Half of cancer patients using cannabis, say doctors
It's a highly charged issue, and when it comes to medicinal cannabis, New Zealand - like many countries - is grappling with what to do about it.
Users have reported dramatic health benefits, and now some oncologists have told The Nation between 40 and 60 percent of their patients use it.
And support for its decriminalisation is coming from some unlikely quarters - such as Grey Power.
So rare and deadly is Dawn's* type of cancer, she wasn't given the option of chemotherapy.
"It's a horrible, aching, umm piercing, stabbing pain," she told The Nation. "Mostly I've got it on my left side, my tumours on my left side and they're rubbing up against my plura."
After beating breast cancer, she was diagnosed with terminal lung cancer. She has 12 growing tumours - the pain is unrelenting and relief is hard to find.
"I'm probably in a unique position because I've tried everything."
She had been on high doses of morphine and oxycodone to control her pain.
"I would get lots of hot and cold sweats… I get withdrawals," Dawn said.
"It was okay for a while because I thought, 'oh yes, I haven't got the pain'. But the tumours were growing, so the more the pain came back, the more I'd have to take. So I was trying to stay at a level so I didn't feel like I was too over the top, because I've been told I can take twice, three times as much - the amount that I take at the moment, I can only just function."
There were other side-effects too. She says she became anti-social, and she lost a kilogram a week for 30 weeks.
"Once you haven't got the pain, you forget about it. But when you've got the pain, it's in your body, it's in your brain, it's just excruciating and ridiculous. And you think, all I want to do is get rid of it."
If her life was ruled by the four-letter word of pain - then it's been another four letter word that's brought her some relief: dope.
"I vape the medicinal cannabis and I don't find that onerous at this stage, and my family and friends think it is absolutely hilarious that I should be vaping. Am I allowed to say that?
Dawn is clear - she's not a fan of cannabis for recreation. She never tried it, and doesn't believe it should be legalised.
Using it now in its medicinal form is a last resort.
"There's nothing left for me. There's no other treatment. It's about managing my pain."
"If mum didn't take medicinal cannabis, I truly believe that she wouldn't be here," said her daughter Toni, a medical student.
"The changes that I've seen in mum have, I would describe them as miraculous - but they're just too good to be true that the medical system doesn't believe it's possible. But I've seen it with my own eyes, and it is."
She's crowdfunded money to make a documentary based on evidence based benefits of medicinal cannabis.
"Since I went public with the crowdfunding for this resource documentary about cannabis as a medicine, I've had huge feedback from medical practitioners, GPs, specialists and there's not been any bad feedback.
"In fact there's been about 12 or 15 doctors who have told me that they do help their patients to get it.
"There's lots of doctors putting their neck on the line for these patients, and try and help them get access to something that is available overseas, and if these doctors who are providing access for their patients were to be found out, would probably be struck off.
"All they want to do is provide best practice for their patients, which is what we're taught to do as practitioners."
Doctors onside with medicinal cannabis
Dawn and Tori aren't the only ones speaking out. Helen Kelly told The Nation last year about how medicinal cannabis was the only thing that helps her sleep through the night after cancerous tumours broke her back.
Anna Osborne too says taking medicinal cannabis has helped her while undergoing chemo, and a growing number of medical professionals are supporting their calls.
"I don't want to see desperate people turned into criminals," says oncologist Anthony Falkov.
Dr Falkov says 40 to 60 percent of his patients are using medicinal cannabis, and it may have benefits beyond pain relief.
"Essentially most patients use it firstly because they hope it'll work and improve their cancer control rates, and that's a very important thing that's been missed in this debate about medical cannabis. It may well increase cancer control rates.
"Secondly, they're using it for pain, and thirdly they're using it basically for appetite stimulation, and a lot of them are using it for anxiety and nausea and vomiting.
He wants to see cannabis treated like any other serious medication.
"What I'd really like to see is not widespread legalisation of every form of cannabis, but allowing doctors to actually ask patients about their cannabis use; record what they take; evaluate the effectiveness of various products and actually be allowed to use cannabis in research protocols with cancers that are subject to normal ethical approval; going through ethics committees, and subject to normal clinical trial constraints.
