Pubdate: Sat, 10 Dec 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: Glen McGregor
Page: 1

ARTHRITIS CLAIMS PUSH HUGE SURGE IN DEMAND

Patients with other ailments may resort to citing severe arthritis on 
applications in effort to get medical marijuana more easily

The federal government has seen a staggering increase in requests for 
medical marijuana authorizations from applicants claiming they have 
severe arthritis to legally obtain the drug.

Applications to Health Canada based on severe arthritis jumped 2,400 
per cent between 2008 and 2010, far outstripping the number of claims 
for cancer, HIV/AIDS and other serious diseases, a Citizen analysis has found.

The spike in arthritis claims was part of an overall rise in 
applications over the past three years, as more private clinics 
specializing in marijuana began referring patients to pot-friendly 
doctors willing to sign their forms.

But unless there has been an enormous, undocumented surge in 
arthritis rates in Canada over the past three years, the data 
suggests that patients or their doctors may be gaming the 
government's rules to obtain medical marijuana more easily.

Arthritis was listed as the reason for 40 per cent of all 
applications under the Marihuana Medical Access Regulations (MMAR) 
received so far in 2011. That was double the rate seen in 2008, 
according to electronic records released to the Citizen under the 
Access to Information Act.

Severe arthritis is one of the Category 1 illnesses that require the 
signature of just a single doctor under Health Canada rules. Cancer, 
multiple sclerosis, HIV/ AIDS infections and spinal cord injuries and 
disease and are also listed in Category 1, but often have more 
obvious visible symptoms than arthritis.

Patients with Category 2 illnesses such as hepatitis, glaucoma or 
ulcerative colitis must go through the additional step of getting a 
specialist to sign their applications, a process that can take many 
months and does not always succeed. Some marijuana advocates believe 
that patients are asking doctors to sign off on the faster Category 1 
condition of severe arthritis to speed their applications.

"I think a lot of people are applying under arthritis even if they 
may have a different condition,"  says Scott Gilbert, who runs the 
Hamilton Medical Marijuana Centre. "They are going with whatever is 
the easier one to get approved on."

Although a patient might otherwise qualify for authorization based on 
a Category 2 illness such as fibromyalgia or Crohn's disease, a savvy 
doctor familiar with the MMAR program might ask if the patient has 
arthritis, too.

Health Canada is conducting a review of MMAR and plans to overhaul 
the way the program works, in part by transferring more authority to 
doctors. The department says it is required to approve applications 
that have been signed by a doctor and meet the conditions of the 
MMAR. It has noticed the sharp increase in marijuana applications, 
but doesn't know why, exactly, the numbers are rising so sharply.

"Increasing awareness of the program among patient groups and 
treating physicians is likely a key contributing factor,"  said 
Health Canada spokesman Gary Holub in an email.

The department is also aware of the increase in arthritis claims, Holub said.

"The risk of abuse exists within the current system. That's why 
changes are being proposed that will balance the legitimate needs of 
patients, while reducing the risk of abuse."

Patients often complain that the refusal of doctors to approve their 
applications is the greatest obstacle to entering the program. But 
the surging number of applications suggest they are finding other 
ways to get approved within the rules. Many privately-run clinics are 
sprouting up across the country, with in-house physicians to sign the 
33-page Health Canada application form or provide referrals to 
doctors who are willing.

The Do No Harm Clinic in Kelowna, B.C., for example, has helped 
process applications for more than 500 patients over the past two 
years. It serves patients who have been unable to find a doctor to 
sign their forms and will provide a physician to consult over the 
Internet with patients anywhere in the country.

A doctor who works at the clinic agreed to speak to the Citizen about 
his practice on the condition he not be named, as he does not want to 
be deluged with requests from potential patients. The Citizen 
confirmed his identity.

"Medical marijuana is not a prescription,"  he said. "I don't have to 
touch the patient to see they have cancer."

But he says he will not list severe arthritis or other illness on the 
application unless the patient can produce documentation of the 
disease provided by a specialist.

"We would make sure you've seen a specialist,"  he said. "If you have 
severe arthritis, are you telling me you wouldn't have seen a rheumatologist?"

He acknowledged, however, that some other Canadian marijuana clinics 
are moving to what he calls the California model, where a patient 
walks in off the street and gets a doctor to sign the forms on the spot.

"That kind of thing goes on,"  he says, but he notes patients can do 
the same thing if they present with back pain to get a prescription 
for Oxycodone, a powerful and addictive pharmaceutical painkiller.

The doctor volunteers his services, but the clinic charges $400 to 
help patients complete the Health Canada application form.

Gilbert's clinic in Hamilton works a bit differently, pre-screening 
patients with cancer, HIV and other conditions and, where suitable, 
sending them to doctors in the community known to be comfortable 
prescribing marijuana.

While many of the clients he refers will buy their marijuana from 
Health Canada's supplier, some will choose to name a staff member of 
his clinic as their designated grower.

Health Canada's rules say one person can supply marijuana to only two 
approved patients. That means for every two clients who ask him to 
grow, Gilbert must hire another employee as a grower. He employs them 
only temporarily, on planting and harvesting days, a tactic he says 
has the approval of local police and municipal authorities.

Before he opened his clinic in Hamilton in June, Gilbert was arrested 
and charged with seven drug trafficking offences related to a 
"compassion club"  he helped run in Guelph. The charges are still 
pending, he said.

Compassion clubs sell marijuana to sick people without Health Canada 
approval, making them vulnerable to arrest and prosecution. There 
have been raids of clubs in Toronto and Montreal, possibly forcing 
some medical marijuana patients to turn to Health Canada to buy pot legally.

An increasing number of private clinics and services are working 
within the system to arrange approval under Health Canada's rules "" 
some charging processing fees.

For $450 plus tax, the Medical Cannabis Resource Centre in downtown 
Vancouver will hook up a patient with a doctor on Skype to confirm 
identity. Like the Do No Harm Clinic, the centre requires a statement 
of diagnosis of a pre-existing condition from another doctor.

These clinics are trying to work around the problems in Health 
Canada's rules to get marijuana to patients who need it, says Rielle 
Capler of the Canadian Association of Medical Cannabis Dispenseries.

"Whether they're entrepreneurs or well-meaning physicians, they're 
stepping in to fill these gaps,"  she said.

Capler says she's concerned about clinics asking large fees from 
patients who are often too sick to work and living on fixed incomes.

"There are some that have been charging $500. But this is what it has come to."
- ---
MAP posted-by: Keith Brilhart