Pubdate: Tue, 01 Nov 2011
Source: Ottawa Citizen (CN ON)
Copyright: 2011 The Ottawa Citizen
Contact: http://www.canada.com/ottawacitizen/letters.html
Website: http://www.canada.com/ottawacitizen/
Details: http://www.mapinc.org/media/326
Author: Sharon Kirkey
Bookmark: http://www.mapinc.org/mjcn.htm (Cannabis - Canada)
Bookmark: http://www.mapinc.org/mmj.htm (Cannabis - Medicinal)

DOCTORS REFUSE TO OK MARIJUANA USE

Patients Left in Pain; Some Users Risked Being Jailed for Using a 
Drug That Helps Them Function. and Proposed Health Canada Changes 
Could Make the Situation Worse, Writes Sharon Kirkey

A decade after Canada legalized the medical use of marijuana, most 
doctors are still refusing to sign the declarations patients need to 
get legal access to pot - meaning patients in pain risk being jailed 
if they use a drug that helps them function.

It's a predicament that threatens to become worse because of proposed 
changes to how Health Canada regulates access to the drug.

At first glance, it appears the government is easing up on strict 
rules for obtaining medicinal marijuana. Health Canada has proposed 
removing itself as the ultimate arbiter in approving or rejecting 
applications to possess.

Instead, doctors alone would sign off on requests.

But the nation's largest doctors' group said the proposals would have 
the perverse effect of putting even greater pressure on MDs to 
control access to a largely untested and unregulated substance they 
know little to nothing about; a drug that hasn't gone through the 
normal regulatory review process. Their licensing bodies have told 
doctors that they are under no obligation to complete a medical 
declaration under the current regulations and that any one who 
chooses to do so should "proceed with caution."

Dr. John Haggie, president of the 75,000-member Canadian Medical 
Association, said the changes being proposed would essentially off 
load all responsibility for using and monitoring marijuana to the 
doctors who sign an authorization - "and they'd be kind out of out 
there, without any infrastructure around them to assess it, to 
monitor it and to know if they were doing the right thing.

"I don't think that's appropriate or fair," he said.

Observers said doctors fear doing harm, exposing themselves to legal 
action and becoming the "go-to" source for people seeking pot not to 
alter their pain but to alter their consciousness.

Haggie said physicians want fundamental research into some basic 
questions - is it safe? Who does it work for? Who should not use it? 
Yet the Conservative government abruptly terminated a medicinal 
marijuana research program in 2006. According to Health Canada, the 
government believes clinical research is "best undertaken by the 
private sector, such as pharmaceutical companies."

A world leader in cannabis research said the logic defies him.

"I cannot imagine how a government agency can supervise (a marijuana 
access) program knowing that there is very little data out there - on 
safety issues in particular - and not try to stimulate research," 
said Dr. Mark Ware, head of the Canadian Consortium for the 
Investigation of Cannabinoids, a non-profit network of more than 150 
clinicians and researchers investigating the potential role of 
cannabinoids in diseases from arthritis to glaucoma.

No drug company wants to evaluate smoked marijuana as a medicine, 
Ware said, because there's no money in it for them. Funding agencies 
have been less than approachable, he added, because there's little 
appetite to support studies involving a product that's often smoked. 
In clinical parlance, "They don't see it as a safe, viable drug 
delivery system," said Ware, director of clinical research at the 
Alan Edwards Pain Management Unit at the McGill University Health Centre.

Ware said he wonders how much the government's disinterest in 
research might be tied to its toughon-crime political agenda - "that 
somehow facilitating research on medicinal cannabis is a way of 
accepting that it may have some value as a medicine."

The Montreal doctor, who is helping reform medical school curricula 
to better educate physicians around pain, received about $2 million 
under the now-dead medicinal marijuana research program. In a study 
published in the Canadian Medical Association Journal last year that 
involved 21 patients with neuropathic pain - a common and dreaded 
condition that causes electric, stabbing pain - Ware's group found 
that smoked cannabis at low doses reduces pain, improves mood and 
helps sleep, without making people high. All had "refractory" pain, 
meaning pain that had defied all traditional treatments. No serious 
or unexpected side effects were reported.

