B.C. doctors criticize Canada’s strict medical marijuana rules

VANCOUVER – The Canadian Medical Association and the federal government apply a far more rigid standard to prescribing marijuana than other drugs, resulting in negative — or even deadly — consequences, say experts from the B.C. Centre for Excellent in HIV/AIDS.

Medical marijuana is held to a different standard than other prescription drugs despite research suggesting it has therapeutic benefits, say three experts from the centre in a commentary published Friday in the Journal of the Canadian Public Health Association.

“When it comes to prescription marijuana, patients’ needs should be considered above political considerations,” Dr. Julio Montaner, one of the authors, said in a news release. “There could be great harm in ignoring the medical uses of marijuana.”

The government and the CMA are being overly cautious, co-author Dr. Thomas Kerr said in an interview.

“This is just not how we deliver medical care and why we’re doing it in the case of cannabis is beyond me,” he said.

Several recent studies have shown prescription cannabis can have therapeutic benefits, but the CMA and others have failed to acknowledge the research, resulting in a position that isn’t based on evidence, Kerr’s commentary said.

Other studies have shown prescribing cannabis may lead to a reduction in overdoses and deaths associated with prescription opioid.

“This can’t be taken too lightly because Canada, like the U.S., is in the midst of an epidemic of prescription opioid abuse and related overdose deaths,” Kerr said.

While marijuana is not associated with an elevated risk of mortality, prescription opioids contribute to nearly half of all overdose deaths — a leading cause of accident related mortality, the article points out.

Under Canada’s current medical marijuana laws, patients must obtain prescription cannabis from federally licensed producers, generally through the mail. There are currently 26 licensed producers listed on Health Canada’s website.

The idea of sending prescription drugs through the mail is odd, Kerr said.

“We would never do that in the case of treating someone with diabetes,” he said. “Really, people should have access to experts who can counsel them on appropriate dosing, potential side effects and their management and who can also provide other options and clinical followup.”

The caution towards cannabis comes because it is illegal and because the federal government “has been making up the science on the fly,” Kerr said, pointing to the example of Stephen Harper saying that marijuana is “infinitely worse” than tobacco.

“It’s unfortunate that the federal government has really failed to deliver an effective medical-cannabis program and it’s unfortunate that they’ve also misrepresented the science in this area,” he said.

Kerr said government and other interested agencies should consider implementing a system where cannabis is legalized, and both medical and recreational use are regulated using evidence-based discussions and approaches.

Kerr is co-director of the B.C. Centre for Excellence in HIV/AIDS’s Urban Health Research Initiative. His co-authors are Montaner, director of the centre, and Stephanie Lake, a research assistant at the centre.

Canada: Medical Marijuana Can Be A Huge Help For People In Pain

People who experience chronic pain can go for years without relief, jumping from one medication to the next without necessarily relieving any of their symptoms.

But hope for these conditions has been found in the form of medical marijuana — as long as doctors continue to study it and prescribe it.

Dr. Mark Ware is one of the preeminent physicians in the world when it comes to pain management and treatment. As the director of clinical research at the Alan Edwards Pain Unit at the McGill University Health Centre (as well as an associate professor at the university and the executive director of the Canadian Consortium for the Investigation of Cannabinoids), he’s spent the last 16 years investigating how medical marijuana can reduce pain in patients.

“I’m a big proponent of the interdisciplinary approach — taking a multiple approach to manage, live and find ways to alleviate some of the suffering that goes along with chronic pain. And the fact is, we are limited with the tools we have to treat pain, both pharmalogical and non-pharmalogical.”

Cannabis, for the record, is considered a pharmacalogical approach, thanks to its active ingredients that bind to receptors in the human body that trigger a response.

