Pubdate: Tue, 21 Jun 2005
Source: StarPhoenix, The (CN SN)
Copyright: 2005 The StarPhoenix
Contact:  http://www.canada.com/saskatoon/starphoenix/
Details: http://www.mapinc.org/media/400
Author: Janet French
Bookmark: http://www.mapinc.org/mjcn.htm (Cannabis - Canada)
Bookmark: http://www.mapinc.org/find?232 (Chronic Pain)
Bookmark: http://www.mapinc.org/topics/Sativex (Sativex)

MS SUFFERERS GAIN ACCESS TO NEW DRUG

Pot-Based Spray Dulls Neuropathic Pain

A marijuana mouth spray approved to treat tingling and burning chronic pain 
in multiple sclerosis patients hit pharmacy shelves across Canada on Monday.

But Saskatchewan patients who want to try the drug may have to hunt around 
to find a doctor willing to prescribe it. And at $124.95 for a 10-day 
supply, users will also be reaching deep into their own pockets -- the drug 
isn't yet covered by any public or private health-care plans.

Jan Britz, a registered nurse and clinic co-ordinator of the Saskatoon MS 
Clinic at City Hospital, said clinic staff will carefully examine the drug 
and its potential side effects before doctors prescribe it to any patients.

"Because we're not a big promoter of the use of marijuana in itself, what 
we have requested is being able to see copies of the clinical trials that 
were done, just so we have more information about the medication before we 
would ever consider prescribing it," Britz said.

"The last thing you want to do is bring harm to the patients in your 
prescribing practice," she said.

Canada was the first country in the world to approve Sativex for use in MS 
patients who experience neuropathic pain, a sensation Britz described as an 
intense burning discomfort deep inside that sometimes tingles like pins and 
needles.

About half of the 50,000 Canadians who have the disease, which causes a 
deterioration of a protective layer of cells around nerves, experience 
chronic pain. Other symptoms include visual disturbances, balance and 
co-ordination problems, spasticity, altered sensations and fatigue.

The drug is an extract from cannabis plants containing active ingredients 
delta-9-tetrahydrocannabinol (THC) and cannabidiol (CBD). Patients squirt 
the peppermint-flavoured spray under their tongue or in the side of their 
cheek four or five times a day to dull the pain.

The drug attaches to receptors in the brain, which helps reduce pain and 
spastic movements, said Allan Gordon, a neurologist and director of the 
Wasser Pain Management Centre at Mount Sinai Hospital in Toronto.

"It's quite exciting," he said. "My patients are very anxious to try it."

Although doctors currently prescribe some epilepsy medications and 
antidepressants to MS patients for neuropathic pain, they aren't effective 
in everyone, he said.

"People have tried other things like acupuncture but many things do not 
work for this kind of pain," Gordon said.

Laurie Murphy, acting director of client services with the Multiple 
Sclerosis Society of Canada's Saskatchewan chapter, said she's glad 
patients will have a legal alternative to smoking marijuana.

Gordon said a third of the patients his clinic has seen have tried 
self-medicating with marijuana at least once.

"I think it's wonderful . . . there's possibly a treatment out there that 
has less side effects that might be able to still treat this neuropathic 
pain that is very difficult to treat," Murphy said. "I'm very happy that 
they have another option that's available to them that's legal so they 
don't feel that they have to sneak around to get something that might give 
them some relief."

Medicinal marijuana is a bureaucratic slog for patients to access and comes 
with other side effects Sativex may be free from, she said.

Despite the risks, Murphy isn't sure dedicated marijuana users will 
relinquish their pipes in exchange for this new alternative.

"I don't know that somebody who was already receiving benefit from a 
marijuana joint is going to be willing to give that up that easily," she said.

Britz said she's also concerned the drug could be abused by users who 
consume it to try and get high.

"Once the patient has filled that prescription, you don't have a lot of 
control over how they're using it," she said.

She hopes the cost of the drug will deter users from taking more than they 
need.

Gordon agrees doctors should be cautious when handing out a prescription.

"The individual prescribing it needs to know a lot about it and needs to 
take the proper precautions to look at addiction issues and other drug 
interactions," he said. "I think (doctors would) be willing to do it, but 
they need knowledge -- the kind of knowledge as if they were prescribing 
any other significant pain drug."

Currently, the drug is only approved for use by Canadian MS patients. 
Gordon said studies are ongoing to see if the painkiller will work for 
other types of nerve pain, such as in diabetes.
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MAP posted-by: Beth