Pubdate: Fri, 24 Feb 2017
Source: Prince George Citizen (CN BC)
Copyright: 2017 Prince George Citizen
Author: Sheryl Ubelacker
Page: 7


TORONTO - The number of Canadians registered to purchase medical
marijuana from licensed producers has exploded since the federal
commercial-access program was introduced almost four years ago,
reaching nearly 130,000 by the end of last year, the most recent Heath
Canada figures show.

As of Dec. 31, 129,876 Canadians had signed up with the country's
cannabis producers, a 32 per cent jump from the 98,460 registered at
the end of September and a whopping 1,544 per cent increase from the
7,900 granted access to medicinal cannabis in mid-2014.

But the surge in demand has many wondering if all these patients have
a legitimate medical need for the drug. Or are some people using the
system to acquire recreational pot before it is legalized, as the
Liberal government has promised to do this spring?

Dr. John Goodhew, a family practitioner in downtown Toronto who
supports the use of therapeutic cannabis for specific conditions, said
he's seen a definite uptick in patients seeking prescriptions.

Because Goodhew has become known as one of a minority of doctors who
will prescribe medical marijuana, he has patients from all over
Ontario contacting him.

"So patients will frequently call me and I'm not able to help them
because I only consider marijuana as a therapeutic agent for people in
my practice, people that I know, people whose medical histories I'm
familiar with," he said Thursday.

"And this is really the only responsible way to do it. Unfortunately
it leaves other people kind of in the lurch."

Goodhew said he prescribes cannabis for such ailments as pain, weight
loss from conditions like inflammatory bowel disease, nausea and
hepatitis C.

But increasingly patients are asking for it because of osteoarthritis,
a painful condition that's on the rise as the population ages.

"Things like anxiety and depression where there really isn't good data
that it works ... I won't prescribe it," he said.

"And other people will come in and just ask (for a prescription) and
I'll say 'What is the medical condition?' and they'll say 'Can't you
just make something up?' And I'm like, 'No, it doesn't work that way."'

Goodhew attributes such behaviour to the "Trudeau effect," a
slackening of concern as people anticipate that Ottawa will soon
decriminalize recreational marijuana. But he acknowledges it can be
difficult for physicians to determine which patients have a genuine
need for the drug and which ones want it just to get high.

"I think there are probably a minority that are strictly medical and
there's a minority that are strictly recreational and with most people
it's probably a combination.

"Because part of pain relief is if it relieves pain and it also makes
you feel good, it's kind of a mixed blessing that way."

Dr. Jeff Blackmer, vice-president of medical professionalism for the
Canadian Medical Association, said the spike in the number of people
registered to purchase medical cannabis could be a reflection of
doctors becoming more comfortable with prescribing the drug, coupled
with growing patient demand.

And he agreed that while some people seek a prescription for authentic
health reasons, others likely simply want it for its euphoric effects.

"When I talk to doctors about this, there's no question people will
say, 'Some of my patients I feel really would not be here asking for
it if they did not have these medical conditions,"' he said from Ottawa.

"But I also hear from colleagues that they do suspect some of the
patients are there asking for the approval to use it recreationally,"
said Blackmer, adding there's no standard test "to tease that out."

While doctors aren't prohibited from prescribing cannabis, the CMA
opposes its use medicinally because of a lack of scientific evidence
proving the drug is effective in treating specific conditions.

Dr. Mark Ware, a pain specialist and medical cannabis researcher at
McGill University in Montreal, said there are several pharmaceutical
cannabinoids approved for use in Canada, including a spray containing
a cannabis extract used to treat pain and spasticity due to multiple
sclerosis or for advanced cancer pain.

But herbal cannabis in the form of dried flowers or oils is not
"approved" as medicine in Canada. But they are legal under federal
Access to Cannabis for Medical Purposes Regulations, he said, noting
that the best available clinical trials support their use for pain
caused by nerve damage, after standard treatments have failed.

"There is a very long list of conditions for which people have claimed
benefit from cannabis use," Ware said by email. "Most of these
conditions have not been formally studied in clinical trials, but
intriguingly, for many such 'claims,' there is a body of scientific
literature that provides a rationale for why cannabis might work for
those conditions."

Some of those trials are either planned or underway in Canada and

In the meantime, Blackmer said doctors are waiting to see if and when
Prime Minister Justin Trudeau's government will legalize and regulate
the sale of recreational pot.

"We would like to see just one system," he said. "So if marijuana is
legalized for recreational use, we feel very strongly that that makes
the 'question' around use of medical marijuana essentially moot,
because it would be something that's available to everyone for any
reason, and you wouldn't need to go through physicians and you
wouldn't need to get special dispensation." Goodhew is anxious for
that day. "I'm supportive of the role that marijuana has in medicine.
But I'm really tired of being the gatekeeper for it. And all my
colleagues are," he said.

"Not only are we the gatekeepers and have to fill out forms constantly
for people with legitimate use, we're now getting inundated with
people who want a prescription so they can get the good-quality stuff
at a decent price from the licensed growers ... (and) we're constantly
having to turn people down.

"So the day that it becomes legal will be a day when we're all going
to breathe a sigh of relief."
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