"All I'd like really is for cannabis to be treated like any other medication."
Grey Power goes green
And there's support from another unlikely quarter.
"Because our group has loved ones suffering from cancers, degenerative diseases, aches and pains, we are advocating for the inclusion of the homegrown cannabis plant to be added to our list of choice of treatment," says Beverley Alridge of Otamatea Grey Power.
The Otamatea Grey Power branch is petitioning the Government to decriminalise cannabis for medicinal use.
"We never considered it. We had other issues like roading and things like that, and we started seeing that people around us were dying and they were dying in extreme pain, and people were getting sick," she said.
"So we did all this research and found that cannabis is this wonderful plant. So no, we didn't actually go looking for cannabis - we went looking for solutions, herbal solutions that would actually be able to cure us, because there was no pharmaceutical drug that would be able to help us."
One of the arguments against the use of medicinal cannabis is that some patients - particularly young people, or those with mental health issues - could misuse it. The clinicians The Nation spoke to agree that it's not for everyone, but in their experience, patients use it responsibly.
"These patients have tried prescription medicines and haven't had success, and now use marijuana in judicious dosing," said Rick Acland, former medical director at Burwood Hospital.
"I am impressed that people don't seem to use it in an escalating manner."
Dr Acland says 20 to 30 percent of his patients use it for spinal cord injuries. He believes New Zealand could follow a similar system to Canada.
The Canadian system works like this: patients can grow their own, get a grower to supply them or get government-supplied cannabis.
There are similar schemes in other countries like Israel, Uruguay, Finland, the Australian state of New South Wales, some US states and Washington DC.
The World Health Organization is also taking a look at reclassifying medical cannabis under international law.
Sativex - just not the same
Technically speaking, New Zealand does have a legal form of medicinal cannabis called Sativex. It's a mouthspray, but it's a synthetic form of the drug rather than a natural one.
It's priced anywhere between $1000 and $1500 a month. It's beyond the budget of most people.
"We thought Sativex was going to be somewhat of a miracle drug, but it hasn't actually been as good as we thought it was going to be," said Dr Acland.
"That demonstrates the complexity of this pharmacology of cannaboid pharmacology, and it's also very expensive."
"I personally think that PHARMAC ought to reconsider the decision to fund Sativex, but the Government doesn't intervene in those decisions," said Associate Health Minister Peter Dunne.
"I respect their integrity, but I do accept that for some people the cost maybe a barrier."
Mr Dunne says he would welcome clinical trials of medicinal cannabis in New Zealand, but no one wants to trial their products here.
"We need manufacturers with product to say 'we would like to trial these formulations in New Zealand', and the sad truth is that for many of those manufacturers they do not see New Zealand as a sufficiently large market to make it worthwhile.
"It's the same story we have for clinical trials generally, but there's no prohibition for sourcing cannabis for medical trials in New Zealand."
Dr Falkov believes the stigma associated with the drug is holding it back.
"It may be [a wonder drug] but we just don't know. My concern really is that I don't want to claim too much for it, but similarly I don't want it to be written off - and if it was a new drug, the drug companies would be lining up to develop it."
"In the 1970s New Zealand missed out on the opium industry and if we don't do something about it soon, we are going to miss out on the medicinal cannabis industry as well," says Tori.
"It could be a huge boon for New Zealand and I think that the public really need to start looking at it - and the Government do too."
Dawn's Sativex has arrived, so she now can now try to get pain relief inside the limits of the law.
For others though, it could be a long wait.
"I just think it's absolutely ridiculous that it's not available for sick people, people who are terminal " said Dawn.
"I mean, it's not as if I'm going out on the street and selling the stuff to the kids on the corner of the street. So if it helps me with my pain and it helps other people in my situation to speak out, well then I think I've done my job.
"Really, at the end of the day, it's important that people begin to know that it's not just something that you smoke and sit around in the garden and get stoned."
* Surname withheld by request.