Medicinal Pot Sparks Ongoing Debate

Nov 25, 2011

Drug Com­pa­nies, Gov­ern­ment and Doc­tors Remain Divided on Plant’s Med­ical Future A decade after Canada legal­ized the med­ical use of mar­i­juana, most doc­tors are still refus­ing to sign the dec­la­ra­tions patients need to get legal access to pot – mean­ing patients in pain risk being jailed if they use a drug that helps them func­tion. It’s a predica­ment that threat­ens to become worse because of pro­posed changes to how Health Canada reg­u­lates access to the drug. At first glance, it appears the gov­ern­ment is eas­ing up on strict rules for obtain­ing med­i­c­i­nal mar­i­juana.  Health Canada has pro­posed remov­ing itself as the ulti­mate arbiter in approv­ing or reject­ing appli­ca­tions to pos­sess. Instead, doc­tors alone would sign off on requests. But the nation’s largest doc­tors’ group said the pro­pos­als would have the per­verse effect of putting even greater pres­sure on MDs to con­trol access to a largely untested and unreg­u­lated sub­stance they know lit­tle to noth­ing about, a drug that hasn’t gone through the nor­mal reg­u­la­tory review process.  Their licens­ing bod­ies have told doc­tors that they are under no oblig­a­tion to com­plete a med­ical dec­la­ra­tion under the cur­rent reg­u­la­tions and that any one who chooses to do so should “pro­ceed with cau­tion.” Dr.  John Hag­gie, pres­i­dent of the 75,000-member Cana­dian Med­ical Asso­ci­a­tion, said the changes being pro­posed would essen­tially offload all respon­si­bil­ity for using and mon­i­tor­ing mar­i­juana to the doc­tors who sign an autho­riza­tion – “and they’d be kind out of out there, with­out any infra­struc­ture around them to assess it, to mon­i­tor it and to know if they were doing the right thing.” “I don’t think that’s appro­pri­ate or fair,” Hag­gie said. Observers said doc­tors fear doing harm, expos­ing them­selves to legal action and becom­ing the “go-to” source for peo­ple seek­ing pot not to alter their pain but to alter their con­scious­ness. Hag­gie said physi­cians want fun­da­men­tal research into some basic ques­tions – is it safe? Who does it work for? Who should not use it? Yet the Con­ser­v­a­tive gov­ern­ment abruptly ter­mi­nated a med­i­c­i­nal mar­i­juana research pro­gram in 2006.  Accord­ing to Health Canada, the gov­ern­ment believes clin­i­cal research is “best under­taken by the pri­vate sec­tor, such as phar­ma­ceu­ti­cal com­pa­nies.” A world leader in cannabis research said the logic defies him. “I can­not imag­ine how a gov­ern­ment agency can super­vise ( a mar­i­juana access ) pro­gram know­ing that there is very lit­tle data out there – on safety issues in par­tic­u­lar – and not try to stim­u­late research,” said Dr.  Mark Ware, head of the Cana­dian Con­sor­tium for the Inves­ti­ga­tion of Cannabi­noids, a non-profit net­work of more than 150 clin­i­cians and researchers inves­ti­gat­ing the poten­tial role of cannabi­noids in dis­eases from arthri­tis to glau­coma. No drug com­pany wants to eval­u­ate smoked mar­i­juana as a med­i­cine, Ware said, because there’s no money in it for them.  Fund­ing agen­cies have been less than approach­able, he added, because there’s lit­tle appetite to sup­port stud­ies involv­ing a prod­uct that’s often smoked. In clin­i­cal par­lance, “They don’t see it as a safe, viable drug deliv­ery sys­tem,” said Ware, direc­tor of clin­i­cal research at the Alan Edwards Pain Man­age­ment Unit at the McGill Uni­ver­sity Health Cen­tre. Ware said he won­ders how much the government’s dis­in­ter­est in research might be tied to its tough-on-crime polit­i­cal agenda – “that some­how facil­i­tat­ing research on med­i­c­i­nal cannabis is a way of accept­ing that it may have some value as a med­i­cine.” In a study pub­lished in the Cana­dian Med­ical Asso­ci­a­tion Jour­nal last year that involved 21 patients with neu­ro­pathic pain – a com­mon and dreaded con­di­tion that causes elec­tric, stab­bing pain – Ware’s group found that smoked cannabis at low doses reduces pain, improves mood and helps sleep, with­out mak­ing peo­ple high. All had “refrac­tory” pain, mean­ing pain that had defied all tra­di­tional treat­ments.  No seri­ous or unex­pected side effects were reported. Ware avoids pre­scrib­ing cannabis to patients with a his­tory of psy­chosis or schiz­o­phre­nia, because it’s psy­choac­tive at high doses – and some­times even ther­a­peu­tic doses. It can also be dan­ger­ous to peo­ple with unsta­ble heart dis­ease. Still, there has never been a proven over­dose death caused by mar­i­juana in humans, accord­ing to Ontario’s high­est court.  Ware said that for patients for whom it works, cannabis can achieve about 30 per cent reduc­tion in pain inten­sity. But doc­tors remain wary – their chief con­cern being: How do I know when a patient is seek­ing a licence for a legit­i­mate med­ical pur­pose and not sim­ply to get legal access to an oth­er­wise illicit drug? Ware’s con­sor­tium has been work­ing hard to edu­cate and sup­port doc­tors around the use of cannabis. He said data from Health Canada sug­gest that the aver­age med­ical user is con­sum­ing two grams per day – about four joints when smoked. “It’s just tak­ing that infor­ma­tion and get­ting it into the hands of prac­tis­ing physi­cians.  