Pubdate: Sat, 21 May 2011
Source: Vancouver Sun (CN BC)
Copyright: 2011 The Vancouver Sun
Author: Pamela Fayerman, Vancouver Sun
Cited: Canadians for Safe Access
Bookmark: (Marijuana - Medicinal - Canada)
Bookmark: (Canada)


Lalanya Blue McGraw believes cannabis is slowing her cancer while 
easing her pain. She's not alone. In B.C., thousands have turned to 
the drug for relief, despite murky scientific evidence

Living with incurable cancer, after a third relapse of Hodgkin's 
lymphoma, 39-year-old Lalanya Blue McGraw credits the daily use of 
medical marijuana for allowing her to make the most of what may be 
borrowed time.

"I've been considered terminal for a long time. The cancer is still 
there, even after all the chemo and two bone marrow transplants. When 
it gets worse, I can go into a clinical trial with a chemo drug that 
has not yet been approved in Canada. But until then, I have defied 
the odds," says the Vancouver resident, a former jazz singer whose 
voice has been affected by the disease.

"I think, I believe, it's the cannabis that is slowing the cancer 
down. That's my perspective anyway. It's the only thing I'm on."

When McGraw first asked an oncologist at the BC Cancer Agency in 2002 
to prescribe marijuana to treat some of the effects of her cancer, he 
was reluctant. He didn't object to her using it, but balked at 
dealing with the Health Canada paperwork required when prescribing 
any one of four products that can be obtained through the federal 
Medical Marijuana Access Regulations, she says.

In 2001, Health Canada delegated the responsibility for prescribing 
marijuana to doctors, who must fill out one of two forms attesting to 
the fact their patients fit certain criteria. The first form asks 
doctors to confirm their patient has a cancer or degenerative 
neuromuscular condition that might benefit from marijuana. If doctors 
don't feel they can attest to that, they must fill out an alternate, 
longer form that can take 20 minutes to complete.

After her last relapse a few years ago, McGraw joined the Compassion 
Club, which has a simple form with check boxes. She had a new family 
doctor who had moved from Ontario and McGraw said she didn't hesitate 
to sign the form.

"I just printed off the Internet form and took it into her. She was 
very familiar with it and giggled as she checked off the boxes."

The Compassion Club form takes only a minute to complete and doctors 
don't have to do much more than declare that the patient reports 
their symptoms are helped by cannabis.

Unlike the federal forms, it does not protect patients from 
prosecution for possession but, as an article in the B.C. Medical 
Journal said: "Practically .. police are usually reluctant to 
prosecute a patient who has a physician endorsement for possession of 

McGraw buys marijuana from the club dispensary in various forms -most 
often in a $15 tincture vial from which she extracts drops that she 
places on her tongue. It calms her mood, alleviates any nausea and 
helps her sleep. Although she sometimes smokes it in the dried form, 
she says it can make her feel "too goofy."

She also buys an olive oil infused with cannabis, "but that's mostly 
when I want to put it in brownies to spoil myself on my birthday," she says.

McGraw was calm throughout the interview, despite facing several 
questions about her own mortality. That sense of calm broke, however, 
when she was asked about her first experiences with the Compassion 
Club. She got teary as she recalled being fast-tracked during her 
orientation process because of her incurable form of cancer.

"It is an exceptionally supportive environment at the Compassion 
Club. I remember on my first visit, a guy with crutches came over to 
me and whispered in my ear to say 'everyone is very friendly in 
here.' And they are. It has definitely become a family for me. I 
don't have the people I've met there over for dinner or anything, but 
in the waiting room there is a passive, friendly vibe. No one tries 
to upstage anyone else when it comes to medical problems. Everyone is 
respectful and compassionate."

Doctors Respond

Thousands of doctors in B.C. have prescribed marijuana over the past 
several years to their patients even though their advocacy and 
regulatory bodies aren't convinced on the scientific evidence.

Dr. Pippa Hawley is one of them.

Although she agrees with the College of Physicians and Surgeons of 
B.C. and the Canadian Medical Association -which both contend the 
lack of credible information makes prescribing marijuana potentially 
dangerous because of unknown risks, benefits, complications and drug 
interactions -Hawley is one of several specialists at the BC Cancer 
Agency who prescribes medicinal marijuana.

"I don't set myself up as a marijuana prescriber. I'm a physician and 
if marijuana, or one of its derivatives, is an appropriate management 
strategy for a particular patient then I have no problem facilitating 
access to it, either by prescribing it or filling in the forms for 
them to take to the Compassion Club. But that doesn't make me an 
enthusiast," says the internal medicine specialist who started the 
Pain and Symptom Management/ Palliative Care program at the BC Cancer Agency.

Hawley was surprised to hear that, according to the most recent 
Health Canada information, 1,773 B.C. doctors have helped 3,627 
patients get permission to legally possess marijuana.

That figure is the highest in Canada, more even than Ontario where 
1,693 doctors signed authorizations for 3,427 patients. Even Quebec, 
which like Ontario has a far greater population than B.C., has only 
306 doctors prescribing marijuana.

While 1,773 B.C. doctors have filled out the official forms to 
authorize patient use of "medicinal" marijuana, the Compassion Club, 
the oldest medical marijuana dispensary in Canada, says many more 
doctors have signed off on the club's less onerous -albeit quasi-legal -form.

It says 3,400 B.C. doctors, including medical doctors, naturopaths 
and traditional Chinese medicine practitioners, have referred 
patients there in the past 14 years.