Ware avoids prescribing cannabis to patients with a history of 
psychosis or schizophrenia, because it's psychoactive at high doses - 
and sometimes even therapeutic doses. It can also be dangerous to 
people with unstable heart disease.

Still, there has never been a proven overdose death caused by 
marijuana in humans, according to Ontario's highest court. Ware said 
that for patients for whom it works, cannabis can achieve about 30 
per cent reduction in pain intensity.

But doctors remain wary - their chief concern being: How do I know 
when a patient is seeking a licence for a legitimate medical purpose 
and not simply to get legal access to an otherwise illicit drug?

Ware's consortium has been working hard to educate and support 
doctors around the use of cannabis. He said data from Health Canada 
suggest that the average medical user is consuming two grams per day 
- - about four joints when smoked. "It's just taking that information 
and getting it into the hands of practising physicians. Then at least 
they know what the ballpark is."

Some patients were getting authorizations for far higher amounts, 
because doctors didn't know that 30 or 40 grams a day could be 
outside the "normal" range, he said.

Health Canada said the proposed changes to the program - which would 
include removing the rights of patients to grow their own supply of 
marijuana or to appoint designated growers, forcing users to get 
their pot from a licensed commercial producer instead - would make 
the program less complicated for seriously ill Canadians.

Paul Lewin begs to differ. Doctors already are boycotting the program 
en masse, the Toronto lawyer said. Lewin said medical regulators and 
insurers sent letters to the government, "saying, 'Don't put us in 
charge, don't make us a gatekeeper, we don't know anything about pot, 
this is a plant product, it's an unapproved drug.' "

Lewin said the court heard stories of how some doctors encouraged 
their patients to use pot for their pain. The patients would return, 
reporting that the marijuana was helping, that they were feeling less 
pain. But when they asked the doctors to sign their forms, "that's 
when the mood changes," Lewin said.

"That's when they say, 'Get out. I'm not risking my practice over you.' "

Lewin's client, Matt Mernagh, started growing marijuana when he found 
it provided some relief from chronic pain and other symptoms of 
scoliosis, fibromyalgia and epilepsy. But he couldn't get a licence 
to grow, because he couldn't find a doctor to sign his declaration.

Police found Mernagh's plants in 2008 when they were in his apartment 
building on an unrelated call. He was charged with production.

Lewin took the case to the Superior Court in Ontario. The court 
declared the federal medical marijuana program unconstitutional. The 
case is scheduled to go to the Court of Appeal for Ontario in March.

Lewin said the proposed changes to the marijuana access program are 
likely to scare off some of the few doctors willing to sign 
declarations, meaning "more seriously ill, lawabiding Canadians will 
be wrongfully treated as criminals" and subjected to humiliating 
arrests, medicine seizures and possibly even jailed, he said.

Twitter.com/sharon_kirkey

AUTHORIZATION TO POSSESS MARIJUANA

In 2001, 727 doctors supported an application for an authorization to 
possess marijuana. In 2010, 3,187 doctors signed a declaration. 
Between Jan. 1 and Oct. 25, 3,803 doctors supported an application 
for an authorization to possess.

As of Sept. 30, 12,216 people in Canada held authorization to possess 
marijuana for medical purposes.

Who has authority to approve or reject submissions in the new system?

Under the proposed changes, patients would continue to consult with 
their physician in order to obtain access to marijuana for medical 
purposes. Once it has been determined that the use of marijuana for 
medical purposes is appropriate, the physician would provide the 
individual with a document. Health Canada is consulting the medical 
community on the form that this document would take.

Individuals would then send the physician's document directly to a 
licensed commercial producer of their choice. The licensed producer 
would validate the document from the physician by confirming that the 
physician is licensed to practice medicine in Canada. The licensed 
producer would register the individual as a customer and would 
process the order for a specific amount of dried marijuana. Health 
Canada would maintain an up-to-date list of licensed producers on its 
website, and work with the medical community to disseminate this 
information as widely as possible.
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MAP posted-by: Jay Bergstrom