The boring business of New Zealand's biggest cannabis clinic

When you drive south down State Highway 1 to get to the Cannabis Clinic in Auckland, you can't ignore the exit number: 420.

The number - spoken as four-twenty - is cultural slang for weed.

But Dr Waseem Alzaher assures me that isn't why he chose the swanky beachside suburb of Takapuna for the location of what would become New Zealand's largest prescriber of medicinal cannabis.

Really, it was convenient and Takapuna doesn't scream weed (it gives off more of a sneaky-bit-of-cocaine, $100 bottle of red kinda vibe).

"It is part of why the universe ended up putting us here," says Alzaher, who spent time as an emergency room doctor and as a GP before setting up the Cannabis Clinic.

"It was all meant to be: exit 420, a big cannabis clinic, big cannabis pharmacy and then we turned Takapuna into the hub of medicinal cannabis in New Zealand."

The clinic isn't what you would expect (or at least not what I expected). There is no cannabis there. That's down the road in New Zealand's first cannabis-focused pharmacy that Alzaher recently opened.

The clinic looks like a corporate office with dark grey carpet, white walls and minimal furniture. The consult rooms where doctors see patients in person or through telehealth appointments are small offices with a desk, chairs and a decorative plant or two.

Yet Cannabis Clinic - there are also locations in Nelson, Hawke's Bay and soon Christchurch - is responsible for prescribing 12,000 products a month, and writes about a third of New Zealand's total medicinal cannabis prescriptions, according to Alzaher. It's all part of a fast-growing industry that was birthed in 2020 when legislation changes enabled a medical cannabis scheme, despite limited scientific evidence that cannabis can help issues such as pain, insomnia and epilepsy.

Alzaher isn't who you think would be running a medicinal cannabis setup. He is a 36-year-old father of two and an Iraqi-born New Zealander.

"My parents want me not to do this," he says. "'Go back to normal medicine, son."

This is the kind of stigma that he hopes to remove for patients who come to the Cannabis Clinic.

GPs can prescribe medicinal cannabis, but most don't have the know-how to do so confidently or the belief that it works. Private setups like the Cannabis Clinic fill that gap in patient care.

However, that makes it more expensive as there are no government subsidies, keeping medicinal cannabis out of reach for many New Zealanders.

A consultation at the Cannabis Clinic costs $99. Depending on the dosage and product prescribed, patients likely pay more than $300 a month for their supply. That's not too much more than what some people paid on the street before they legalised their cannabis use, according to Alzaher.

A medicinal cannabis scheme also gives patients access to high quality products without the inconsistency and purity problems of cannabis bought illegally. Medicinal cannabis comes in the form of a tea, gummies, oil or, most commonly, a flour that is ingested through a vaporiser (you can also bake with it).

Alzaher mostly divides his patients into two categories: people who are new to it, or existing cannabis users.

"There is definitely a group of people who are older, who are generally cannabis-naive and they are looking for help with osteoarthritis or some sort of long-term pain or sleep."

Many Cannabis Clinic patients transition to prescriptions after illegally self-medicating with cannabis for conditions such as pain, anxiety, epilepsy and poor sleep. Alzaher disputes calling illegal cannabis users "recreational users".

"Recreational in my mind is for fun," he says.

New Zealand Drug Foundation analysis of NZ Health data in 2020 estimated that more than 250,000 New Zealanders use cannabis for medicinal purposes. Only six percent did so through a prescription, a number that has no doubt grown in recent years.

"It is peace of mind," Alzaher says. "People don't want to live with a stigma in the back of their head, 'Oh I'm doing something wrong... if the police stop me this is wrong.'"

Katy Thomas began medicating her son Eddy's epilepsy with oil made from cannabis without a prescription when he was three years old. She feared the repercussions of what she was doing but the 25 seizures a night Eddy typically had were more scary and other treatments were not working.

"It's instant. I give it, he has no seizures," says Thomas, who lives in Auckland.

She then got Eddy a prescription and he became a patient of the Cannabis Clinic after it opened in 2018. Now, aged 10, Eddy has gone months without a seizure, which can occasionally happen when he is sick or in pain.

But whether medicinal cannabis really works for pain, sleep, anxiety or disorders like epilepsy is far from proven (there is some evidence it helps reduce seizures in many forms of paediatric epilepsy).

One of the problems is that the gold standard in scientific research, a double blind study where participants and researchers don't know who got the drug or the placebo, is difficult with active ingredients. Participants would know they were given cannabis rather than the placebo because they would get high.

"That's going to really muddy the waters in terms of any research outcome," says Dr Geoff Noller, a medical anthropologist.

However, Noller has surveyed hundreds of New Zealanders who say medicinal cannabis has helped them with various physical and psychological alignments.

Then there's ethics on the business side of medicinal cannabis. When you go to a GP, you explain your symptoms and the doctor treats you how they see fit. When patients go to a place like a Cannabis Clinic, they go to get cannabis.

"It's called drug seeking, isn't it?" says Noller, using the term used to describe those trying to satisfy a pharmaceutical drug dependency.

There are limited checks and balances for prescribing medical cannabis, like most drugs and medicines you get through a GP.

"There is no list of conditions that would qualify for a prescription so that is left for the medical practitioner to prescribe," said Dr Marta Rychert from Massey University who studies New Zealand's medicinal cannabis industry.

The new pharmacy adds to Alzaher's growing medicinal cannabis business. Its outside is discreet, the green storefront blending in with a nearby Woolworths store. On the inside, about a dozen staff are working away in front of large computer monitors while boxing up cannabis products for the post or patient pickup.

It's unlikely you can go into your local chemist and instantly fulfil a cannabis prescription because most won't have it on the shelf. A pharmacy typically has to order it in and then dispense it to patients.

"We can cut right through that process and supply efficiently," Alzaher says.

Darren, a 58-year-old Hawke's Bay resident, gets his medical cannabis posted to him from the new pharmacy.

He doesn't care much for discussions about the ethics or effectiveness of medicinal cannabis. He has been using cannabis since he was 18 after finding it helpful for the debilitating pain that followed injuries from a motorbike accident. Six months ago he legalised his use with a prescription.

He laughs when I tell him that there wasn't a ton of research to support medicinal cannabis as an effective pain relief. Henson prefers it to the morphine prescribed to him in the past.

"What is worse: being a drugged up waste of space where you are a zombie all day or you have a bit of cannabis?" he says.