Home' Australian Pharmacist : Australian Pharmacist March 2015 Contents Australian Pharmacist March 2015 I ©Pharmaceutical Society of Australia Ltd.
Since the beginning of time, treating pain has been the cornerstone of
medical and healthcare practices. According to the Universal Declaration
of Human Rights 1948 -- Article 26: 'Everyone has the right to a standard
of living adequate for the health and well-being of himself and of his
It follows therefore that alleviation of
pain -- the most debilitating health issue
in the human race, is a human right.
Yet, the debate regarding legalisation of
medicinal cannabis continues. In NSW,
clinical trials to provide the so-called
'evidence' are marked for 2016 and
beyond, allowing decision makers to
buy time and keep heads in the sand.
Meantime, the suffering of those
experiencing intractable pain continues,
and so does the existence and
exploitation of the black market -- taking
full advantage of the legal vacuum that
To illustrate this issue, I share with you
this personal experience -- a haunting
story that every pharmacist, palliative
care specialist and healthcare provider
should know about.
One patient's journey
I sat mesmerised as a dear friend slowly
recounted the last days of his wife's life.
He had not dared share this part of his
and his wife's ordeal before. What he was
driven to was after all illegal, but he now
no longer cared.
Only a few weeks after diagnosis of
ovarian cancer, his wife's body was
riddled with metastases. Her abdomen
so distended with ascites she could
hardly move within the confines of her
bed. The pain intensified steadily; even
breathing began to hurt. Although
injectable opioids were at hand,
oxycodone tablets and capsules strewn
everywhere, along with several other
gadgets and attempts at pain relief;
nothing seemed to touch this particular
pain. In desperation, her husband
started asking questions. Being an
engineer he knew little or nothing about
medicines, palliative care or anything
to do with healthcare. But he had heard
He quietly but urgently began
to enquire about how to acquire
cannabis...at first with only a whisper of
hope. He followed thread after thread.
He paced the streets of Kings Cross
in Sydney, day and night. He poked
A few days in, he was handed a slip
of paper. He followed directions and
landed -- not onto a daggy peddler
in a dark alley, nor onto a mafia of
drug dealers. To his surprise he had
stumbled on a well-established system
of manufacturing, packaging and
distributing the extract of cannabis
in the form of concentrated drops for
oral administration. But it was not in
NSW, and it wasn't going to be easy to
persuade them of his authenticity.
Determined, he travelled interstate with
documents, photos and his story -- real
and raw at the edges. After very cautious
verification, he was signed up, sworn to
silence -- and asked to pay a hefty 'bond'
and a first instalment of $800 for each
bottle of 10 mL. He took that precious
bottle with him home to his wife and
proceeded to administer three drops
sublingually every few hours or whenever
she groaned in agony. He swore after he'd
place the drops in her mouth, she would
almost instantaneously sit up and chat
Dr Betty Chaar is Senior Lecturer and MPharm Co-
ordinator at the Faculty of Pharmacy, The University
of Sydney. Opinions expressed in this column are not
necessarily those of the Pharmaceutical Society, its
Board or staff.
with those around her as if nothing had
happened. It was, using his words, 'magic'.
And so, he continued to order the 'magic'
at $800 a bottle. It would arrive in a
special mail package, with a 'scent proof'
lining to avoid the sentinel sniffer dogs
along the way. Smart manufacturing,
smart packaging, smart exploitation.
She passed away peacefully after
consuming, over time, several of these
little bottles of 'magic'. He was deeply
out of pocket, but at peace with his
conscience, despite the 'illegality'. It was
when I visited to offer my condolences
that he let loose all the anguish, the pain
of having to keep all this secret when
so much more was happening, and the
sheer, fierce sense of wrong about the
illegality of the 'magic'. He threw the last
package with a bottle of the concentrate
in it into my lap with much anger -- anger
at government/s, authorities, doctors and
pharmacists; all of whom, in his eyes, had
failed his wife.
The ethical argument
The first and foremost ethical principle
in bioethics is 'to do good'. It has been
the basis of healthcare since the time
of Hippocrates. So has the principle of
'do no harm'. Denying a patient pain
relief, even if it happens to be the 'illegal'
medicinal cannabis, causes harm,
without a shadow of a doubt. There is
no ethical justification for denying the
'good' resulting from administration of
a substance that can easily be legislated
and controlled, if there is a will to do so.
So, we have established it is a human
right to access pain relief. And there
is no ethical justification for denying
access to medicinal cannabis through
legal, affordable channels. There is no
justification for allowing this story to
happen again to anyone. It is not a
dilemma; it is a 'no-brainer'.
What are we waiting for?
BY DR BETTY CHAAR
Links Archive Australian Pharmacist February 2015 Australian Pharmacist April 2015 Navigation Previous Page Next Page