Pubdate: Wed, 08 Aug 2001
Source: National Post (Canada)
Copyright: 2001 Southam Inc.
Contact:  http://www.nationalpost.com/
Details: http://www.mapinc.org/media/286
Author: David Gratzer
Note: Dr. David Gratzer is the author of Code Blue: Reviving Canada's 
Health Care System, which was awarded last year's Donner Prize.

LEGALIZED POT: MORE SMOKE THAN FIRE

Canada is now the first Western nation to legalize marijuana for medical 
uses. The new regulations allow the prescribing of marijuana for the 
terminally ill, those with specific medical conditions (such as multiple 
sclerosis patients with severe pain) and seriously ill patients who have 
failed "conventional treatments."

The decision to allow the weed is monumental -- and irrelevant.

That marijuana was illegal in the first place makes sense to the casual 
observer. After all, pot is a street drug that is both addictive and, with 
sustained use, harmful.

It's a compelling argument -- and one borne of ignorance. The reality is 
that many street drugs (often illegal for recreation) are allowed for 
medical use. Consider that possessing cocaine is a crime. But, in a health 
care setting, cocaine is an anesthetic; I have never seen an emergency room 
that didn't have liquid cocaine.

Morphine, codeine and heroin are used for pain relief. In fact, morphine is 
one of the most basic and effective drugs used to treat pain. Several years 
ago, two prominent physicians wrote a book titled the ABCs of Palliative 
Care. They had harsh words for doctors reluctant to prescribe morphine for 
the dying, going so far as to suggest these colleagues were "part of the 
problem."

Why the ban on marijuana? "It's all politics," explains a pharmacist friend.

Contrast marijuana and codeine. Marijuana is a relatively innocuous drug. 
Codeine is a modified morphine chemical. It takes an estimated 1,500 pounds 
of marijuana to achieve a lethal dose -- smoked in under 15 minutes. 
Codeine overdoses may require just a bottle or two of pills. Marijuana is 
banned. Codeine is not only widely available in prescription drugs (like 
Tylenol 3), but can be purchased over the counter in low doses.

Indeed, marijuana should never have been blacklisted. That decision 
reflects bad politics, not good medicine.

Not everyone sees it that way. A former president of the Canadian Medical 
Association criticized the federal government's action, suggesting that 
allowing marijuana for medical purposes was a first step toward 
decriminalization. In medical circles, it's a commonly argued point -- but 
is it convincing? After all, we have always allowed morphine for end stage 
renal cancer and cocaine for nose bleeds, but has this bolstered in any way 
the efforts to decriminalize street drugs? Would medical marijuana?

Last week, the federal government corrected a past wrong. The 
self-congratulations have already begun. Speaking at the July announcement 
of the regulatory changes, Allan Rock, the Minister of Health, declared: 
"Today's announcement [of the revised rules] is a landmark in our ongoing 
effort to give Canadians suffering from grave and debilitating illnesses 
access to marijuana for medical purposes. This compassionate measure will 
improve the quality of life of sick Canadians, particularly those who are 
terminally ill."

I have no philosophical objections to lifting the ban, but will it really 
result in better, more compassionate medical care?

Anecdotal evidence appears plentiful -- and photogenic. TV news reports 
often portray patients who offer amazing testimonials to the power of pot. 
Proponents of legalization frequently tout two uses for medical marijuana: 
in the management of pain and as an anti-nausea medication.

The reality is that marijuana probably doesn't have much use in either 
capacity.

In a review of all randomized controlled trials comparing the efficacy of 
cannabinoids with conventional drugs published in the British Medical 
Journal, marijuana proved to be no more effective than codeine at pain 
relief -- but had several undesirable side effects. As well, most of these 
studies were done in the 1970s, before the development and better 
utilization of several pain killers (such as NSAIDs) in use today.

In a review of 30 studies involving cannabinoids as a treatment for 
chemotherapy-induced nausea and vomiting, marijuana was reported to be 
effective for moderate nausea, but not for severe symptoms. Since the bulk 
of these studies were done, newer medications have been developed that 
unquestionably have better ability to control the side effects of chemotherapy.

Not surprisingly, then, in a recent editorial of the British Medical 
Journal, Professor Eija Kalso suggests: "The current information is that 
the adverse effects of cannabinoids outweigh their effectiveness."

Make no mistake: alleviating the pain and suffering of patients is a noble 
and vital pursuit. What remains unclear is that medical marijuana will 
contribute anything to the arsenal physicians already have at their 
disposal. Of course, there is always the potential for marijuana to have 
unforeseen applications. Perhaps a future Nobel laureate will one day cite 
Allan Rock in his acceptance speech.

More likely, however, the practical implications of legalized pot will be 
more smoke than fire.

Dr. David Gratzer is the author of Code Blue: Reviving Canada's Health Care 
System, which was awarded last year's Donner Prize.
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