How Canadian Doctors Approach Prescribing Weed for Pain and Anxiety

A field of legal weed at Medreleaf in Ontario. Photo by the author.

In September, the College of Family Physicians of Canada published a set of guidelines for Canada’s doctors titled, “Authorizing Dried Cannabis for Chronic Pain or Anxiety.” Doctors around the country are in a tricky position when it comes to prescribing weed, as Health Canada (the government's department of health issues) doesn't seem to care about funding additional research that would help uncover more information about marijuana, a product they have not officially “approved” as a drug. (Of course, Health Canada clearly condones the sale of medical cannabis, given the authorization of 13 legal weed factories known as licensed producers, or LPs.)

The College’s new document notes that Canadian doctors are dealing with “intense interest from patients (often accompanied by less interest in evidence)” who want medical marijuana, but without more research being published to indicate how much weed say, a chronic pain sufferer, needs in order to alleviate discomfort, doctors are left in the dark.

As the document states, “Health Canada has not reviewed data on… the safety or effectiveness [of cannabis].” This leaves people seeking medical marijuana in an unfortunate position. They may believe that cannabis can help them feel better, but since they have to go through their doctors to get legal weed, tension can develop between doctor and patient.

For now, the College of Physicians believes that “the only sensible advice for physicians involved with authorizing dried cannabis is the maxim "Start low, and go slow’” Doctors are advised to avoid prescribing weed to patients who show signs of abusing drugs.This advice, however, runs contrary to the experience of those who want to use cannabis for more purposes, like harm reduction for heroin and crack addicts.

If a chronic pain patient approaches a doctor and wants to obtain some chronic, the doctor has been advised by the College to “conduct a pain assessment, assess the patient for anxiety and mood disorders, and screen and assess the patient for substance use disorders.”

The College carefully notes that “many psychoactive drugs with abuse liability will temporarily blunt the patient’s perception of pain without improving function.” The report also tells doctors to cancel the cannabis prescription if it’s not working, while reiterating that any signs of “cannabis use disorder” should result in a discontinuation of the prescription.

As far as anxiety, most people who have smoked weed know that it can make anxiety worse. Just talk to anyone who turns down a joint because it freaks them out. But there are plenty of people, like our friend Damian Abraham, who swear by cannabis as an effective treatment for their anxiety disorders. So who’s right?

Based on the information that the College of Physicians has to work with, “dried cannabis is not an appropriate therapy for anxiety or insomnia.” What's more, “Acute cannabis use can trigger anxiety and panic attacks… studies suggest that high doses of cannabis actually worsen anxiety,” though “an oral extract of pure cannabidiol has been shown to relieve symptoms of social anxiety.”

Well, that's a problem, since Health Canada’s troubled medical marijuana program, the MMPR, only supports the sale of dried cannabis.

There are, however, strains of cannabis that are low in THC (that’s the funky brain chemical that gets you high and stuff) but high in CBD (the more medically relevant, body-buzz ingredient), which has been shown to be much more helpful for anxiety sufferers. The College of Physicians has encouraged doctors to prescribe high-CBD strains, and  even published a guide of the most dank, anxiety-relieving buds available from LPs.

Strains of weed recommended by the College of Physicians.

I reached out to Health Canada and asked them if this document—the bits about anxiety in particular—had swayed their stance on selling marijuana edibles through the MMPR. "The answer would be 'no,'" wrote back Sara Lauer, a Health Canada spokeperson.

So despite a thoroughly researched document by one of Canada’s foremost medical associations concluding that eating or taking oral extracts is safer than smoking dried cannabis, the government has no plans to revise its medical marijuana program. (My other questions for Health Canada, about CBD and THC content, were left unanswered.)

Since the advent of the MMPR, organizations like Cannabis Advocates have begun advertising to Canadians in need of medical authorization to buy cannabis from an LP. Basically, they’re around to fast-track the prescription process. While this may do the trick for people in need of weed who don’t want to deal with their family doctor, it indicates that there’s accessing cannabis is a big problem in the Canadian health system, despite Health Canada’s declaration last year that weed will soon be a $1.3 billion industry in this country.

That's certainly good news for fans of bud. It would be great if it were just a little easier to get your hands on legal cannabis without jumping through so many hoops.

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