In Canada, the Category 1 approved conditions from Health Canada for possessing dried marijuana for medicinal use are:

Any symptom treated within the context of compassionate end-of-life care,

OR

Symptoms related to
Severe pain and/or persistent muscle spasms from multiple sclerosis
Severe pain and/or persistent muscle spasms from a spinal cord injury
Severe pain and/or persistent muscle spasms from a spinal cord disease
Severe pain, cachexia, anorexia, weight loss, and/or severe nausea from cancer
Severe pain, cachexia, anorexia, weight loss, and/or severe nausea from HIV/AIDS infection
Severe pain from severe forms of arthritis
Seizures from epilepsy

There is a second category, which is defined as “a debilitating symptom that is associated with a medical condition or with the medical treatment of that condition, other than those described in Category 1.”

It’s a vague definition, and for some, that can mean plenty of frustration. Keith Mullan, a former Navy officer, told the CBC it took three months — and a lot of paperwork — to get his prescription refilled recently. Veterans are one of the populations that often use medical marijuana to deal with past injuries — Veterans Affairs Canada paid out $5.2 million for marijuana prescriptions for former soldiers in 2014-2015, according to the CBC.

“One of the biggest areas of discovery has been PTSD and the nightmares associated with that,” Ware says. “What happens with patients is that they’ve been exposed to some form of trauma, and your brain normally has a way of extinguishing that trauma. For example, somebody who has given birth has experienced a painful, major life event, and you have memories of that pain and discomfort, but the brain has a way of extinguishing it. We have the ability to forget something that was painful because it enables us to do it again.

“Someone with PTSD doesn’t have that ability to extinguish that memory so it keeps coming back — they get flashbacks or nightmares when they’re sleeping so they relive it again. This is an area where the endocannaboid system has been shown to be important in extinguishing those memories. If that system is not working properly, you have those consistent memories. Cannaboids can help extinguish those memories in that specific area of the brain.”

Ware, who sees medicinal marijuana as part of a pain treatment plan, not the be-all-and-end-all, knows there are plenty of challenges to be faced when both studying and distributing the drug.

“Cannabis has been touted by many patients over many years as something that helps them manage their pain, and it’s come to us through a different route than we normally learn about drugs,” he says. “It’s a unique situation where we have patients telling us what the drug is doing for them, that from there, we can then study to see if that’s true.”

Everything from the “giggle factor” of stoner weed culture to the legalities of distribution to figuring out exactly how to have people smoke it in non-smoking facilities have proven to be obstacles along the way, but Ware has seen enough results to make him want to keep going.

The pain conditions in which cannabanoids have been shown to be most effective are those caused by damage to the nervous system, either peripheral or central. That can include diabetic neuropathy, post-traumatic pain after surgery and HIV-associated neuropathy in the case of the peripheral system, and multiple sclerosis or a spinal cord injury for the central system.

Patients report a number of effects from cannabis, including improved sleep and help for their anxiety or stress, as well as a reduction in discomfort.

“They tell us, ‘It doesn’t really make my pain go away, but it allows me to focus on something other than the pain,'” explains Ware. “That sounds like, ‘Duh, they’re stoned,’ but these are patients who are trying really hard to function and have normal social and work lives.”

Ware also notes that small studies have linked cannabanoids to helping with chronic pain syndromes, like fibromyalgia, rheumatoid arthritis and cancer — both the pain associated with the disease, and the treatment. But of course, more research is needed, and the drug isn’t for everyone.

In honour of Arthritis Awareness Month in September, the Arthritis Society launched an explanatory series specifically for those suffering from the joint disorder who were interested in access to cannabis for the pain. In it, they noted 65 per cent of Canadians who request access to medical cannabis do so for arthritis pain, and went through the various challenges patients can encounter when trying to access the drug, including a physician’s hesitation to prescribe it.

A 2012 study from the Canadian Medical Association found that 60 per cent of physicians who responded to a survey on the topic would “never” or “seldom” honour a request for access to medical cannabis. But with more research, it’s possible these opinions will change, and that’s just what people like Ware are trying to accomplish.

Ware points out that cannabanoids don’t have the same toxicity issues as other drugs used for pain management, like opioids and anti-inflammatories, in that the drug itself in high doses doesn’t cause death or major health disorders. But that said, there are other factors to consider when prescribing it to patients.

