Pubdate: Sat, 20 Dec 2014
Source: Windsor Star (CN ON)
Copyright: 2014 The Windsor Star
Author: Doug Schmidt
Page: A1

Special Report - Part 1 of 2


Dr. Tony Hammer treats drug addicts and people seeking pain relief -
the latter sometimes feeding the former - but don't expect him to jump
aboard the medical marijuana bandwagon.

"I am utterly incapable of distinguishing between those who need it
and those who enjoy it," said Hammer. He's convinced most of the tens
of thousands of Canadians prescribed medical marijuana are instead
using it "recreationally."

And what that means for this Windsor doctor, is that companies like
Leamington's Aphria Inc., now being licensed to commercially grow and
sell medical marijuana, are "in competition with the illegal grower"
for the same market.

Hammer's advice to his colleagues is to follow the no-nonsense advice
of their profession's governing body, the Canadian Medical
Association, don't prescribe pot to patients.

"Because of the lack, at this time, of robust scientific evidence of
its effectiveness and safety ? we're stepping away from this as a
profession," said Dr. Tom O'Callahan, an Amherstburg family physician
and the new president of the Essex County Medical Society.

The Canadian Medical Association, the College of Family Physicians of
Canada and the Federation of Medical Regulatory Authorities of Canada
are among those urging doctors to avoid steering patients to the
purported benefits of cannabis.

Even Health Canada, the agency tasked with licensing the producers
that grow and sell medical marijuana, as well as with drawing up the
guidelines under which they operate, has launched an expensive
advertising campaign on the dangerous effects of weed.

Canadians must turn to Health Canada's website to find out where to
get medical marijuana, but the information provided is limited and the
agency also urges patients seeking relief to stay away from pot. In
bold print above the government agency's list of those allowed to sell
pot comes a warning "marijuana is not an approved drug or medicine in
Canada. The Government of Canada does not endorse the use of marijuana."

Health Canada was forced into what Joseph del Moral of CanvasRx, a
Toronto-based cannabis counselling service, describes as a "kind of
schizophrenic" position on pot after the federal court ordered Ottawa
to provide "reasonable access to a legal source of marijuana when
authorized by a physician." The system that was replaced last spring
permitted patients to grow their own, a method of delivery that led to
concerns by police that users could be selling some of their product
on the side.


The legally approved sellers of medical marijuana are prohibited from
advertising the purported health benefits of the product they grow.
Last month, almost all the producers approved so far received warning
letters from Health Canada threatening action if they didn't rid their
websites of such things as photos of what they sell. At the same time
as doctors are being urged not to prescribe cannabis, Health Canada's
guidelines require patients to get a doctor's signature before they
can purchase any pot from a licensed supplier.

"I think it's a bizarre situation," said O'Callahan.

But medical marijuana's proponents promise that relief is on the way.
The authorities were not always so cold to cannabis, known and valued
by ancient civilizations and in medieval times for its medicinal properties.

The Canadian courts have ordered a reluctant federal government to
open the legal doors ever so slightly on medical marijuana, and the
first who have passed through are confident more acceptance and
support is inevitable.

And Windsor will play a role in getting there.

If local doctors don't want to shoulder the burden of prescribing pot,
the advocates argue, then doctors who are already on-side will be
brought in. And if the medical community is concerned the hard
scientific evidence is lacking, then some of the local area's first
legally harvested pot will be devoted to research.

Windsor will soon host a "cannabis clinic," and some Windsor cancer
patients will soon be part of a medical study looking at marijuana's
effectiveness in treating severe pain.

"We decided to tackle this head-on," del Moral said.

"We realized there was a piece missing ? a surprising number of
doctors are marijuana-naive," said del Moral, one of the entrepreneurs
behind the company established in April to assist those seeking
medical relief through marijuana.


Shortly after its creation, CanvasRx founded Canadian Cannabis
Clinics, which opened its first operation in St. Catharines in
September, with marijuana-knowledgeable staffing, including a
physician and "cannabis counsellor." Clinics in Mississauga and
Etobicoke will be opening in the coming weeks, and then, by the
spring, it should be Windsor's turn, said del Moral.

"Windsor's not well-served at all," said del Moral, who is unaware of
any local doctors openly prescribing pot, despite what he sees as a
patient demand. "We ask people to come in with a referral from their
family doctor, but if their family doctor is opposed ? the patient can
see us," he said.

Ottawa changed the medical marijuana rules last April to require
patients with doctor-supplied prescriptions to purchase pot from
licensed producers.

Before, approved patients were permitted to grow their own pot. By
last spring, Health Canada was reporting there were about 40,000
registered medical marijuana users in the country, a figure that had
been rising quickly as more and more Canadians began turning to legal

The work of CanvasRx, including a website with information on the many
different strains of cannabis offered commercially and how each
targets various illnesses and symptoms, is paid for by a "small
processing fee" from the producers with each sale, said del Moral. The
Cannabis Clinics, which look no different than any other medical
office, are paid through OHIP and will offer their services to
patients for free.

