Canadian Docs Won’t Authorize Cannabis, Leaving Patients In Pain


Cannabis Culture

​A full decade after Canada legalized medical marijuana, most doctors in the Great White North are still refusing to sign the forms that patients need to get access to cannabis — meaning patients in pain risk jail if they use what works best to help keep them functional.

Far from improving, the predicament seems likely to get worse because of proposed changes to how Health Canada regulates access to marijuana, reports Sharon Kirkey of Postmedia News.
To the casual observer, it may seem that the government is actually easing up on the strict rules for obtaining medicinal cannabis. Health Canada has proposed removing itself as the ultimate authority in approving or rejecting medical marijuana applications.

Instead, doctors alone would sign off on medicinal cannabis requests.
But the proposals would have the perverse effect of putting even greater pressure on medical doctors to control access to a substance most of them know little to nothing about, according to Canada’s largest doctors’ group. Their licensing bodies have told physicians they are under no obligation to complete a medical declaration under the current regulations, and that anyone who chooses to authorize marijuana for patients should “proceed with caution.”
The changes being proposed would essentially switch all responsibility for okaying and monitoring medical marijuana to the doctors who sign an authorization — “and they’d be kind of out there, without any infrastructure around them to assess it, to monitor it and to know if they were doing the right thing,” said Dr. John Haggie, president of the 75,000-member Canadian Medical Association.
“I don’t think that’s appropriate or fair,” Haggie said.
Doctors reportedly fear doing harm, exposing themselves to legal liability and becoming the “go-to” source for people who want marijuana not for pain but for pleasure.
Haggie said that although physicians want fundamental research into medicinal cannabis, the Conservative government of Canada abruptly cut off a medical marijuana research program in 2006.
According to Health Canada, the government believes medicinal cannabis research is “best undertaken by the private sector, such as pharmaceutical companies.”
And of course, Big Pharma isn’t going to research any medical benefits of dried marijuana flowers, since it’s so hard for them to make any money on something people can grow for themselves. What they’ll study — if anything at all regarding marijuana — is how to best make it into pills and tinctures upon which hefty profits can be made.

Microscope to Stethoscope
Dr. Mark Ware: No drug company wants to evaluate smoked cannabis as medicine “because there’s no money in it for them”

​The logic behind Health Canada’s position is faulty, according to a world leader in cannabis research.
“I cannot imagine how a government agency can supervise [a marijuana access]program knowing that there is very little data out there — on safety issues in particular — and not try to stimulate research,” said Dr. Mark Ware, head of the Canadian Consortium for the Investigation of Cannabinoids, a nonprofit network of more than 150 clinicians and researchers investigating the potential of cannabinoids to treat conditions ranging from arthritis to glaucoma.
No drug company wants to evaluate smoked cannabis as medicine, said Ware, director of clinical research at the Alan Edwards Pain Management Unit at McGill University Health Centre, “because there’s no money in it for them.” Funding agencies have been less than approachable, he added, because nobody wants to support studies involving a product that’s often smoked.
“They don’t see it as a safe, viable drug delivery system,” said Ware.
Could it really be that potential researchers really don’t know about alternate delivery methods such as vaporization and cannabis-infused edibles?
Ware said he wonders how much the government’s pronounced disinterest in marijuana research might be tied to its “tough-on-crime” political agenda — “that somehow facilitating research on medicinal cannabis is a way of accepting that it may have some value as a medicine.”
The Montreal doctor received about $2 million under the now-terminated government medical marijuana research program. In a study published in the Canadian Medical Association Journal last year that involved 21 patients with neuropathic pain, Ware’s group found that smoked cannabis at low doses reduces pain, improves mood and helps sleep, without making people high.
All of the test patients had “refractory” pain, meaning pain that had defied all conventional treatments, including opiate and opioid narcotics. No serious or unexpected side effects were reported.
Ware said that for patients for whom it works, cannabis can achieve about a 30 percent reduction in pain intensity, and has never caused a proven overdose death.

Canadian medical marijuana patient Matthew Mernagh, left, and lawyer Paul Lewin outside the Court of Appeal in June

​Health Canada claimed the proposed changes to the program — which would include removing the rights of patients to grow their own cannabis or to appoint designated growers, forcing them to get their marijuana from a government-licensed commercial producer instead — would make the program less complicated for the seriously ill people who use it.
Toronto lawyer Paul Lewin said that’s hogwash.
Doctors are already boycotting the medical marijuana program en masse, according to Lewin. He said medical regulators and insurers sent letters to the Canadian government, “saying, ‘Don’t put us in charge, don’t make us a gatekeeper, we don’t know anything about pot, this is a plant product, it’s an unapproved drug.”
Lewin said the court heard stories of how some doctors encouraged patients to try marijuana for pain. The patients would return, reporting that the cannabis was helping and that they were feeling less pain.
But when they asked the doctors to sign their medical marijuana authorization forms, “that’s when the mood changes,” Lewin said. “That’s when they say, ‘Get out. I’m not risking my practice over you.’ ” (Editor’s note: I had the same experience in the U.S.; hi, Dr. Stephens.)

Lewin’s client, Matt Mernagh, started growing cannabis when it found it provided some relief from chronic pain and other symptoms of scoliosis, fibromyalgia and epilepsy. But Mernagh couldn’t get a license to grow, because he couldn’t find a doctor willing to sign his authorization.

Police found Mernagh’s plants in 2008 when they were in his apartment building on another call. He was charged with cannabis production.
Lewin took the case to the Superior Court in Ontario. The court declared Canada’s federal medical marijuana program unconstitutional. The case is scheduled to go to the Court of Appeal for Ontario in March.
The proposed changes to the marijuana access program are likely to scare off even more of the few doctors who had been willing to sign authorizations, meaning “more seriously ill, law-abiding Canadians will be wrongfully treated as criminals” and subjected to humiliating arrests, medicine confiscations and possibly even jail time, Lewin said.
Doctors need education and guidance, according to Ware.
The consortium of cannabinoid researchers said it’s not only easier and cheaper for patients to grow their own supply of marijuana, but the act of growing their own medicine may be therapeutic in itself.
“It gives them a sense of control and ownership of their health and treatments,” Ware said.
This CBC story has a poll in which you can vote on whether the Canadian government should fund medical marijuana research: