LETTER OF RESIGNATION, Dr Graham Gulbransen

1 November 2020

LETTER OF RESIGNATION, Dr Graham Gulbransen

I have signalled my discontent with the NZMA in the media and am following through with this letter of resignation, regardless of the Referendum outcome.

REPRESENTATION
I do not feel represented by the NZMA in my clinical practice of cannabis medicine and on the importance of legalising cannabis, as discussed with Dr Baddock on several occasions at GPCME’s. Ironically the covering letter for the current membership invoice (5/10/20) includes ‘We enjoy working with you… [to] champion change that is needed.’ I am disappointed NZMA is not showing leadership with evidence-based policy and is not championing change that is needed.

40 YEARS
I joined the NZMA in 1981 as a house surgeon when my consultant, surgeon Dr Dean Williams spoke of the benefits of membership. He became NZMA chairman 1983-84. It is with regret that I now leave. I will miss the NZMJ and Vital Signs.

IMPORTANT POINTS NOT RAISED BY NZMA
HALF OF ILLEGAL CANNABIS USE IS FOR MEDICINAL (HEALING) PURPOSES, often for conditions not responsive to standard medical treatments. This will continue and must be made safer. ‘Recreational’ is just half the issue.

‘The Cannabis Referendum is a once in a generation opportunity to place evidence-informed controls around a substance that is widely used and unregulated. A yes vote is not a vote in support of cannabis – it is a vote in support of placing public health controls around a substance that is currently left to the black market to manage.’ [Their italics.] Professor Michael Baker and others, NZMJ 9 October 2020.

CANNABIS LEGALISATION AND CONTROL BILL
I feel the NZMA mislead members and voters by indicating their 2012 policy, reiterated in 2019 was evidence-based. Until a week before the election the NZMA position appeared to be that cannabis is a harmful drug that should not be legalised. This is contrary to harm minimisation approaches supported by Addiction Medicine.

Better would have been to recommend a neutral information source such as the Chief Science Advisor’s report.

Focussing on the harms ignores the 80 to 90% of cannabis who are safe users for medicine or pleasure. Remember that cannabis is safer than alcohol (Doug Sellman, NZMJ 21/8/20). Forensic harms are the greatest risk for these safe users, and pointless when 95% of those prosecuted continue to use cannabis.

On 9 October the NZMA letter to members presented a face-saving and expedient change of direction. Here Dr Baddock mislead members by commenting the referendum is for ‘… the legalisation of recreational cannabis.’ The referendum question asked, ‘Do you support the proposed Cannabis Legalisation and Control Bill?’ The Bill does not use the word recreational, a word that carries a cannabis-related stigma. Personal use includes medicinal as well as recreational use. The NZMA is an influential body that undoubtably affected voter behaviour.

PERSONAL USE INCLUDES MEDICINAL USE
The Ministry of Health Cannabis Use 2012/13 NZ Health Survey online (http://www.health.govt.nz/publication/cannabis-use-2012-13-new-zealand-health-survey ) and also published in NZMJ in 2015 found that 11% of those aged 15 and over reported using cannabis in the past year. ‘Forty-two percent of cannabis users reported medicinal use (ie, to treat pain or another medical condition) in the last 12 months.’

Thirty per cent of my last 200 prescription cannabis patients reported recent use of illegal cannabis for medicinal purposes eg chronic pain.

This point has been missed by the NZMA over and over. Approximately 150,000 NZ adults have used cannabis in the past year for medicinal purposes. Many experience benefit. Most cannot afford prescription cannabis. Use of home grown or street cannabis will continue regardless of legal status. Government regulated stores would allow purchase of standardised cannabis, much safer than black market purchases.

DECRIMINALISATION
Decriminalisation is an unsatisfactory compromise that would leave supply in the hands of the black market. Better to legalise stores where products are labelled for constituents and if there are contaminants. As with other consumer products such as alcohol and tobacco, government-regulated stores are the safest option.

INSTITUTIONAL RACISM
Cannabis prohibition came to prominence with the USA Marihuana Tax Act 1937, criticised by the American Medical Association at that time. It empowered authorities to prosecute minority groups for possession of cannabis. Most affected were Mexican immigrants and Afro-Americans. Cannabis was lumped in with narcotics at the League of Nations and prohibition spread virally around the world. Prohibition was never a health strategy. As a political tool against minorities cannabis prosecutions harm mental health, education, work and travel prospects of Maori significantly out of proportion to their population. Legalisation and reducing the stigma around cannabis would improve social equity consistent with the Treaty of Waitangi.

BEST EVIDENCE
Ironically some of the best evidence appears in recent NZMJs. I recommend NZMA consult with the authors of this paper when reviewing policy, The Cannabis Referendum: why a yes vote offers a net gain for public health, Sam McBride, Papaarangi Reid, Louise Signal, Michael Baker, NZMJ 9/10/20, https://www.nzma.org.nz/journal-articles/the-cannabis-referendum-why-a-yes-vote-offers-a-net-gain-for-public-health . Also, Alcohol is more harmful than cannabis, Doug Sellman, NZMJ 21/8/20, https://www.nzma.org.nz/journal-articles/alcohol-is-more-harmful-than-cannabis . As an Addiction Specialist I read and recommend Drug and Alcohol Review including this paper by NZ authors, A call for greater policy and regulatory coherence for an expanding menu of legal psychoactive substances, Benedikt Fischer, Chris Bullen, Wayne Hall, September 2020, https://onlinelibrary.wiley.com/doi/abs/10.1111/dar.13071 . This paper notes, ‘… the quantified disease burden for cannabis is substantially lower than that for alcohol and tobacco… there are thus substantial inconsistencies between the regulation of use and availability of the three major substance groups that are not easy to reconcile with scientific evidence or public health objectives.’

FUTURE NZMA POLICY ON CANNABIS
In 2019 Dr Baddock advised me in person to continue my membership otherwise I would not have opportunity to influence NZMA policy. You now have my views above. I recommend NZMA consult an expert committee to update policy including authors of recent pertinent papers in the NZMJ. Then check with members.

CONCLUSION
Thank you for following this to the end. I am confident that in future NZ will legalise cannabis with public health and social justice outcomes in mind. I am not confident the NZMA will ‘champion the change that is needed’.
Throughout my career I have stood for social justice and seen positive changes in areas such as anti-apartheid, Takaparawha-Bastion Point, East Timor Independence, gay rights, the antinuclear movement, the environment and climate change, support for home birth choice and funded opioid substitution treatment.
I leave the tired old NZMA to continue my work with the real leaders of change for social justice and the health of people and the planet.

NGA MIHI NUI