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Medicinal Cannabis: Issues Paper Medicinal Cannabis ISSUES PAPER MARCH 2015 A COMMUNITY LAW REFORM PROJECT Published by the Victorian Law Reform Commission CHAIR The Hon. Philip Cummins AM The Victorian Law Reform Commission was established under the Victorian Law Reform Commission Act 2000 SPECIALIST COMMISSIONER as a central agency for developing law reform in Victoria. Dr Ian Freckelton QC © Victorian Law Reform Commission 2015. COMMISSIONERS Liana Buchanan This work is protected by the laws of copyright. Except for Helen Fatouros any uses permitted under the Copyright Act 1968 (Cth) or Bruce Gardner PSM equivalent overseas legislation, no part of this work may be Dr Ian Hardingham QC reproduced, in any matter or in any medium, without the His Honour David Jones AM written permission of the publisher. All rights reserved. Eamonn Moran PSM QC This publication of the Victorian Law Reform Commission Alison O’Brien follows the Melbourne University Law Review Association Inc, The Hon. Frank Vincent AO QC Australian Guide to Legal Citation (3rd ed., 2010). CHIEF EXECUTIVE OFFICER This report reflects the law as at 5 March 2015. Merrin Mason National Library of Australia REFERENCE TEAM Cataloguing-in-Publication data Lindy Smith (team leader) Michael Adams Medicinal Cannabis: Sharyn Broomhead Issues Paper/Victorian Law Reform Commission Aviva Kalman (intern) ISBN 978-0-9925955-3-1 COVER DESIGN Notes: Includes bibliographical references. Letterbox Subjects: Marijuana—Health aspects. Marijuana—Law and legislation—Victoria. Cannabis—Health aspects. Cannabis—Law and legislation—Victoria. Other Creators/Contributors: Victorian Law Reform Commission, author. Dewey Number: 364.177 Medicinal Cannabis ISSUES PAPER MARCH 2015 Victorian Law Reform Commission Medicinal Cannabis: Issues Paper Contents Preface ......................................................................................... vii Call for submissions ..................................................................... viii Terms of reference ......................................................................... xi Glossary ........................................................................................ xii 1 Introduction ................................................................................. 2 Referral to the Commission ................................................................................................ 2 Conduct of this reference .................................................................................................. 2 Specialist Commissioner ................................................................................................ 2 Division ......................................................................................................................... 2 Advisory committees ..................................................................................................... 3 Issues paper and submissions ........................................................................................ 3 Summary of this paper ....................................................................................................... 3 2 Cannabis and cannabinoids ......................................................... 6 Introduction ....................................................................................................................... 6 What is cannabis? .............................................................................................................. 7 The cannabis plant ........................................................................................................ 7 Cannabis terminology ................................................................................................... 8 Cannabis pharmacology ................................................................................................ 8 Preparation of the cannabis plant for use ......................................................................... 12 Dried plant material (leaves and flowers) ..................................................................... 12 Infused products ......................................................................................................... 14 Newer concentrated forms .......................................................................................... 15 Pharmaceutical forms of cannabis ............................................................................... 16 Synthetic cannabinoids .................................................................................................... 19 Medicinal use .............................................................................................................. 19 Recreational use .......................................................................................................... 21 Identifying therapeutically appropriate forms ................................................................... 23 ii Victorian Law Reform Commission Medicinal Cannabis: Issues Paper 3 The use of cannabis for medicinal purposes ..................................................... 26 Introduction ................................................................................................................ 26 Reviews of the clinical literature .................................................................................. 27 Current significant medicinal applications of cannabis ................................................. 29 Pain relief .................................................................................................................... 31 Potential to reduce opioid deaths ................................................................................ 34 Nausea and vomiting suppression and appetite enhancement .................................... 35 Anti-spasticity properties ............................................................................................. 36 Anti-convulsant properties .......................................................................................... 37 Capacity to inhibit or alleviate degenerative neurological conditions ........................... 39 Capacity to inhibit intra-ocular pressure ...................................................................... 40 Anti-psychotic properties ............................................................................................. 41 Potential side effects of medicinal cannabis ................................................................. 42 Psychiatric issues ......................................................................................................... 42 Dependence and withdrawal ...................................................................................... 44 Safety issues and mood changes ................................................................................. 46 Respiratory issues ........................................................................................................ 46 Pregnancy issues ......................................................................................................... 47 Cardiac issues .............................................................................................................. 47 Medical responses to side effect issues ........................................................................ 47 Defining ‘exceptional circumstances’ ........................................................................... 48 Allowing compassionately for exceptional circumstances of need ............................... 48 Drawing the distinctions in law ................................................................................... 51 4 How cannabis is regulated ................................................................................. 56 Introduction ................................................................................................................ 56 Victorian laws .............................................................................................................. 57 Drugs, Poisons and Controlled Substances Act ............................................................ 57 The Therapeutic Goods (Victoria) Act .......................................................................... 59 Other relevant legislation ............................................................................................ 61 Relevant Commonwealth laws .................................................................................... 61 The Therapeutic Goods Act ......................................................................................... 62 Goods on the Australian Register of Therapeutic Goods ............................................. 63 International Conventions ........................................................................................... 65 The Single Convention on Narcotic Drugs ................................................................... 65 The Convention on Psychotropic Substances ............................................................... 66 The Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances ... 67 Scope for regulating medicinal cannabis ..................................................................... 67 Importation ................................................................................................................. 67 iii Victorian Law Reform Commission Medicinal Cannabis: Issues Paper Cultivation .................................................................................................................
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