As North America continues to grapple with the opioid crisis, it's become obvious that there is no straightforward fix for what we're experiencing. It's a multifaceted issue that touches on many disciplines and preexisting stigmas in society, but the opioid crisis is a public health problem first and foremost. What's more is that it's a public health problem that in part started in the healthcare industry itself, in doctors offices with the over-prescribing of addictive pain medication.
Some in the medical community who've witnessed the onset of the crisis and its effects on patients have started speaking out about potential public policy solutions, from positions on decriminalization of drug use to legalizing heroin. For a medical marijuana doctor in Ontario, though, he thinks that weed could help remedy the situation we're facing. Canada is currently on the verge of legalizing and regulating cannabis for recreational use, slated for 2018. But for Dr. Ira Price—an emergency-room doctor who started the first medical cannabis clinic in Ontario, Synergy Health Services, and medical director of a licensed producer of medical marijuana—a concern has arisen about how the medical side of cannabis could fall by the wayside under a recreational weed system.
"I think [medical marijuana] will revolutionize medicine if we don't lose the momentum we have in research currently," he said. And one way that cannabis could revolutionize medicine, according to Price, is by helping those who are addicted to opioids—by acting as a substitute for opioid pain medication.
VICE: Why do you think that cannabis might help solve the opioid crisis?
Dr. Ira Price: I'm an emergency physician by trade, and I spent 12 years in school to do this. We currently have an opioid crisis, all of Canada knows this. It's a nationwide crisis and also a provincial crisis and municipality crisis. Our federal government is trying to come up with ways to deal with the issue. I had been in the emergency department since 2005… You see patients requesting earlier and earlier refills, or overdosing or with acute intoxication or acute withdrawal from opioid medication. There's a time for opioids. No doubt that in an acute pain situation, there is a way to prescribe them. But we know that the harm profile is so high, and we have an alternative that works very similar to the way that opioids work.
Cannabinoids work like opioids and like an anti-inflammatory combined, without the harsh side effects profile. So why wouldn't we go there? I think it's our duty as physicians to do no harm first and then do what we can for our patients. Using those principles is what brought me into the medical cannabis world. Cannabis and opioids work on similar receptors... It allows us to decrease the number of opioids one uses and decrease that harm profile they have. So in clinic, at Synergy, we exchange them, and we help patients come off opioids by using cannabis.
It's not a simple answer to say here's a drug, go home, and you're going to be fine. Addiction is addiction, and the opioid crisis is multifactorial issue.
How has the opioid crisis affected where you work, in Hamilton, Ontario?
I work at the general hospital, which is a level-one trauma center right off of Barton Street. We have an issue. You can go on our city's website and see who's presenting to the emergency department. We have a notification system. It's on the rise. Just in one month, we have between 50 and 80 presentations to the emergency department with drug-related issues. That's a lot in one month. I can say on my own shift, I see one to three patients coming in with an opioid-related issue. That's huge. We're seeing things on the street right now like carfentanil, which is 10,000 times stronger than morphine, and fentanyl-laced crack. We're seeing things that we shouldn't be seeing.
We have programs, but I think the programs need to be louder and we need to bring more attention to them. We need to help people.
How would you deal with someone who comes into the ER and is going through withdrawal? The emergency department isn't the place to deal with putting someone on long-term therapy. I think we don't want to add to any other crisis, with whatever medication we're starting. Emergency department is acute care medicine: We see patients for a short amount of time and deal with that acute life-threatening injury or illness… The person who prescribes them medication should be the person who follows them for that medication on a long-term basis. That's just common sense. In the emergency room, though, that's the place to start that conversation. If someone comes in and is "dopesick"... What brought you to that circumstance? It's not just a matter of saying let's change it and put in another drug, because then we're just exchanging and not dealing with the underlying problems. The underlying problem could be mental health, it could be socioeconomic, a familial issue… We can't just say this is the one answer.
What do you think of the cannabis legalization plan that came out last week?
On the pro side, my hope is that it opens up some of the insurance companies to covering cannabis for people who are patients. I hope that it decreases the stigma that's been around cannabis for the past 100 years, which is totally unfounded and based on politics and discrimination. My fear is that we will lose the research momentum that we have currently in cannabis. I firmly believe that if we study cannabis and we take it apart and start looking at it for specific disease processes that we can revolutionize medication therapy for a lot of diseases. I fear that with legalization we will use that momentum for recreational use… It could fall by the wayside over money. That's what you're looking at: big business taking over.
What do you think will happen to people who have already been self-medicating with weed for various conditions, including opioid addiction, under a recreationally focused market?
That fear of going to a physician for medical marijuana is not based in medicine anymore. When I started, it was. In 2010, I was standing alone waving my flag… Now, it's turned around in the past two years. There aren't many physicians left who won't entertain the idea of medical cannabis because they know the safety profile, and we follow the evidence. The cannabis community perpetuates this idea of not going to the doctor because it's not going to help you—that's how it was five to seven years ago. The physicians who are still like that—I go around lecturing telling them how they should be approaching this as a subject. The change doesn't need to come from medicine anymore; the change needs to come from media. That's what's left to change.
I'm seeing medical clinics opening up all over the place, physicians referring. When I first started, we had about a 97 percent self-referral rate; today, we have a 99 percent physician referral rate. The tide has turned for medicine. If you ask people about why they started using cannabis, you'll probably find out that they were self-medicating for something in the first place.
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