ethical Issues in Chronic Pain Management (Informa, 2007) 165. Submission 30. See Appendix B for list of submissions. 6 ‘The flip side of those who passionately shout for the “legalisation of cannabis” is that their call may inadvertently hamper the medical development of cannabinoids, which is a shame’: Wai Liu, ‘Why Anti-Cancer Properties in Cannabis Must be Investigated’, The Conversation (online), 26 June 2015 <> 7 Consultation 32. See Appendix C for list of consultations. 199
Purpose Explanation Amend ‘poison or controlled substance’ to include medicinal cannabis Various rules in the Act apply to ‘poisons and controlled substances’ as a class, the definition applying to all scheduled medicines. It is desirable for the bulk of these rules to also apply to medicinal cannabis. Where rules should not apply to medicinal cannabis, a specific exemption has been suggested, as occurs with other scheduled medicines. Exempt medicinal cannabis from the poisons schedules The Commission regards it as appropriate to treat medicinal cannabis as a wholly separate ‘schedule’ of medicine. This allows rules applying to different schedules of medicine to be applied to medicinal cannabis as is desired, and also permits new rules specific to medicinal cannabis to be created. This could be achieved by introducing medicinal cannabis into Part 3 of the Poisons List, in reliance on s 12A(1)(b) of the Act. Exempt medicinal cannabis from the offences the Act imposes for breaching the Commonwealth Standard for the Uniform Scheduling of Medicines and Poisons’ rules with respect to the labelling, containing, storing and packaging, and advertising of poisons and controlled substances Medicinal cannabis medicines should not be subject to the SUSMP’s rules about labelling, containing, storing, packaging, and advertising. New rules will be created under the Victorian scheme. This would require an additional provision to be introduced into s 27A of the Act. Add medicinal cannabis to the rules about registered nurses administering certain medicines to residents in aged care services who are in high-level residential care Registered nurses are currently permitted to manage the administration of drugs of dependence, Schedule 4, 8 and 9 poisons that have been prescribed to residents of aged care services who are in high-level residential care. A new section may be required to ensure registered nurses can administer medicinal cannabis. Section 36E refers to ‘prescription’ and s 36F refers to national guidelines of the Nursing and Midwifery Board. These may not be features of a Victorian medicinal cannabis scheme. Exempt the medicinal cannabis scheme from the requirement that the Secretary of the Department of Health maintain a public list of persons holding licenses, permits or warrants. Like the poppy scheme and the low-THC hemp scheme, it is not desirable to require the Secretary to make public the details of licence- holders under a Victorian medicinal cannabis scheme. Section 118 of the Act is used to exempt the poppy scheme and can be used to similarly exempt medicinal cannabis 222
Table 10: New offences under a Victorian medicinal cannabis scheme to be provided in the Drugs, Poisons and Controlled Substances Act 1981 (Vic) and Drugs, Poisons and Controlled Substances Regulations 2006 (Vic) Conduct to be prohibited Section capturing conduct Explanation An authorised patient supplies medicinal cannabis to an unauthorised person Section 71AC No new offence required An authorised patient would only be authorised to possess and use medicinal cannabis; if they supplied it to another person they would be trafficking without being authorised. A carer supplies medicinal cannabis to an unauthorised person Section 71AC No new offence required A nominated carer would only be authorised to possess medicinal cannabis and to administer it to their registered patient; if they supplied to another person they would be trafficking without being authorised. A patient misleads or deceives medical practitioner in order to obtain an Authority to Dispense to obtain medicinal cannabis Section 78 Amendment required Additions may be required to reflect the ‘Authority to Dispense’ procedure proposed for medicinal cannabis – presently references are only to prescriptions and orders. A doctor seeks a permit in relation to a patient who is not eligible for medicinal cannabis Closest offence is r 8 New offence is required An amendment or new provision would be required because regulation 8 refers to a ‘prescription’. Medicinal practitioners who issued an Authority to Dispense medicinal cannabis would not be required to ‘prescribe’. Authorising a person who is ineligible should still be penalised. A pharmacist supplies cannabis products which were not made under government licence Sections 71 to 71AC No new offence required Pharmacists would only be authorised to possess and supply ‘medicinal cannabis products’ made under licence and supplied by the Secretary of the Department of Health and Human Services. Supply of other products would contravene the prohibition on trafficking. A person other than a pharmacist supplies cannabis products (whether or not made under government licence) Sections 27, 71 to 71AC No new offence required Only pharmacists would be authorised to supply medicinal cannabis products. Anyone else who does so would engage in: • the sale of a poison or controlled substance when not authorised or licensed to do so, and • trafficking. 229
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