Many veterans are turning to marijuana to ease symptoms of post traumatic stress disorder, despite concerns from the medical community about how effective pot is at treating the condition.
There are a "tremendous" number of testimonials from patients with post traumatic stress disorder who say dried cannabis helps them, but there is a lack of randomized, controlled trials, said Dr. Stewart Cameron, a family physician and professor at Dalhousie University's faculty of medicine.
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In September 2014, the College of Family Physicians of Canada released a document to help doctors decide how to use cannabis in their practices.
"They strongly recommended that it not be used for PTSD," said Cameron. "They suggested it should be reserved as a third or fourth line agent in people who suffer certain types of pain."
Veterans Affairs paid out $5.2 million for medical marijuana to veterans across Canada last year. Of that, $3.4 million went to veterans in Atlantic Canada.
The department could not say which ailments the veterans are treating with marijuana, because Veterans Affairs doesn't track cannabis reimbursement by condition.
'Natural choice medicine'
Medical marijuana advocate Fabian Henry says most of the 500 veterans who visited his company last year were looking for authorization to use marijuana to help with post traumatic stress disorder.
Henry's company, Marijuana for Trauma, connects veterans with physicians willing to authorize medical cannabis. The organization has helped hundreds of veterans fill out forms for medical pot reimbursement from Veterans Affairs Canada.
Marijuana for Trauma calls cannabis "a natural choice medicine" and says it's "proven to be effective in 85 per cent of those who suffer with PTSD."
But Canadian medical authorities are far from assigning such a high efficacy rate to the drug.
Doctors Nova Scotia has said it is "concerned about the lack of evidence to support the efficacy of medical marijuana as well as the need for education for physicians who choose to prescribe."
'I'm not doing it until it's commonplace'
Physicians have varying levels of comfort when it comes to authorizing dried cannabis for medical conditions, said Cameron.
"Some physicians are innovators and early adopters, they're happy prescribing this," he said. "Some physicians say, 'I'm not doing it until it's commonplace, until there's solid evidence in place.'"
Dr. Michael Hart, an Ontario family physician, is one of the early adopters. He works with the recently opened branch of Marijuana for Trauma in Markham, Ont.
In an interview with CBC News when the Markham clinic opened, Hart anticipated having to slow down his family practice because 70 to 80 per cent of his patients were expected to be veterans with post traumatic stress disorder looking for cannabis treatment in person or remotely, using video conferencing technology.
The guidelines from the College of Physicians and Surgeons of Nova Scotia for authorizing dried cannabis seem to rule out prescribing by video conferencing, said Cameron.
"The college says that medical cannabis, the dried product, must only be authorized in the case of a doctor-patient relationship and direct contact, meaning one of your patients in front of you," he said.
When authorizing dried cannabis, there are concerns about reselling the drug, abuse and using the drug for recreational purposes, said Cameron.
Prescribing through so-called telemedicine is allowed in Ontario.
Some patients with post traumatic stress disorder can barely leave their houses because of their acute conditions and need to attend appointments via video conferencing, said Hart.
'We'll see if there's any benefit'
Traditional pharmaceuticals have not been effective in many PTSD patients, he said.
"If someone's coming to me for PTSD, then you have to assume that they have severe PTSD symptoms and their symptoms are not being adequately controlled," Hart said.
"If that's the case, then I will prescribe them cannabis and then we'll see if there's any benefit to it."
Veterans are also reimbursed up to $300 for vaporizers to administer the marijuana. That cost to Veterans Affairs is not included in the $3.4 million the department paid out to veterans in Atlantic Canada last year.
"Dried marijuana is not an approved drug or medicine in Canada. The Government of Canada does not endorse the use of marijuana, but the courts have required reasonable access to a legal source of marijuana when authorized by a physician," said a spokesperson for Veterans Affairs.