One Windsor user of medical marijuana, whose approval to grow his own
pot came under the old regime, said he's been referring others to the
Toronto clinics.

The patient, who asked not to be identified, said it was "frustrating"
that other locals who feel marijuana might help them are now "forced
to continue to use the black market" despite court rulings that
Canadians should be given legal access.

The new Marihuana for Medical Purposes Regulations will replace
thousands of personal producers with a smaller number of commercial
growers whose product is kept secure and whose output is closely
tracked and reported.

Leamington's Aphria Inc. is among the most recent of only 15 corporate
producers licensed so far. At one point, Health Canada faced a backlog
of more than 1,100 other applications needing vetting. Aphria's CEO
Vic Neufeld acknowledges that, while there might be a wealth of
"patient evidence" on the efficacy of medical marijuana in treating a
range of illnesses, there is a dearth of hard science to back it up.

"Human evidence and patient testimonials ? that's the best we can do
for now," said Neufeld.


"There's very limited evidence now," said Dr. Caroline Hamm, a medical
researcher with the Windsor Regional Cancer Program. "It's very
controversial because marijuana is also a recreational drug ? (but) if
it's something that can help people, it has to be validated," she added.

Hamm is preparing a clinical trial for the new year that will see
palliative care physicians administer medical marijuana supplied by
Aphria, which is sponsoring the research, to a limited number of local
patients whose pain levels are "poorly controlled" by standard drugs.

Part of the problem until now has been that, because marijuana was
illegal - and remains so, for the most part - the research that has
taken place has focused mainly on the harm caused by a criminalized
drug rather than on the potential benefits.

Many of those studies have focused on youth and the negative effects
of regular pot use on the developing brain. But other studies,
including a recently published survey of fibromyalgia patients, show
medical marijuana can be even more effective than conventional opioids
in the treatment of severe, chronic pain.

"It's not the holy grail, as some make it out to be, but it's another
treatment option," said Dr. Ryan Yermus, a Toronto-based family
physician who runs a medical practice dealing with addictions. Yermus
said there's plenty of scientific literature on marijuana, and he
argues it's far less dangerous than the opioids and other approved
medications conventionally prescribed to deal with pain.

"You need to keep an open mind. I don't think it's unreasonable if the
patient is reporting it's having a positive effect and wants to pursue
it," said Yermus. He's also the medical director at Medical Marijuana
Clinics of Canada, which in June became the country's first such
service for patients.

"Many of my colleagues are unwilling to prescribe. There's not enough
guidelines out there," said Dr. Gary Ing, the chief of medical staff
at Windsor Regional Hospital. "But this is just the beginning ? I only
wish we had more information," he added.

Ing said he wouldn't rule out signing one of the "medical documents"
Health Canada requires of those wishing to purchase marijuana from a
licensed producer, but he's yet to be convinced by any of his patients
who have approached him on it at his family practice.

He agrees with criticism about the lack of hard scientific evidence on
the safety and efficacy of pot, as well as with the absence of
guidelines from professional bodies.

Aphria's Neufeld said that, in addition to funding scientific
research, the company will be following up with all its customers to
gauge the pros and cons of whichever marijuana strain was purchased by
the patient to treat their particular illness or symptom.

CanvasRx has also begun a tracking system of attributes and
side-effects for the various producers' products and strains it lists,
with patients also rating the products. For example, users so far of
Canna Farms' Master Kush, selling for $8 a gram, give it a 100 per
cent rating for alleviating chronic pain.

Del Moral said it's still early days, but as the database gets more
comprehensive, it will be another helpful tool for those seeking
medical relief through marijuana. CanvasRx is already trying to make
it simple, with visitors to its website asked to select a symptom -
anything from loss of appetite, insomnia and depression to stress, PMS
and seizures - and then directed to the types of strains likely to

Hammer, who runs a methadone clinic in Windsor to help drug abusers
overcome addictions - including to prescription medications - said the
current "corporatization" of marijuana and the marketing of its
purported benefits reminds him of what business did with tobacco and

On his office wall at the Erie-St. Clair Clinic is a framed
prescription from the Prohibition era.

Alcohol may have been banned at the time, but armed with a doctor's
prescription, you could buy booze.

"They're putting us in the exact same position," Hammer said of Health
Canada making doctors the gatekeepers of pot while also decrying its

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Refers to the use of cannabis and its active ingredients such as
tetrahydrocannabinol (THC) and cannabidiol (CBD) as medical therapy to
treat disease or alleviate symptoms.

Marijuana comes from the dried flowers of the female cannabis

Used for many years to treat pain, reduce nausea and vomiting. More
recently, used to address a variety of symptoms, from lack of appetite
and insomnia to PMS and seizures.

Many different strains with different properties to target different

THC is the psychoactive ingredient that provides the "buzz," or
feeling of euphoria, and provides pain relief. CBD has a more
prolonged affect and helps manage pain, inflammation.

The product is retail-priced per gram, which is about enough to roll
two joints for smoking. The pot can also be vaporized.
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