Pubdate: Fri, 07 Nov 2014
Source: Montreal Gazette (CN QU)
Copyright: 2014 Postmedia Network Inc.
Contact:  http://www.montrealgazette.com/
Details: http://www.mapinc.org/media/274
Author: Charlie Fidelman
Page: 4

SYMPOSIUM TO STUDY USE OF MEDICAL MARIJUANA

As of April, Health Canada gave doctors the go-ahead to prescribe 
medical marijuana, but to which patient and at what dose?

It was put in the hands of physicians who did not know what to 
prescribe "for lack of hard evidence," says Denis deBlois, Universite 
de Montreal professor of pharmacy and co-director of a research group 
on medication.

Marijuana for therapeutic reasons remains controversial. Few clinical 
trials have evaluated its effects. Which conditions does it help?

There's a strict process of evaluation of risk-to-benefit ratio 
before Health Canada gives its stamp of approval to a medication, but 
that's not the case for marijuana, said deBlois, a co-organizer of a 
one-day symposium on medical marijuana that takes place Friday and 
brings together experts in pain management, addiction, and drug monitoring.

"What we need is data," deBlois said. A body of anecdotal evidence 
suggests pot may be useful and well tolerated, but there is a lack of 
systematic scientific evidence.

Many physicians are uncomfortable having the onus shifted on their 
shoulders, deBlois said, considering that pot is an illegal substance.

A landmark study by pain specialist Marc Ware, director of clinical 
research at the Alan Edwards Pain Management Unit at the McGill 
University Health Centre, found that smoked cannabis alleviates 
neuropathic pain, a chronic condition caused by nerve injury from 
trauma or surgery. The study was published in the Canadian Medical 
Association Journal in 2010.

Under the new regulations, patients with prescriptions for pot can no 
longer grow their own but must use medical-grade marijuana from 
private operations authorized to grow and sell pot by Health Canada.

According to the College of Family Physicians of Canada guidelines, 
doctors should only prescribe marijuana for treatment of pain when 
all other treatments have failed. It is not recommended for people 
under 25 and for those with a history of psychosis or drug abuse. 
It's also not recommended for the treatment of insomnia and anxiety.

The Quebec order of physicians initially said that Quebec doctors 
would not be authorized to provide access to medical marijuana, but 
has recently come out with its own restrictions.

Under Quebec's new protocol, which will not go into effect until 
early 2015, physicians will only be able to prescribe cannabis under 
the context of research. They will have to register patients, 
maintain follow-up, "and gather data that will be used in 
pharmcovigilance, an ongoing monitoring of benefit-risk ratio," deBlois said.

The gradual shift in the way medical marijuana is being administered 
in Canada has raised a number of issues including the need for more 
education, said Ware, who is also the executive director of the 
non-profit Canadian Consortium for the Investigation of Cannabinoids, 
which provides educational material to health professionals so they 
can have informed discussions about possible medical use of cannabis 
with patients.

Several strains of medical cannabis are available from government 
approved growers and they need to be evaluated for safety and 
efficacy in a population of patients that often suffers from more 
than one condition, Ware said. Quebec's new tracking policy will be a 
good opportunity to inform patients and doctors and policy-makers, he said.
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MAP posted-by: Jay Bergstrom