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Drugs

Here’s How Canadian Doctors Approach Prescribing Weed for Pain or Anxiety

A new report from the College of Family Physicians of Canada outlines new guidelines for prescribing weed to patients who have chronic pain or anxiety. Along the way, they subtly poke more holes in Health Canada's medical marijuana program.

by Patrick McGuire
Oct 7 2014, 4:14pm



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 entitled: “Authorizing Dried Cannabis for Chronic Pain or Anxiety.” The doctors of the Great North are in a tricky position when it comes to prescribing weed, as Health Canada does not seem to care about putting any funding into research that would help uncover more information about a product they have not officially “approved” as a drug.

That said, Health Canada clearly condones the sale of medical cannabis, given their authorization of 13 legal weed factories known as licensed producers (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 user, needs to alleviate their discomfort, doctors are being left in the dark.

As the document states, “Health Canada has not reviewed data on… the safety or effectiveness [of cannabis].” This leaves both chronic pain users and anxiety sufferers (two of the most common medical cannabis users) in an unfortunate position. They may believe that cannabis can help them feel better, but with their doctor being the only legal gatekeeper to obtain their medicine, tension can develop between doctor and patient.

For now, the College of Physicians has stated that “the only sensible advice for physicians involved with authorizing dried cannabis is the maxim ‘Start low, and go slow.’” They also have advised doctors to avoid prescribing weed to patients who show signs of abusing drugs; that is, anyone who admits to feeling annoyed at people who want them to cut down their drug use, or who has felt guilty about their own drug use, or who uses drugs or drinking to wake up, steady their nerves, or get rid of their hangover.

This methodology is in opposition to more radical uses for cannabis, 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.” It also advises doctors to cancel the cannabis prescription if it’s not working (obviously) while reiterating that any signs of “cannabis use disorder” should result in a discontinuation of the prescription.

As far as anxiety goes, colloquially, most people know that weed can make anxiety worse. Just talk to anyone who turns down a joint because it makes them crazy or 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, they have concluded that “dried cannabis is not an appropriate therapy for anxiety or insomnia.” That said, they do state that: “An oral extract of pure cannabidiol has been shown to relieve symptoms of social anxiety.”

Unfortunately, Health Canada’s troubled medical marijuana program, the MMPR, only supports the sale of dried cannabis.

As far as dried cannabis and anxiety goes, the College of Physicians declares what many of us already know: “Acute cannabis use can trigger anxiety and panic attacks… studies suggest that high doses of cannabis actually worsen anxiety.”

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, if they are prescribing cannabis at all. The College even published a guide of the most dank, anxiety-relieving buds available from LPs.



High-CBD, legal weed, as recommended by the College of Physicians.

The College also recommends that patients “ingest (that is, eat) your cannabis or take it using a vaporizer instead of smoking it.” This point highlights another shortcoming of the MMPR: Health Canada’s refusal to sell anything but dried cannabis, leaving the more medically safe alternatives like edibles and oral extracts to be relegated to a legal grey area.

I reached out to Health Canada and asked them if this document had swayed their stance on selling marijuana edibles through the MMPR. I received a curt answer from Sara Lauer, a Health Canada media relations officer, who wrote in an email: “the answer would be ‘no.’”

So despite the evidence of a thoroughly researched document by one of Canada’s foremost medical associations, which concludes that eating or taking oral extracts is safer than smoking dried cannabis, Health Canada, an organization that ostensibly cares for the health of Canadians, has no plans to revise their medical marijuana program, which only offers dried cannabis.

Wonderful.

My other questions to Health Canada (Will they encourage high CBD strains at licensed producers? Will that also include a mandate for LPs to advertise their strains’ CBD/THC content? Will they be funding any new research to see how cannabis can help chronic pain and/or anxiety?) were left completely unanswered.

Since the advent of the MMPR, organizations like Cannabis Advocates have popped up by advertising a service for 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 that weed will soon be a $1.3 billion dollar industry in this country.

While they certainly seem to have a money-boner over all this legal weed, it would be great to see Health Canada get more in line with this country’s actual doctors, who seem to have a pretty firm grasp on what kind of weed is good for medical relief, rather than sticking to the MMPR; a set of arbitrary and largely unhelpful rules.


@patrickmcguire

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