Pubdate: Wed, 12 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: A7

MINISTER URGES CAUTION ON POT

Opening First Medical Marijuana Clinic Was Premature, Barrette Says

Rules imposed by Ottawa last spring put physicians in a rough 
position of operating in the dark when it comes to prescribing 
marijuana, Quebec Health Minister Gaetan Barrette said after 
Montreal's first medical marijuana clinic opened its doors to patients Tuesday.

There could be accidents, Barrette told reporters, since marijuana 
did not go though the usual drug approval process: "We're 
experimenting. What is happening today is total experimentation."

Doctors are unsure of dosages, Barrette said, but stopped short of 
demanding the Sante Cannabis clinic be shuttered.

It will be up to Quebec's professional order of physicians to set 
guidelines on therapeutic use of cannabis, Barrette said. The College 
des medecins du Quebec is preparing guidelines for prescription under 
a research framework for next January.

But it was premature to open such a clinic, said Barrette, who urged 
doctors "to move with caution."

Pain specialist Mark Ware, director of clinical research at the Alan 
Edwards Pain Management Unit at the McGill University Health Centre, 
said he was in no position to comment on the opening of the new clinic.

But there is a scientific rationale for the use of marijuana in 
therapy, said Ware, who heads a Canadian consortium that evaluates 
the safety and effectiveness of medicines derived from cannabis.

Nearly everyone has heard of endorphins, the body's own production of 
feel-good opioids in the brain that help with stress, pain and 
depression, he said. "We have a similar, parallel system of 
cannabinoids receptors and these play a very important role in 
everyday physiological processes - mood, eating, sleeping, movements 
and pain management."

Several molecules derived from cannabis are already approved as 
pharmaceutical preparations, Ware said, "and of course, there is 
herbal marijuana, which is crude but nonetheless an important 
potential mechanism to harness this system."

But cannabis is unique, Ware said. It is not approved as a drug or as 
a natural product. Canadians have access for medical purposes under a 
federal program of regulation but outside of a drug approval process 
because the courts found it unconstitutional to keep it illegal for 
patients with genuine need.

"A lot of people miss the fact that it's not Health Canada that 
decided to make it available, but the courts. Patients couldn't use 
it because it wasn't legal. There have been some important court 
cases of patients with severe epilepsy and HIV whose use of cannabis 
was demonstrable - at least to the courts - so that the rules had to 
be rewritten."

Several small-scale clinical studies in pain patients demonstrated 
safety and pain relief, while studies looking at healthy recreational 
users also provided vital information, he said: "We know what the 
major risks are."

There is a lot more information out there, Ware said, just not in a 
package that physicians are used to, and stigma continues to hamper 
medical usage.

"It's hard to get away from the stereotype of the cannabis street 
user to the ill patient trying to get symptom relief," he said. "It's 
very difficult to tease those two apart in the public eye, and in 
fact, the professional arena as well."

The research framework proposed by the College will help provide data 
that is missing, he added.

- - Geoffrey Vendeville of the Montreal Gazette contributed to this report
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MAP posted-by: Jay Bergstrom