Medical marijuana – who’ll speak up for ‘Mario’s Bill’ now his voice is silent?

When Inkatha Freedom Party MP Dr Mario Oriani-Ambrosini killed himself on August 16, 2014, he was terminally ill with lung cancer, and the medical marijuana lobby in South Africa lost one of its most vocal supporters. Oriani-Ambrosini admitted using the drug, and the Medical Innovation Bill he tabled in Parliament in February has come to be called ‘Mario’s Bill’. Whether another politician will be brave enough to take on his voice remains to be seen. MS

By Marika Sboros

medical marijuana
Medical marijuana remains controversial in SA and other countries

In February 2014, Oriani-Ambrosini tabled his Medical Innovation Bill that seeks to decriminalise medical use of marijuana,  and  make alternative  cancer  treatments available to patients with cancer and other life-threatening diseases.

That Bill was very much an individual member’s Bill,  says Johannesburg attorney Neil Kirby, and much of its future depends on the ability of a particular person to champion it in Parliament.

“I fear that following Dr Oriani-Ambrosini’s passing, that champion no longer exists, and the Bill may flail,” says Kirby, director and head of  Healthcare and Life Sciences at Werksmans Attorneys.

In support of the Bill during the second state-of-the-nation debate, Oriani-Ambrosini ruffled medical feathers saying not to do so was “irrational”, and “a crime against humanity” – given the global pandemic of  cancer, and unnecessary pain, suffering and death facing millions of patients who were denied alternative options.

Oriani-Ambrosini, a doctor of law, also said the Bill on medical marijuana was based on solid scientific evidence, and was “a fight I didn’t look for. It looked for me”.

He joined lobby groups across the world, fighting for the same rights for patients facing not just cancer, but many other serious, chronic, and disabling diseases, among them Parksinon’s, epilepsy, anorexia, cachexia (wasting syndrome), and HIV/Aids .

Illegal substance

In South Africa, marijuana (also called dagga, grass and pot), is still on the statute books as an illegal substance. The issue of medical marijuana remains mired as much in political expediency in this country  and other countries, as in genuine concerns about safety and efficacy, and a gateway to recreational drug use.

After Oriani-Ambrosini’s impassioned plea to Parliament, the conservative Cancer Association of South Africa (Cansa) came up with a statement declaring that “there are sufficient
 medicines available in South Africa for the effective 
treatment of nausea, vomiting and other conditions related
to cancer including end-of-life care”.

The Association included a punt for Big Pharma in its position statement, saying morphine was “one of the drugs of choice for the control of severe pain” that is available at a reasonable cost”.

Oriani-Ambrosini was one of many who vigorously disagreed with Cansa’s stance, describing it at best as “outdated” and “thoroughly discredited”.

In his address to Parliament, Oriani-Ambrosini said he started using medical marijuana  for pain control rectally (that  had no effect on his brain), and  because research suggested it has curative benefits. He went public, he said, because “hundreds of people (in SA) are doing the same thing underground”.

He quoted an oncologist who said he had been quietly telling his patients “to do the same thing for years”.

So what are other countries up to? Lots, it seems. Here are two examples:

‘Valid treatment’

In the US, currently, 23 states and DC have legalised the use of marijuana as a medical treatment, according to a report in Medical News Today. Maryland, Minnesota and New York are the most recent to join in 2014, and legislation to legalise medical marijuana in Florida, Ohio and Pennsylvania is pending, the report says.

The report says the fight by pro medical marijuana groups, patients and doctors to have the drug recognised as a valid treatment for specific medical conditions is not a recent phenomenon: in 1972, the US National Organisation for the Reform of Marijuana Laws filed the first petition to have marijuana rescheduled from a Schedule 1 to Schedule 2 drug, so that it could be legally prescribed by physicians in 1972.

That petition followed then US President Richard Nixon’s declaration of a “war on drugs,” in which he rejected the recommendations of a White House commission that had voted to legalise marijuana, Medical News Today reports.

Canada has introduced a  medical marijuana approval regime with oversight tightened over approval of marijuana for medical reasons — and how much can be prescribed. According to the country’s health ministry, the average amount authorised by a doctor has fallen from 17 grams a day to 4 grams – a substantial decrease in the amount of marijuana being prescribed and in line with “the available medical evidence of what a patient would use per day”.

Challenging enactments

At the time Oriani-Ambrosini tabled the Bill in Parliament, Kirby said  novel statutory enactments such as the Medical Innovation Bill were “challenging enactments to pass into law”.  The Bill’s position on a controversial topic such a legalising marijuana meant that the process was likely to be “even more challenging, mired in debate both in the public marketplace and Parliament, and possibly even derailed”.

The Bill’s wording and intentions “may change dramatically between its current version and what South Africans ultimately receive as the final Act”, Kirby said.

Since Oriani-Ambrosini’s death, Kirby says the  introduction of the concepts contained in the Bill is controversial in South African law. This is especially the case with  the use of novel or untested treatments, including the use of cannabis and avoiding medical negligence for doctors who use novel and untested treatments, because the Bill proposed a significant departure from how healthcare services are conventionally regulated.

New champion

“Hopefully, the Bill will find a new champion in order for its course through Parliamentary channels may continue.”

That isn’t looking very likely even as Kirby points out that the Ebola epidemic sweeping across West Africa has “shifted the light onto the role to be played by untested drugs and medicines in providing expedited healthcare where it is suddenly needed”.

The Bill as Oriani-Ambrosini proposed it is “certainly designed to achieve the results that we are seeing in the debate about the untested Ebola medication, and places the emphasis on how we view and appreciate what is or is not safe and efficacious as a medicine or medical treatment”, Kirby says.

There may indeed be a place in healthcare law for a Bill that allows for medical treatments that “bypass the conventions in the interests of saving life and creating access to healthcare, which is enshrined in our Bill of Rights”, he says.

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