Then at least they know what the ball­park is.” Some patients were get­ting autho­riza­tions for far higher amounts, because doc­tors didn’t know that 30 or 40 grams a day could be out­side the “nor­mal” range, he said. The Mon­tréal doc­tor, who is help­ing reform med­ical school cur­ric­ula to bet­ter edu­cate physi­cians around pain, received about $2 mil­lion under the now-dead med­i­c­i­nal mar­i­juana research pro­gram. Health Canada said the pro­posed changes to the pro­gram – which would include remov­ing the rights of patients to grow their own sup­ply of mar­i­juana or to appoint des­ig­nated grow­ers, forc­ing users to get their pot from a licensed com­mer­cial pro­ducer instead – would make the pro­gram less com­pli­cated for seri­ously ill Cana­di­ans. Paul Lewin begs to dif­fer.  Doc­tors already are boy­cotting the pro­gram en masse, the Toronto lawyer said.  Lewin said med­ical reg­u­la­tors and insur­ers sent let­ters to the gov­ern­ment, “say­ing, ‘Don’t put us in charge, don’t make us a gate­keeper, we don’t know any­thing about pot, this is a plant prod­uct, it’s an unap­proved drug.’” Lewin said the court heard sto­ries of how some doc­tors encour­aged their patients to use pot for their pain. The patients would return, report­ing that the mar­i­juana was help­ing, that they were feel­ing less pain.  But when they asked the doc­tors to sign their forms, “that’s when the mood changes,” Lewin said.  “That’s when they say, ‘Get out.  I’m not risk­ing my prac­tice over you.’” Lewin’s client, Matt Mer­nagh, started grow­ing mar­i­juana when he found it pro­vided some relief from chronic pain and other symp­toms of sco­l­io­sis, fibromyal­gia and epilepsy.  But he couldn’t get a licence to grow, because he couldn’t find a doc­tor to sign his dec­la­ra­tion. Police found Mernagh’s plants in 2008 when they were in his apart­ment build­ing on an unre­lated call.  He was charged with pro­duc­tion. Lewin took the case to the Supe­rior Court in Ontario.  The court declared the fed­eral med­ical mar­i­juana pro­gram uncon­sti­tu­tional. The case is sched­uled to go to the Court of Appeal for Ontario in March. Lewin said the pro­posed changes to the mar­i­juana access pro­gram are likely to scare off some of the few doc­tors will­ing to sign­de­c­la­ra­tions, mean­ing “more seri­ously ill, law-abiding Cana­di­ans will be wrong­fully treated as crim­i­nals” and sub­jected to humil­i­at­ing arrests, med­i­cine seizures and pos­si­bly even jailed, he said. Ware said doc­tors need edu­ca­tion and guid­ance. They would need to know whether patients who come seek­ing a licence for med­ical pot have been arrested for traf­fick­ing or diver­sion in the past. Abuses of the des­ig­nated pro­duc­tion licenses have occurred and Ware believes they should be phased out.  But the con­sor­tium of cannabi­noid researchers said that it’s not only eas­ier and cheaper for patients to grow their own sup­ply but the act of grow­ing their own “med­i­cine” may be ther­a­peu­tic in itself.  “It gives them a sense of con­trol and own­er­ship of their health and treat­ments.” [side­bar] THE PROPOSAL The fol­low­ing infor­ma­tion was pro­vided by Health Canada to Post­media News: In 2001: 727 doc­tors sup­ported an appli­ca­tion for an autho­riza­tion to pos­sess mar­i­juana. In 2010: 3,187 doc­tors signed a dec­la­ra­tion.  Between Jan.  1 and Oct.  25, 3,803 doc­tors sup­ported an appli­ca­tion for an autho­riza­tion to pos­sess. As of Sept.  30: 12,216 peo­ple in Canada held autho­riza­tion to pos­sess mar­i­juana for med­ical pur­poses. Who has author­ity to approve or reject sub­mis­sions in the new sys­tem? Under the pro­posed changes, patients would con­tinue to con­sult with their physi­cian in order to obtain access to mar­i­juana for med­ical pur­poses. Once it has been deter­mined that the use of mar­i­juana for med­ical pur­poses is appro­pri­ate, the physi­cian would pro­vide the indi­vid­ual with a doc­u­ment.  Health Canada is con­sult­ing the med­ical com­mu­nity on the form that this doc­u­ment would take.  Indi­vid­u­als would then send the physician’s doc­u­ment directly to a licensed com­mer­cial pro­ducer of their choice.  The licensed pro­ducer would val­i­date the doc­u­ment from the physi­cian by con­firm­ing that the physi­cian is licensed to prac­tice med­i­cine in Canada. The licensed pro­ducer would reg­is­ter the indi­vid­ual as a cus­tomer and would process the order for a spe­cific amount of dried mar­i­juana.  Health Canada would main­tain an upto-date list of licensed pro­duc­ers on its web­site, and work with the med­ical com­mu­nity to dis­sem­i­nate this infor­ma­tion as widely as pos­si­ble. Source: StarPhoenix, The (CN SN) Copy­right: 2011 The StarPhoenix Con­tact: http://​www​.canada​.com/​s​a​s​k​a​t​o​o​n​s​t​a​r​p​h​o​e​n​i​x​/​l​e​t​t​e​r​s​.​h​tml Web­site: http://​www​.canada​.com/​s​a​s​k​a​t​o​o​n​s​t​a​r​p​h​o​e​n​ix/ Author: Sharon Kirkey

e47fd61547ijuana.jpg 150x99 Medicinal Pot Sparks Ongoing Debate

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Med­i­c­i­nal Pot Sparks Ongo­ing Debate

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