Pubdate: Mon, 11 May 2015
Source: Montreal Gazette (CN QU)
Copyright: 2015 Postmedia Network Inc.
Contact:  http://www.montrealgazette.com/
Details: http://www.mapinc.org/media/274
Author: Charlie Fidelman
Page: A1

A STUDY OF SUBSTANCE

Pot seems to ease pain, but for which conditions and at what dose? A
study led by Mark Ware aims to fill that gap

Curled on the floor retching, Tzvetanka Chiderova yelled for her
mother to get the water pipe. Within minutes, the Montreal
web-designer stopped gagging. The waves of nausea disappeared, she
said.

"It was instantaneous," said Chiderova, who turned to marijuana for
medicinal purposes as a last resort while being treated for stomach
cancer. Without it, she says, she could not have continued with
life-saving chemotherapy.

Yet Chiderova's personal experience does not count in the medical
literature. Marijuana obtained on the streets is of unknown quality,
the dosage is not standard, and there is no data on risk and safety.
Also, few studies evaluate the claims of patients, while thousands of
Canadians continue to seek relief from an array of symptoms - pain and
inflammation - from migraines to multiple sclerosis, cancer to epilepsy.

But that is about to change. A Canadian consortium led by
Montreal-based pain expert Mark Ware is to launch a massive,
longitudinal study of medical marijuana, tracking the long term
effects of patients using it for chronic conditions.

The Canada-wide research is expected to address the knowledge gap in
cannabis treatment for patients.

Initial research in animals decades ago showed the active ingredients
in pot can relieve pain; there have since been more than two dozen
reputable clinical trials in Canada and internationally, looking at
cannabis and various conditions including HIV, diabetes, multiple
sclerosis, pain, inflammatory bowel disease and cancer.

One of these was a 2010 investigation on pot versus placebo, published
in the Canadian Medical Association Journal and led by Ware, also
director of clinical research at the Alan Edwards Pain Management Unit
at the McGill University Health Centre.

The two-month study compared levels of THC, a main ingredient in the
marijuana plant, in 23 patients suffering pain from nerve injury.
Turns out that a single puff of 25 milligrams of 9.4 per cent THC
herbal cannabis three times a day for five days reduced pain and
improved sleep. But small-scale studies did not provide guidelines
physicians could use after Health Canada changed its regulations in
April 2014, making them responsible for deciding who should legally
have access to marijuana for medical purposes. For which condition and
at what dose? Doctors weren't clear on what they were
prescribing.

What's needed is more research and education to inform patients,
doctors and policy-makers, Ware told the Montreal Gazette last year,
once the Quebec College of Physicians responded to the federal change
of regulations by imposing its own restrictions. The College does not
recognize cannabis as medical therapy. But under a new protocol,
physicians can now prescribe cannabis under the context of research.

Which is why the oncologist treating Chiderova did not suggest
marijuana to relieve nausea so severe that she lost 25 pounds.

Under the Quebec research protocol, doctors will be able to register
patients like Chiderova and track them for a provincial database.

"It was awful, five days in the emergency room unable to eat or sleep,
and no one could help me," Chiderova said of unstoppable retching
caused by chemotherapy.

In November, a nervous Chiderova spoke to a friend visiting from
Toronto about how worried she was to start chemo again. Nothing had
worked, not the anti-nausea drugs the hospital gave her, not the
acupuncture or naturopathy. Her friend responded,"Why don't you try
marijuana? It helps a lot of people."

Chiderova who had never smoked in her life turned to pot. "It was
emergency. I had to find out how to smoke and where to get marijuana.
Luckily, I live in Montreal and people talk about it openly," she
said. A friend gave her a pipe and the first batch of pot was bought
on the street. When she came back from the hospital after the first
round of chemo and collapsed on the floor heaving, she called to her
mother, "bring the weed and bong. And it was like magic - I couldn't
believe it," Chiderova said.

The same friend told her about Sante Cannabis, Montreal's first
medical marijuana clinic, which has about 400 patients and seven
physicians. Armed with a referral from her doctor, the clinic helped
Chiderova get a prescription and access to legal sources of medical
cannabis. She also switched to a smokeless, hand-held vaporizer that
travelled with her to the hospital. In the waiting room before the
nausea got full-blown, she'd step outside for a puff, then go back
inside relieved.

"It was my security. I wouldn't leave the house without it. I took it
to bed," she said. "My oncologist was very happy that marijuana helped
me - she'd seen me in the emergency. She thanked me for showing her
the vape."

But there was no "getting high" - it was an absence of nausea, said
Chiderova, who stopped using medical marijuana in March when her
symptoms subsided. "I wanted to share my story to help others."

It's too late for Chiderova to be part of the new chapter on medical
marijuana launched in Quebec. But for thousands of other patients like
her, the Canadian Consortium for the Investigation of Cannabinoids
longitudinal study means an end to self-experimentation with unknown
substances and a move toward evidence-based marijuana therapy.
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MAP posted-by: Matt