Pubdate: Sun, 31 Jul 2005
Source: St. Petersburg Times (FL)
Copyright: 2005 St. Petersburg Times
Author: Susan Taylor Martin, Times Senior Correspondent
Bookmark: (Cannabis - Medicinal)
Bookmark: (Chronic Pain)
Bookmark: (Decrim/Legalization)
Bookmark: (Sativex)
Bookmark: (Treatment)


Canada's Approval Of A Cannabis-Based Medicine Has People Wondering What 
Would Be Possible If A Stigma Could Be Removed

BURLINGTON, Ontario - Since she was diagnosed with multiple sclerosis 13 
years ago, Alison Myrden has suffered from pain so intense it feels like 
"lightning going off in my face."

To reduce her agony, Myrden, 41, has long taken dozens of prescription 
pills a day, including the powerful Dilaudin. Now, though, she has a new 
weapon in her arsenal: Sativex, billed as the world's first cannabis-based 

"I think it has good potential," says Myrden, squirting Sativex into her 
mouth from a small sprayer. "It's really fabulous that the government has 
taken marijuana seriously and is making a medicine of it."

This spring, Canada became the first country to approve Sativex, a 
prescription drug for MS that contains tetrahydrocannabinol, or THC, and 
other active ingredients of the Cannabis sativa plant. The drug went on 
sale throughout Canada in mid June, just a week after the medical marijuana 
movement in the United States was dealt a major setback by the U.S. Supreme 

Sativex is so new and expensive that few Canadians are using it so far. But 
given the timing of its debut, it has highlighted the divergent views on 
marijuana's therapeutic benefits.

Sativex "is an important step, but why should this whole field be centered 
in Canada and England instead of the United States? It's because of the 
repression of science in the United States," says Rick Doblin, whose 
Sarasota-based Multidisciplinary Association for Psychedelic Studies funds 
research of marijuana's medical effects.

But the U.S. government's Office of National Drug Control Policy, which 
deems marijuana a dangerous drug, says many of those touting its 
therapeutic use want to legalize its recreational use as well.

"Of course we would look at any medicine proven safe or efficacious," says 
spokesman Tom Riley. "But the medical marijuana issue has been kind of 
larded with hype for a number of years by a lot of people with agendas in 
this area."

Sativex was developed by GW Pharmaceuticals, a small British company that 
is trying to distance itself from the medical marijuana debate as it seeks 
U.S. and European approval of a potentially lucrative product.

"There is a clear distinction to be drawn between what you would call 
medical marijuana and Sativex, which is the name of a medicine," says Mark 
Rogerson, a GW spokesman. "Medical marijuana is smoking a joint or baking a 
cake. This is a prescription medicine for MS."

Multiple sclerosis is a chronic disease of the central nervous system 
(brain, spinal cord and optic nerves) that affects people in unpredictable 
ways. Some patients suffer from spasticity, causing the muscles to lock up; 
others, like Myrden, shake or have excruciating pain.

In Britain, GW has focused on Sativex as a treatment for spasticity. So far 
the British government has refused to approve it without more evidence it 
works for that purpose.

In Canada, however, Sativex has been approved for use in treating 
neuropathic pain, another common symptom.

Myrden, a disabled former corrections officer and one of 50,000 Canadians 
with MS, says Sativex helps relieve pain but is not as cheap or effective 
as the plant.

Unlike the other drugs she takes, Sativex is not covered by Ontario's 
health care program. A small bottle, with enough sprays to last Myrden just 
31/2 days, costs $125.

For Sativex to gain wider use, "it has to be cost effective," says Myrden, 
who lives on government disability and help from her mother and boyfriend. 
"It's about $1,000 a month - where am I going to get money for my next 

By comparison, it costs Myrden about $400 a month to buy marijuana from 
compassion clubs, the quasilegal establishments that sell it for medicinal 
purposes. She is also among a few hundred Canadians licensed by the 
government to grow marijuana and smoke it wherever tobacco cigarettes are 

Despite its high price, Sativex is less effective than regular marijuana, 
Myrden has found. She never used marijuana before developing MS, she says, 
but now smokes it several times a day and eats it in oatmeal cookies.

With the right strain of marijuana, "I can get rid of the pain in minutes 
for two hours. I would rely on marijuana hands down - it's the only thing 
that gives me quality of life."

The Multiple Sclerosis Society of Canada considers Sativex "just another" 
treatment for MS-related symptoms.

That it comes in spray form and is obtainable only by prescription "is a 
little more reassuring because it's less apt to be abused," says Dr. 
William McIlroy, the society's medical adviser. "The majority of doctors in 
Canada don't want to be known as the primary source of smoked marijuana."

In the United States, where MS afflicts 400,000, the National Multiple 
Sclerosis Society says anecdotal evidence suggests marijuana can help 
reduce MS-related pain. But it remains difficult to measure relief 
objectively: Participants in one study realized they were getting a 
cannabinoid-based treatment instead of a placebo when they developed the 
dry mouth and lightheadedness familiar to marijuana users.

"So far the studies that have purported to show the benefits of marijuana 
have not been well-blinded, and so people knew what they were receiving," 
says John Richert, the society's vice president for research. "That makes 
it impossible to distinguish whether one is seeing a true effect of the 
treatment or whether it is a placebo effect."

As for Sativex, "there is still no good scientific study that proves its 
efficacy," Richert says.

GW Pharmaceuticals has yet to formally seek approval for Sativex in the 
United States, though it has "started the process" of talking to the Food 
and Drug Administration, says Rogerson, the GW spokesman. "No disrespect to 
the FDA, but we would expect it be a longer process in the States."

Advocates of medical marijuana claim the U.S. government has made it 
difficult to do scientific research into the plant's therapeutic effects. 
Researchers must get federal approval for their studies and must use 
marijuana from a government farm in Mississippi.

"This is the only drug in America for which the only source for research 
purposes is the U.S. government, and they have a reputation for producing 
not very good quality stuff," says Ethan Nadelmann, executive director of 
the Drug Policy Alliance, which advocates more liberal drug policies.

Availability of the Mississippi marijuana used to be limited to those 
studying the plant's effects on behavior and reasoning. But the government 
began giving it to other researchers after a federal advisory panel found 
enough evidence of marijuana's medical benefits to warrant additional study.

"Except for the harm associated with smoking, the adverse effects of 
marijuana are within the range of effects tolerated for other medicines," 
said a report by the Institute of Medicine.

Thousands of people with MS, cancer, AIDS and other diseases routinely use 
marijuana in California and the 10 other states with medical marijuana 
laws. (Florida is not among them.) In June, however, the Supreme Court 
ruled that the federal government still can ban marijuana possession in 
states that have eliminated penalties for its therapeutic use.

That's unfortunate, says Myrden, who applauds the Canadian government for 
approving Sativex and allowing sick people to use marijuana in other forms 
as well.

"I'm really excited this is available," she says of Sativex, "but you have 
to realize the natural form is just as good if not better."
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