“It’s a remarkably safe compound from a purely pharmacalogical standpoint,” he says, “but then you have to take that and apply it to other people who may be taking other medications, or have other conditions, or other interactions. A lot of patients with chronic pain also have mental health issues like anxiety, depression. How is the drug interacting with those conditions? Is it helping or harming? These are important long-term effects that need to be evaluated.”

According to the College of Physicians and Surgeons of Ontario, marijuana is not to prescribed to those under the age of 25, “unless all other conventional therapeutic options have been attempted and have failed to alleviate the patient’s symptoms.”

Ware points out that developing teenage brains are very susceptible to THC, the psychoactive ingredient in the plant. And when administered at too young an age, it can have important effects, including triggering a latent psychosis.

“We don’t think [cannabis] causes [psychosis] by itself — most of the time there’s some underlying risk factor that cannabis can unmask or reveal. We don’t know exactly what those are, but we can’t screen for it, so we can’t advise who should use it. Conservatively, people set the age at 25, because at that point we think the brain has finished its development. It depends on the age of onset, and how much is being used.”

One big condition cannabanoids don’t seem to touch is acute pain, like a twisted ankle or a toothache. If anything, Ware warns, it can make the pain worse because you become more aware of it.

And just because the conditions noted above have been helped by prescription cannabanoids, that doesn’t mean any old weed will do. Ware points out the meds prescribed by professionals can have very different effects than street drugs.

“I think it’s worth thinking about cannabis not as the end game in all of this, but maybe for some people a part of their pain management, especially if coupled with other things like exercise, positive thinking, stretching and the like,” says Ware.

“I don’t think of cannabis as a miracle cure — I think it’s a piece of the puzzle that in the right hands can be used to help patients.”

News Moderator: Jacob Redmond 420 MAGAZINE ®
Full Article: Medical Marijuana Can Be A Huge Help For People In Pain
Author: Rebecca Zamon
Contact: Email The Author
Photo Credit: Aspen Peak Magazine
Website: Huffington Post Canada

‘Marijuana is infinitely worse’ than tobacco, Harper says as he encourages pot debate to go up in smoke

MONTREAL — Marijuana is “infinitely worse” than tobacco and its use should be widely discouraged in Canada, Conservative Leader Stephen Harper says.

The remarks come the morning after the federal leaders’ French-language debate, in which Harper’s clash with Liberal Leader Justin Trudeau over the issue of legalization was among the evening’s more memorable exchanges.

The Liberals support legalization; Trudeau argued during the debate that if pot were legal and regulated, young people would be less able to easily procure the drug than they are currently.

The Conservatives are vehemently opposed to the idea, with Harper saying that regulating its sale in the same way as cigarettes or alcohol would do nothing to keep it out of the hands of kids.

When asked Saturday how the Conservatives square that position with the fact medicinal marijuana is currently used by thousands of Canadians to treat a variety of causes, Harper said there’s overwhelming evidence about the drug’s long-term effects.

Last year, Health Canada kicked off an anti-marijuana ad campaign — repeated shortly before the start of the election campaign — that said the drug was responsible for lower IQs, a statement derived from two separate studies whose conclusions have since been challenged.

The Conservatives also often link marijuana use to increased risks of mental health issues, such as psychosis and schizophrenia, but medical research on that is divided as well.

Harper likened what the government is trying to do with marijuana to its tobacco control strategy.

“We’ve spent a couple of generations trying to reduce the use of tobacco in Canada with a lot of success,” he said.

“Tobacco is a product that does a lot of damage — marijuana is infinitely worse and is something we do not want to encourage.”

A government survey of tobacco use found that the overall smoking rate among Canadians over the age of 15 declined from 25 per cent in 1999 to 16 per cent in 2012.

THE CANADIAN PRESS/Nathan Denette

THE CANADIAN PRESS/Nathan Denette

By contrast, Statistics Canada has reported that the prevalence of marijuana use among Canadians over the age of 15 has remained relatively stable, with 12 per cent reporting they used the drug in the last year both in 2002 and 2012.

