Pubdate: Tue, 07 Mar 2017
Source: Victoria Times-Colonist (CN BC)
Copyright: 2017 Times Colonist
Author: Geordon Omand
Page: C3


VANCOUVER - Not all medicinal marijuana is created equal. That's what
some experts are saying as they warn about the health risks and
curtailed effectiveness associated with smoking medicine.

As medical pot becomes increasingly mainstream and Canada moves toward
legalizing the substance, health experts are emphasizing the need for
doctors and patients to consider the sometimes serious side-effects
linked to the various ways of consuming the drug.

Paul Farnan, an addictions specialist at the University of British
Columbia, likened a recommendation to smoke medicinal marijuana to a
doctor handing out a prescription to light up an opium pipe. "We know
there's something in opium that helps pain, and we're able to
pharmaceutically develop morphine and other analgesics, but we
wouldn't say to people: 'You have pain? Why don't you smoke opium?' "
he said.

"We're kind of saying to people: 'We think there's some stuff that
cannabinoids will be helpful for. Why don't you just smoke cannabis?'
First of all, cannabis is actually a really dangerous thing for your

Mikhail Kogan, medical director of the Center for Integrative Medicine
at George Washington University in Washington, D.C., said he sees no
reason for people to smoke marijuana medically anymore.

It's difficult to absorb enough of the drug through the lungs, and
gastric acids interfere when someone eats it, he said, adding that
it's more effective to take the drug by other means, such as under the

"Rectally is actually a lot more preferred because of the volume of
absorption. You can put a lot more and it gets absorbed a lot better,
but not everybody is open to this way of administration," Kogan said.

"We have so many other products now, so many modes of delivery, that
smoking in my opinion is very archaic and has very little clinical
applicability," he added.

"Having said that, I think that probably the majority of people still
smoke because it's the most available method."

Health Canada officially recommends against smoking marijuana. "Many
of the chemicals found in tobacco smoke are also found in cannabis
smoke," reads its website.

The Canadian Medical Association has no formal position on the
consumption of medicinal pot, but it officially opposes the inhalation
of any burned plant material.

Association spokesman Jeff Blackmer added that many physicians are
reluctant to prescribe medical marijuana because of the absence of
peer-reviewed research into whether the drug is medically effective,
its possible side-effects, appropriate dosage and more.

A "strong majority" of doctors would prefer not to be involved as
so-called gatekeepers, Blackmer added. "Most of them hate it," he
said. "This is something that was imposed on us by the government and
the majority of physicians do not want to have anything to do with

Debra Lynkowski, head of the Canadian Lung Association, urged patients
and doctors to take lung health into consideration when discussing
medicinal marijuana.

"When you burn something, that combustion releases toxins and
carcinogens, and they're released regardless of what the source is,"
she said.

"Our primary concern with regard to that is just to be considering any
kind of lung health implications."

Colette Rivet, head of the association that represents licensed
cannabis producers in Canada, said that while the industry is against
smoking medical marijuana, ultimately it can't restrict what patients

"We know that there's an issue with smoking. However, we can't control
it at the patient level," Rivet said. "We're trying to develop new
product forms so they would be more inclined to go away from that."

Each licensed producer has its own unique document that physicians
fill out when prescribing medical marijuana, which includes a minimum
amount of information required by Health Canada, Rivet said.

Beyond that, some companies ask whether a patient would prefer dried
marijuana or oil, while others don't, she added.

A Health Canada spokesman confirmed that patients are in charge of
requesting the form of medical marijuana they prefer, whether dry leaf
or oil, and they are not restricted in how they wish to consume it.

The sale of edibles is banned, but a June 2015 decision from the
Supreme Court of Canada ruled medicinal marijuana patients have the
right to prepare their medication however they want, including cooking
- ---
MAP posted-by: Matt