Monday, June 24, 2013

Medical cannabis use? Sure!

I received an invite a few weeks ago, by a medical user group, to present my take on the issue of medical cannabis use in Canada . Unlike the Brockville General Hospital, that cancelled my keynote address in response to pressure from well-connected religious pressure groups, the medical cannabis folks didn't cancel my presentation, even though they had no idea whether I would be supportive of their cause. Truth be told, they probably did not like much of what I had to say, but attending their meeting permitted me to learn quite a bit about the bizarre status quo in Canada.

Here's what I learned (small detail might be slightly off, but the gist of this is correct, as far as I can tell). Some years back the Canadian courts forced the federal government to permit access to medical cannabis users. This decision was made in the absence of conclusive medical research demonstrating that THC (the biochemical substance at the heart of it all) works. There are a bunch of studies suggesting that THC works as a complementary substance in palliative care, that it helps people with appetite issues to get hungry again, etc. The thing is though, no conclusive research was undertaken that would have determined what dosage should be given to what patients for what duration. So, medical cannabis is NOT a prescription drug.

Strangely, under the current system (to be changed in March 2014) doctors must confirm that a patient suffers from a condition listed by Health Canada in response to the court finding. This, of course, is a quasi-prescription for a non-medication. Doctors were rightly concerned about this. After all, why should they fill in such a form? If Canadian courts want biochemical substances made available to particular patients - in the absence of conclusive clinical research evidence - why should doctors oblige them? Well, the thing is, THC clearly does some patients good. So, doctors obliged government - when, to my mind, the profession should have declined. How can you participate in getting someone access to non-drug drugs in the absence of uncontroversial clinical evidence?

Well, the current system sort of worked. Patients could either get permission to grow their own cannabis or purchase it from a government facility. Comes in the Canadian Tea Party, ie our current federal government. A new system will kick in. Crucially, the government facility that produced medical cannabis will shut down, and self-produced cannabis - ie self-produced by users -  will be a thing of the past. Commercial enterprises (because government is pro-business, even when it comes to cannabis!) will now sell cannabis to approved medical cannabis users. According to evidence presented by medical users during said meeting, their bills would increase from 200$ (self-produced) to in excess of 50,000$ commercial-enterprise produced. Even if you take that claim with a pinch of salt, you can see that users will be taken for a ride here by government approved commercial producers, and you can also see that a whole bunch of users likely won't be able to access medical cannabis any longer. Giver the current government's ideological commitments... ein Schelm were boeses dabei denkt.

Clinical research to investigate whether cannabis actually works uncontroversially for particular patient groups is not on the horizon, after all, cannabis is a prohibited substance, so for clinicians to undertake the necessary research would be truly difficult. It goes without saying that this is a pretty bad status quo, but that's where we are.

I suggested during the conference that medical cannabis users should take a leaf out of early AIDS activism's book and engage in activism aimed at bringing political pressure to bear on government and research funding agencies so that the necessary research is undertaken. Turns out, the users were primarily concerned to get the right back to grow their own cannabis. They didn't care about much else. This is understandable, if you think the drug works for your pain, appetite issues etc, but it is bad health policy. It is also understandable on the background of the conservative government's pernicious attempt at increasing prices for medical cannabis to such an extent that only the very wealthy can access it. Surely there is an equity issues here, as far as the Charter of Rights and Freedoms is concerned.

Well, I began my talk by saying that I thought access to cannabis ought to be decriminalised, because a) there isn't a hell of a lot of evidence that cannabis is harmful, b) there isn't a hell of a lot of evidencethat it is an entrance drug, leading users to move on to more dangerous substances, c) the war against drugs has been a dismal failure in any case, and d) last but not least, more dangerous drugs (alcohol comes to mind) are currently legally available, which doesn't seem sound policy. Conveniently, the Sun Media journalist (for you outside Canada, that's a conservative media organisation) forgot to mention this and proceeded to quote me at great length about the need to undertake the necessary clinical research (which is something I did actually emphasise). Here's the newspaper report in the Ottawa Sun. 

6 comments:

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  2. AnonymousJune 28, 2013

    Greatful you wrote this blog. I would like to ask a question or two if I might, as I was unable to attend in Ottawa. How many drugs have been prescribed that were studied have; been recalled, caused death or deformation, produced addicts or created potentially long term effects? Are vitamins, and holistic treatments considered drugs? Doctors have for years recommended echinacea only to recently prove little to no benefit. Doctors often recommend more vegetables in a diet, can that be considered promoting natural remedies. Why should a plant be considered a drug? With the federal regulation allowing medicinal use for over a decade, should the government have not conducted studies and educated Drs? If Drs refuse to acknowledge studies that have been conducted, and wish to NOT be responsible for prescribing this treatment, should the plants usage be regulated any different than ginseng? Have Drs given out samples of drugs like Fen Fen that were not prescribed? Should a Doctor be permitted to fore go a Canadians right to access a federally recognized treatment simply because the doctor (or College of Physicians) disagree with federal program? At a very minimum, should marijuana not be recognized as a natural holistic treatment, as their is no conclusive evidence suggesting it is addictive, as well as the fact it is less harmful than legalized alcohol?

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  3. I attended your talk in Ottawa and am among those that are unimpressed with your conclusions. The CMA cries for lack of studies, but they abound, if they are unearthed from archives that are created to downplay positive results. I am also quite incredulous that the doctors can accept negative feedback fro other natiuons, but not do follow up studies to those clinical findings reported in the US, Britain and Israel. History illustrates quite accurately, how big pharma created the institution of western medicine as we know it, that they continue to influence it's direction. IT isn't a great leap of logic to come to the realisation that we are organic constructs, not mechanical. We need organic medicines, not petroleum by-products and isomeric misfits. The medical establishment has had 13 years to conduct studies and upgrade their education and have done nothing but hinder the process, to protect their patrons, the drug companies. Our medical system is a mockery of ethical medicine.

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  5. Having been confided for half the last year in the hospital because of the Chron disease, I can sincerely sympathies with you. I've been feeling better for some time, but the pain is never far away, I've just managed to get used to it.
    Being ill is hard...in every way, both physical and mental. Because of the hospitalization I had to miss my honeymoon...but one must stay focused and live day at the time. I do hope you get better soon!

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