However, the Canadian Cancer Society notes that while 85 per cent of lung cancers can be directly linked to smoking, more evidence is needed to know whether there’s a similar cancer risk posed by smoking marijuana.

While some studies suggest there is an increased risk, the quality of the research is not as strong as the evidence on tobacco and cancer, the society says on its website.

The Ironic Comparison Of Cannabis and Pharmaceuticals

Comparing Testing, Health Benefits and Side Effects

Proponents and advocates of the medical cannabis industry have long pointed at the pharmaceutical industry as to why medical cannabis is not further along in research, development and most importantly, application. On one hand, it would be a safe assumption to say that cannabis is currently one of the most tested and researched substances in America. However, the application of medical cannabis continues to move at a snail’s pace, if not a dead snail’s pace. On the other hand, America continues to see new pharmaceuticals pushed behind the counter of your local pharmacy nearly as quickly as they restock the candy aisle. So what is behind all of these pharmaceuticals, and their FDA approvals, that are being deemed as useful and effective in the treatments to which they are claiming? Well, it turns out that answer is much less than you think.

In a recent analysis of the past 206 FDA supported pharmaceutical drugs, over 36% of those (74 drugs) were approved on the basis of a single clinical trial. Furthermore, many of those 200+ FDA approved drugs were passed through with little, if any, research as to the long-term side effects. Now, the theory behind the US Food and Drug Administration (FDA), as well as the public expectation, is that the FDA will test and vet these substances before they hit the market.

Many Americans consider FDA approval as a legitimate medical claim. In fact, in a nationwide study of nearly 3,000 Americans, 39% reported that they believe the FDA only approves ‘extremely effective’ drugs. 25% of people in the same study are of the opinion that the FDA only passes pharmaceuticals that have no serious side effects. Unfortunately, this belief is very dangerous, for patients as well as medical physicians who might take the FDA endorsement at face value.

In a recent analysis of the past 206 FDA supported pharmaceutical drugs, over 36% of those (74 drugs) were approved on the basis of a single clinical trial.1

The blind leap of faith is not only dangerous due to the lack of clinical trials, but the side effects listed with these pharmaceuticals are vast and often overwhelming. A recent study conducted by Dr. Jon Duke, assistant professor of medicine at the Indiana University School of Medicine, analyzed 5,600 drug labels and found more than 500,000 listed effects. Their findings indicated that more commonly recommended pharmaceuticals came with an average of 100 side effects, with some listing as many as 525. Now, obviously most of the side effects listed are less than likely, but the fact that the FDA is passing these medicines, often with one clinical trial and an average of 100 side effects, says all that needs to be sad about the hypocritical state of the medical system in America.

To make the comparison, feel free to visit PubMed, the National Library of Medicine’s database. A simple search for the term ‘cannabis’ will yield you over 14,000 studies, dating all the way back to 1843 and Dr. John Clendinning’s ‘Observations on the Medicinal Properties of the Cannabis Sativa of India.’ Now, a study is certainly not a clinical trial. However, as cannabis is federally illegal, those clinical trials have not been allowed and are left as ‘studies’. If we could speculate that those studies would have turned in to legal clinical trials, which, given the ‘anecdotal’ medicinal evidence, would be the case, then we could assume a certain percentage of these 14,000 studies would have become legal trials.

If we were then so bold as to take the FDA single-study approval percentage and apply it to even a third of these studies, you would have well over 1,000 cannabis related medications approved for medical use. However, currently the FDA has approved 0 cannabis related substances for medicinal use.

The National Cancer Institute, the federally recognized authority on cancer research, recently released their findings that ‘Cannabis has been shown to kill cancer cells in the laboratory.’

But what about the long-term side effects? Cannabis has to be as bad for you as the pharmaceutical alternative, right? Well that depends on who you ask. If you were to ask Dr. Jordan Bechtold, a psychology research fellow at the University of Pittsburg, he would say that cannabis use, especially as a teenager, does not lead to long-term side effects. Dr. Bechtold was part of a recent research group who, in conjunction with PITT and Rutgers University, followed 408 males from adolescence to their mid 30’s for the study. The findings were thereafter published in Psychology of Addictive Behaviors and disseminated through the American Psychological Association (APA).