The Compassion Club says it has about 4,000 members for a total of 
6,500 since it opened its doors in 1997.

While patients and marijuana advocates have complained over the years 
about the lack of enthusiasm on the part of doctors, Hawley says she 
knows of no colleagues withholding access to medicinal marijuana.

"Not that I think they are fantastic products. There may be doctors 
who aren't keen on marijuana, but I don't think anyone would deny a 
patient access if it was medically justifiable," she says.

"With all symptom control there is a degree of trial and error 
because everyone is different, but particular pain syndromes that can 
respond well to marijuana are the ones where there is neuropathic 
nerve pain or if there are a lot of muscle spasms.

"And it is not well documented, but people who have difficulty with 
anxiety, especially if they have been recreational users of marijuana 
in the past, may be those ones who tend to do well," she says.

Since marijuana is known to sometimes carry side effects, Hawley says 
doctors have to be aware of that.

"It can make people paranoid. That's why we have to be careful about 
being too liberal with it. People who have already been recreational 
users tend to know their threshold."

The oral (pill) form is good for treating nausea and poor appetite, 
but when pain and anxiety are the main complaints, then a spray 
inside the mouth can be prescribed.

The Health Canada form allows patients to possess dried marijuana for 
smoking; they also can grow it themselves or buy it from authorized 
growers. Hawley said some patients prefer she fill out the Health 
Canada form instead of the Compassion Club form, but she has to warn 
them that it can take weeks or months for processing by the 
government so "forget it for people at the end of their life; they 
are better off going to the Compassion Club or some other dispensary."

Those who favour - about one in three patients - going the Health 
Canada route are patients who tell her they feel more secure knowing 
they have the full legal, Health Canada designation, especially if 
they have a history of any drug infractions, she says.

Hawley says she wouldn't be surprised to hear that family doctors 
sometimes encounter patients who ask for the authorizations just 
because the marijuana is so much cheaper when bought from the 
Compassion Club rather than from dealers on the street.

"There may be some patients who are faking something. But if someone 
has a genuine pain problem and they are reasonable people who have 
not behaved dysfunctionally, have not been aggressive or abused 
previous prescriptions, have been polite and pleasant, then I think 
very few doctors would have problems filling out the forms."

She says a third to a half of cancer patients report that medical 
marijuana provides symptom relief.

"I give people fairly low expectations when I first prescribe and I 
am more receptive to prescribing if they have tried other stuff [like 
methadone] but not responded."

Some patients hate the "spacey" side-effect of marijuana because they 
don't like feeling different, while others find it to be a pleasurable effect.

Opinion Divided

Getting any kind of agreement on the pros, cons, risks and benefits 
of marijuana is seemingly impossible.

The Canadian Medical Association's position statement on medical 
marijuana has evolved over time.

Initially, it "vigorously" opposed making physicians part of the 
supply chain because of the lack of evidence. More recently, it has 
stated it accepts that physicians who feel qualified to recommend 
medical marijuana to their patients do so in accordance with Health 
Canada regulations, which ask doctors to attest to a diagnosis and 
the failure of conventional therapies.

It has encouraged government to fund research on safety, dosing and 
delivery systems.

And it has endorsed compulsory education and licensing programs for 
doctors who do prescribe.

The doctors' legal defence agency, the Canadian Medical Protective 
Association, has told its members that anyone who is uncomfortable 
with the Health Canada regulations should refrain from prescribing 
the drug to patients.

In B.C., the College of Physicians and Surgeons has a position 
statement that says the lack of good evidence on smoked marijuana's 
medicinal use makes it "difficult and possibly dangerous for 
physicians to prescribe," especially because of uncertainty about 
interactions with other drugs.

Doctors could be "the subject of accusations or suggestions of 
negligence, including liability if a prescribed drug [like marijuana] 
produces unforeseen or unidentified negative effects."

Like the CMA, the college says only doctors who are familiar with the 
pharmacology of marijuana should prescribe it.

A medical literature search on marijuana will turn up anywhere from 
12,000 to 15,000 articles and studies. But Dr. Robbert Vroom, senior 
deputy registrar of the college, says there is a "minuscule" number 
with "real science" methodology.

If the evidence was clear, then doctors across Canada would be 
uniformly prescribing, he says.

Instead, B.C. now has the highest number of doctors prescribing - 
"seven times more per capita than Quebec" - a situation he attributes 
to the "lack of robust evidence-based guidelines as well as a 
spillover of the highly prevalent use of recreational marijuana in B.C."

Vroom, a former emergency room doctor at Surrey Memorial Hospital, 
said he doesn't doubt that some patients experience benefits when 
they use marijuana.

He said they may well be the same kinds of people who turn to "the 
comfort and pleasure of a substance they enjoyed in the past, be it 
tobacco, wine or Scotch."

"I maintain that medical marijuana is a substance of unknown 
composition, potency, or dose administered by smoke inhalation, 
foisted on the medical profession for us to gate-keep," said Vroom, 
in a recent letter in the BC Medical Journal.

He was rebutting a letter from Philippe Lucas and Rielle Capler, 
co-founders of the advocacy organization Canadians for Safe Access, 
who contend that "the fact that cannabis has an excellent reputation 
as a recreational drug in no way negates the evidence of the efficacy 
and relative safety of its medical use."



A Four-Part Series

FRIDAY: Health vs. safety: Municipalities raise concerns over grow-ops

TODAY: The human case for medical marijuana

TUESDAY: The law

WEDNESDAY: Criminal concerns 
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