Pubdate: Fri, 09 Oct 2015
Source: Globe and Mail (Canada)
Copyright: 2015 The Globe and Mail Company
Author: Mike Hager
Page: S1


Canadian doctors should use medical marijuana instead of frequently
abused opioids to treat patients with neuropathic pain and a host of
other conditions cannabis has been proven to combat, Vancouver-based
HIV/AIDS researchers argue in a newly published editorial.

Thomas Kerr, Julio Montaner and Stephanie Lake of the B.C. Centre for
Excellence in HIV/AIDS argue the Canadian Medical Association is
holding pot to a higher standard than other pain-relieving
pharmaceutical drugs and is ignoring high-quality, peer-reviewed
studies on the use of cannabis. Their editorial is in the latest
edition of the Journal of the Canadian Public Health

Dr. Kerr, co-director of the centre's Urban Health Research
Initiative, said five recent randomized control trials and two
systemic reviews have found marijuana helps relieve neuropathic pain.
Yet many doctors are still loath to prescribe a drug that has not been
approved by Health Canada.

"The evidence supporting the therapeutic use of cannabis is actually
much stronger than the use of other drugs that are used to treat the
same conditions and it also seems, in many cases, that cannabis has a
more favourable side-effect profile," Dr. Kerr said.

He said opioids, such as oxycodone, hydromorphone and morphine, are
increasingly being prescribed and have contributed to nearly half of
all overdose deaths in the country. Canadians are the second-largest
per capita consumer of opioids in the world.

"Opioids are killing people right now," said Dr. Kerr, whose previous
research helped prove the efficacy of Vancouver's controversial
supervised-injection site, known as Insite. "There is no association
with cannabis and mortality, and yet North America is in the midst of,
really, what is a public-health emergency associated to opioid
overdose deaths."

If doctors prescribed more marijuana to those with chronic pain, they
may cut down on these deaths, said Dr. Kerr, citing research in the
United States that showed such fatal overdoses dropped by 25 per cent
in states that enacted medical pot laws

He said medical pot has also been proven to relieve spasticity and
"wasting" associated with HIV/AIDS, as well as nausea and vomiting
caused by chemotherapy.

In a Supreme Court ruling this summer that enshrined a patient's right
to buy edible forms of the medicine from federally licensed growers,
judges also accepted that cannabis has anti-inflammatory and
anti-spasmodic properties.

Stressing the danger it poses to young people and public health in
general, the Conservatives have repeatedly gone to court to restrict
patients' use and production of the drug.

Medical marijuana is legal in Canada, but the federal Conservative
government repeatedly says it is not an approved drug and it does not
condone its use. The government notes the courts have required it to
allow patients to access medical marijuana, which is now grown and
distributed by a network of large-scale commercial producers.

While doctors can prescribe pot, most say they simply aren't confident
enough in their knowledge of the drug to safely recommend it to patients.

Charles Webb, head of the association representing B.C.'s doctors,
agreed that medical marijuana may well help with those conditions
described by Dr. Kerr, but he said many physicians will remain
reticent to prescribe it until Health Canada comes out with guidelines
on dosage, concentration and best practices for administering the drug.

Dr. Webb said he doesn't believe cannabis is stigmatized by his

He notes his colleagues have no problem prescribing a synthetic
marijuana drug named Nabilone, which is used to treat nausea for
chemotherapy patients, because it has gone through all the regulatory

"Let's study, trial and come up with some answers in terms of how to
work through this [cannabis] situation with [administering] inhaled,
versus vaporized, versus oils, versus baked products," Dr. Webb said.

Cindy Forbes, president of the Canadian Medical Association, declined
an interview request, but issued a statement expressing doctors'
concerns that Health Canada has exempted the drug from the regulatory
requirements that pharmaceuticals must face.

"The limited clinical evidence combined with very limited guidance for
the therapeutic use of marijuana pose a challenge for physicians in
providing the best care to patients," Dr. Forbes wrote.
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