Sunday March 29, 2015

How medical is medical marijuana? - an hour-long special report

Marijuana skin creams are shown at a medical marijuana dispensary in Vancouver.

Marijuana skin creams are shown at a medical marijuana dispensary in Vancouver. (The Canadian Press/Jonathan Hayward)

Listen 51:01

The number of Canadians authorized to use medical marijuana has been skyrocketing. In 2002 – a year after the government first permitted access through Health Canada regulations – 500 patients had registered. Today, there are more than 50,000.

        This has happened despite the official position of the Canadian Medical Association that “there is insufficient scientific evidence available to support the use of marijuana for clinical purposes.” The CMA also believes we don’t know enough about its risks and benefits, about the interactions between marijuana and other medications or how to prescribe an appropriate dosage. It advises doctors they are not obligated to write cannabis prescriptions for patients.

        “It was very difficult to get my prescription,” said Jennawae McLean, who uses medical marijuana mainly for chronic pain due to arthritis. “A doctor was willing to prescribe me Percocets and Humira and Lyrica and different pills like this, but they weren’t willing to prescribe cannabis…which has no recorded deaths, no overdoses, no negative long-term side effects. It just doesn’t make sense.”

        Thousands of Canadians are flouting the law. Government guidelines for medical marijuana are outlined in Health Canada’s Marihuana Medical Access Regulations (MMAR) and state clearly that prescriptions may be written only by a physician or nurse-practitioner; that medical marijuana must be purchased through a licensed producer, only as dried plant material; and that it is not permitted to sell it through storefronts or retail outlets.

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        These rules are being broken across the country, but nowhere more than in British Columbia. There are now more medical marijuana shops in Vancouver than there are Tim Horton's coffee shops, and more than in the rest of Canada combined. These stores are selling cannabis and hashish with names like Purple Kush, West Coast Rockstar, Polar Hash and even Barbara Bud, in addition to a variety of edible marijuana products. On-site naturopaths provide medical marijuana access cards to those who say they are feeling stressed.

         Vancouver city councillor Kerry Jang, who also teaches in the Department of Psychiatry at the University of British Columbia, says these dispensaries have been sprouting up across the city “like pop-up shops” in virtually every neighbourhood. He believes it is not appropriate for the city to stand between patients and their medicine.

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Vancouver Councillor Kerry Jang. ((CBC))

        Jang said Health Canada was counting on municipalities to enforce the MMAR rules, however the federal government did not provide any resources.

        “In fact, at one point they said you have to go and shut down all the home grow-ops, people growing small plants for themselves. Well, how can we do that? Knock on every door in Vancouver?” Jang said, in an interview with Michael Enright of The Sunday Edition.

         Vancouver police are enforcing municipal regulations, governing rules such as a prohibition on selling marijuana to minors, however they focus their criminal enforcement efforts on the trafficking of more serious street drugs, such as cocaine and heroin and methamphetamines.

          Researchers have published thousands of peer-reviewed articles about medical marijuana, mainly on the therapeutic properties of the various cannabinoids found in cannabis plants.

          “When you narrow the search down to clinical trials, the number drops dramatically,” said Dr. Mark Ware, the Executive Director of the Canadian Consortium for the Investigation of Cannabinoids. He is also the Director of Clinical Research at the Alan Edwards Pain Management Unit at the McGill University Health Centre.

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Dr. Mark Ware of the McGill University Health Centre Pain Clinic. ((CBC))

         “If you think about conventional pharmaceutical drug development, there is usually a company behind a new drug that’s investing hundreds of millions of dollars in doing those clinical trials in order to make a claim that this drug, at this dose, is effective in the treatment of this symptom, in this disorder,” Dr. Ware told Michael Enright. After government approvals, the drug is launched on the market and the company recuperates its investment.

         “There isn’t such an interest in investing in that work for herbal cannabis, which is something you can grow in your backyard,” he said.

         Most of the research into the effectiveness of medical marijuana has focused on pain management, however patients are using it for a variety of conditions ranging from Crohn’s disease to chronic seizures.  Dr. Ware believes the medical community would benefit from “real world evidence,” which could be gathered by monitoring the progress of the thousands of patients who are using therapeutic marijuana.

          With rare exceptions, medical insurance companies will not pay for medical cannabis, however taxpayers are covering that expense for more than 600 Canadian soldiers, through the department of Veterans Affairs.

          Doctors who are willing to write marijuana prescriptions do not endorse smoking the drug. They recommend that patients use it in a way that will not be potentially harmful to their lungs. This may include edibles, oils, tinctures or topical medicines, none of which may be sold legally.

          Vancouver resident Owen Smith has challenged that law, all the way to the Supreme Court of Canada. It heard arguments on March 20th and has reserved judgment in the case. It can take at least six or seven months for the Court to publish its decision, which will be near the date of the next federal election, October 19.

OrganiGram ships first major crop

OrganiGram is the only licensed medical marijuana grower east of Ottawa. (Tori Weldon/CBC)

          A 2014 poll conducted by Angus Reid Global showed that 59 per cent of Canadians support the legalization of marijuana, however the Conservative government is opposed.

          Councillor Kerry Jang said that, based on what has happened in Vancouver, he believes we already have de facto legalization.

          “And quite frankly, I’m glad it’s above ground in a dispensary where we can regulate and see what’s going on, rather than underground,” he said.