“What we found was a little surprising. There were no differences in any of the mental or physical health outcomes that we measured regardless of the amount of frequency of marijuana used during adolescence.” – Dr. Jordan Bechtold – University of Pittsburg Psychology Research Fellow 

In the spirit of comparison, a simple search for ‘pharmaceutical long-term effects’ yields dozens of results that correlate to studies showing drastically negative side effects to long-term prescription pharmaceutical consumption. Not to mention thereported prescription drug overdose total, which according to the National Institute on Drug Abuse, a federally operated agency, in 2013 topped 24,000 people, 15,000 more than heroin.

So, in order to potentially overdose on a cannabis edible, one would have to eat 2.2 million times the suggested dose in 15 minutes.

Now, in order to hit the comparison out of the park, one most point out one last bit of information. Throughout the history of cannabis consumption, as far as we can trace it back that is, there are no documented cases of a cannabis consumer dying from overdose. It’s been reported that science has, however, figured out the amount of cannabis one would need to consume edibly in order to be at risk for a lethal reaction. That number is 22 kilograms. The recommended dose for a cannabis edible is 10 millagrams. So, in order to potentially overdose on a cannabis edible, one would have to eat 2.2 million times the suggested dose in 15 minutes. In terms of smoking cannabis, those numbers are comically more impossible to reach.

The point of all of this information is not to demonize the pharmaceutical industry, and not to glorify cannabis as the end-all perfect solution to medical treatments. Rather, this article simply aims to jumpstart the conversation as to the hypocrisy in which America allows medical treatments to be developed and approved for human consumption. For those who already knew this information, it is a data and research based compilation they can share with the skeptics in their lives. These studies are not coming from the cannabis community. Instead, these studies are coming from national renown medical colleges and federally funded research. In fact, the National Cancer Institute, the federally recognized authority on cancer research, recently released their findings that ‘Cannabis has been shown to kill cancer cells in the laboratory.’

So we did it. We’ve found a possible cure for cancer. After all of these years, and the billions of dollars that have gone towards researching this terrible disease, America has finally found something that could reverse the curse and treat suffering and dying patients. Let’s throw it in a single clinical trial and push it through the FDA. Oh wait…the treatment is cannabis related? Whoops. Never mind, back to the drawing board. This is the state of medicine in America right now. Sadly, this is not just one man’s opinion. This information is based on facts, research and information that is accessible to everyone, even the American government. Your move America.

What are your thoughts on this comparison? What do you think needs to happen so that cannabis can be treated in the same medical light as the pharmaceutical world? Do you even want it to be?

B.C. could legalize marijuana, says former U.S. prosecutor

B.C. could legalize marijuana on its own without federal approval, believes a former prosecutor that helped legalize pot south of the border in 2012.

Marijuana falls under federal jurisdiction in Canada, but with some creativity local politicians can push from the bottom up for change, saysTonia Winchester the former deputy campaign director for Yes on I-502.

“I think it’s possible for something like that to happen in B.C. But I think it will take a lot of creativity and courage on the local level to really stand-up and say our communities are ready for something different and I think B.C. is really poised to do that,” she said.

Winchester is speaking at the Union of B.C. Municipalities annual general meeting on the role cities need to play when it comes to legalizing pot and the lessons they can take away from Washington state.

Tonia Winchester the former deputy campaign director for Yes on I-502 is in Vancouver to speak with the Union of B.C. Municipalities on legalization of marijuana in Washington. (Charlie Cho/CBC)

“I think it’s challenging as a politician to step out and be pro-marijuana. Because people think if you are pro-marijuana, you are pro the use of marijuana. But what we are really talking about is what is the best policy for our community,” she explained.

Regulating and taxing marijuana is about taking money out of the hands of cartels, freeing up law enforcement to work on other matters and investing in drug treatment and education, she said.

“I think really B.C. and the politicians here are poised to have that same conversation. What can we do that is better for communities than putting more people behind bars,” she said.

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