Pubdate: Mon, 17 Dec 2012
Source: Montreal Gazette (CN QU)
Copyright: 2012 Canwest Publishing Inc.
Contact: http://www.canada.com/montrealgazette/letters.html
Website: http://www.montrealgazette.com/
Details: http://www.mapinc.org/media/274
Author: Mark Ware, Special to the Gazette

MOVING AHEAD ON THE MEDICAL USE OF CANNABIS

MONTREAL - After two years of consultation, Health Canada has released
a draft of the new Marijuana for Medical Purposes Regulations.
Following a 75-day period of review and comment, the final version
will be published next spring, to come into effect in March 2014.

What do these new regulations mean?

The new regulations are a significant departure from the old ones.
Gone are the lengthy delays for patients to obtain licenses to possess
cannabis for medical purposes. Gone is the reliance on a single
cultivation company and strain. Gone are the arbitrary categories of
diseases and symptoms that governed whether a patient needed the
support of one doctor or more. Gone is the ability for patients to
grow their own cannabis or to designate someone else to grow for them.
Gone is the reliance on only physicians to authorize cannabis.

What will we have instead? Authorized health-care professionals
(doctors, nurse practitioners) will be able to prescribe cannabis to
anyone, for any reason, if deemed medically appropriate. With a valid
prescription, patients will be able to register with a licensed
cannabis producer to obtain dried cannabis. Licensed producers will be
able to grow several strains of cannabis, to offer choice. Pharmacists
and hospitals will be able to order, store and dispense cannabis. This
new model proposes to treat herbal cannabis like any other medication
requiring a prescription from a medical professional.

Except, of course, that cannabis is not like any other
medication.

As a dried herb, it resembles a natural health product, except that it
is also a controlled substance. There is a stigma attached to
cannabis, its users, champions and detractors. It is most commonly
smoked, a primitive delivery system that is effective, but raises
concerns about safety. It is smelly, relatively easy to grow and
popular among teenagers for its euphoric effects and rebellious culture.

There is also a polarization of opinion on cannabis. Addiction
workers, concerned on the one hand by increases in problem cannabis
use, have also reported on the other hand that cannabis has been used
successfully in harm-reduction programs. Psychiatrists, alerted about
adolescent cannabis use and psychosis, are also aware of positive
effects on post-traumatic stress and attention disorders. Pain
specialists, intrigued by the effects of cannabis on pain, sleep and
anxiety, are concerned about drug-seeking behaviour and functional
impairment. Parents, worried about the ambivalence children show
toward cannabis, are interested in the genuine pain relief that the
drug may offer loved ones who need it.

As Canadians, we are not alone in facing these issues. South of the
border, Americans have approved medical cannabis in 18 states and
advocated successfully for legal cannabis in two. The global drug
trade, cannabis-producing nations and international stakeholders
breathlessly await President Barack Obama's next move. The world is
searching for a cannabis policy that maximizes potential benefits and
minimizes potential harm. No single approach will be perfect, and
there will be ongoing reforms if we learn from each other and the
lessons of the past.

Health Canada has put Canada's cards on the table. Its approach is
aimed squarely at medical use, which ought now to launch a national
discussion among the various professional orders of physicians,
nurses, pharmacists and other health-care professionals about the
standards of care that should apply when prescribing cannabis.

They need to know more about cannabis: its mechanism of action,
interactions, precautions, contraindications, clinical-trial data,
alternative-delivery systems, screening, dosing, monitoring - and all
in the absence of a classical pharmaceutical approach.

Do the data exist? There are more data than people realize.
Conclusions with respect to safety issues can be drawn from studies of
recreational use. But an emerging number of small randomized
controlled trials involving such medical conditions as multiple
sclerosis, neuropathic pain and HIV/AIDS has supported patients'
claims of relief of spasticity and pain. Not enough, perhaps, to
satisfy the clinician relying only on evidence-based medicine, but
enough perhaps to make sensible clinical judgments. It is where the
art and science of medicine meet. And this is where these regulations
lead.

It is time for clinicians to accept our role in the cannabis program.
It is now a health issue, not a legal one.

We can no longer put our heads in the sand and claim we do not know
enough, or worse, to refuse to discuss it. We cannot let our beliefs
about cannabis, positive or negative, govern our interactions with
patients, or our responsibility to society. We are the custodians of
our patients' health, and cannabis use may be a help or a hindrance.
Waiting for pharmaceutical-type data on this drug is a convenient
cop-out. We have an opportunity under these new regulations to work
with licensed producers to develop research priorities, support
education, and inform patients and the public. These surely are steps
in the right direction.

[photo caption]

Tamara Cartwright - who has a licence to grow and use medical 
marijuana - uses a vaporizer to fill a container so as to inhale 
marijuana vapours in Alberta in November 2011. Under new proposed 
Health Canada regulations, authorized professionals will be able to 
prescribe cannabis to anyone, for any reason, if deemed medically appropriate.
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MAP posted-by: Jo-D