I magine waking up in the morning too panicked to leave your bed. Everywhere you go, there are potentially infectious microbes—on door handles, railings, on public transportation, and even in the air. For Catherine*, a U of T student, this nightmarish scenario is a reality. Catherine has a psychiatric disorder called Obsessive Compulsive Disease (OCD), and the most effective treatment she has tried for her condition is smoking medicinal marijuana.
On July 30th, 2001, Health Canada brought new regulations into effect governing the use of medicinal marijuana. Before last summer, Canadian doctors could apply for a twelve-month exemption from legal consequences for their patients to possess marijuana for medicinal purposes. Under the new legislation, patients can apply on their own for the authorization to possess or grow marijuana through the newly created Office of Cannabis Medical Access. With all application forms available online, and a toll-free number for information, medicinal marijuana has become more easily accessible. Also unlike before, applicants require no proof of a clean criminal record.
Former Health Minister Alan Rock promised a domestic supplier of government-distributed cannabis, and more funding for research on the risks and benefits of long-term marijuana use. Said Rock, “This compassionate measure will improve the quality of life for sick Canadians, particularly those who are terminally ill.”
Catherine is one of 365 Canadians who have applied for the right to smoke marijuana medicinally under the new regulations. Supported by her psychologist and psychiatrist, she feels marijuana is the best treatment she has tried so far.
She is allergic to benzodiazapenes and tried other antidepressants for a year, to no avail. After gaining weight, feeling constantly nauseous and struggling with insomnia and fatigue, Catherine failed a year in school. That’s when she started looking for alternative therapies like marijuana.
Catherine describes her lifestyle today as notably more relaxed, even on days when she does not smoke. “If I have a really bad panic attack, smoking [marijuana] will totally kill it. It relaxes me. I can sit back and say ‘Okay, I shouldn’t be panicking.’ When you’re in a panic attack, it’s really hard to think rationally. If I can relax myself and get out of the whole anxiety stage, I can look at things and say, ‘It isn’t really rational to think touching a doorknob is going to kill me.’ Despite positive feedback from patients smoking medicinal marijuana, the medical community is wary of the drug. Dr. Liesly Lee is the consultant neurologist at Sunnybrook and Women’s College Hospital. Dr. Lee, along with second-year University of Toronto medical student Gregory Silverman, are examining how marijuana relieves the symptoms of multiple sclerosis patients. The two are assessing who has used marijuana as a therapy, and whether or not their use correlates with severity of disease.
Dr. Lee warns a patient may report he feels better not necessarily because his symptoms are relieved, but instead because he feels happy and high. He says clinical trials administering THC, the active ingredient in marijuana, to MS patients in Europe and the United States rely on data that is too anecdotal. “The problem when you look at that data is that it can be confounded by many other variables. For example, if someone is happy, they will say they are better. [Because of] the euphoric response, it’s really hard to know if they are better, because objectively, clinically, are they better? Or is it because they felt better, so they claimed the symptom was better?”
Dr. Lee says smaller clinical trials using biochemical measurements rather than the patients’ emotional responses have shown negative results. “Besides the fact that the patient got high, they haven’t been able to confirm much more than that.”
But Catherine says she has observed a noticeable improvement in her symptoms. Before medication, she was having 20 to 30 panic attacks a day. Once on antidepressants, she was down to five per day. Now, by trial and error, she has ironed out the wrinkles in her smoking routine and has only two or three panic attacks in a week.
To skeptics of marijuana’s efficacy, she says, “Look at the frequency of panic attacks. I’ve been able to do so much more this year, I can get on a bus again, I can use a public washroom again, I can come to school every day… and I don’t have days where I wake up panicking and I don’t leave the house all day.”
Dr. Lee says he is hesitant to use marijuana therapeutically, and does so only after all other conventional methods have been ruled out.
Although he has no objection to the use of marijuana to minimize the suffering of ill patients, Dr. Lee stresses it is more important to seek the cause rather than mask the symptoms. “If someone is depressed, there’s a reason why they’re depressed. I think it’s much more effective if I try to go to the root of the depression, solve the underlying stresses or the biochemical abnormality than try to cover up the symptoms.”
One reason for concern is evidence that prolonged marijuana use may cause permanent damage to the brain. “I have concerns about the long-term effects of marijuana. It’s not a well-studied area, but there is some concern about the cognitive effects of the drug. For that reason I am very cautious to give this drug to people [who already have] a brain disease, and to add another drug that can have potential insulting effects onto the brain.”
Catherine admits that motivation, especially to do schoolwork, is sometimes a problem for her. However, her marks are dramatically better than when she subscribed to more conventional treatments.
“It was an issue for a while, when I was trying to find what was right for me. I try to control [my motivation]. If I know I have an important day, I’m not going to smoke right when I get up. I don’t smoke before I go to school and I don’t smoke before I go to work.”
Complicating matters further, the medical community says the government’s move to legalize medicinal marijuana may have been premature. The Canadian Medical Physicians Agency (CMPA) has asked doctors not to prescribe marijuana until the drug is better understood and Health Canada has set guidelines for its use. As a future physician, Gregory Silverman is also concerned.
“I think [the move] sets a dangerous precedent for the government to bow to political pressure and legalize a drug for use without good evidence as to its safety, long-term and in conjunction with other medications, or its effectiveness. I think the government has tried to pass the buck to doctors on a very contentious and politically tricky issue. If marijuana is to be used to treat pain in patients, this is already an area that is notoriously hard to properly diagnose and treat.”
Like Silverman, Lee is also concerned. He says most drugs must go through rigorous testing before the Canadian government makes them available to the public, but for a reason unbeknownst to him, this was not the case with marijuana. “As a doctor, we are sort of stuck. I don’t really know when I am supposed to use this drug. There’s been no good evidence to tell me [prescribing marijuana] is the right thing to do.”
To improve this situation, Lee would like to see more funding given to researching the long-term effects of marijuana, and education available to physicians about when marijuana should be prescribed. Silverman thinks the absence of guidelines given to doctors for prescribing marijuana is a dangerous thing, and may result in doctors avoiding prescribing it to evade legal consequences.
As of March 1, 145 Canadians have been granted the right to possess cannabis for medicinal uses under the new regulations. 101 of those have licences to produce their own, and five people have been designated to grow the plant for someone else.
Health Canada media relations officer Andrew Swift says applicants who are terminally ill have priority over those with chronic, yet not immediately life-threatening diseases. However, despite their legal right to smoke, Health Canada has not yet made available the domestically-produced cannabis. Swift says the marijuana, which has been grown in Flin Flon, Manitoba by Prairie Plant systems, still requires lab testing and a finalized distribution system and will be available “in the coming months.”
Although the Office of Cannabis Medical Access cites a 30-day waiting period for applicants to be approved, Catherine applied last summer and is still waiting to hear back. Until then, she will continue to smoke discreetly under the watchful eye of her physicians.
“I like people who are willing to try new things, especially in a doctor. I don’t want somebody who’s behind the times and set in their ways. I want people to keep an open mind and not immediately think of marijuana as [a hard drug]. I have an illness, and it helps me, so why would you take it away from me?”
Nevertheless, Catherine feels she cannot tell her family because they would not accept her decision. As for her friends, they support her decision.
“They think it’s cool. I’m a hero. I know a lot of people that smoke just for recreational purposes, and people that smoke because they have diabetes [and] epilepsy. I think I’m the test case for all of my friends. If I get approved, there will be a flood of applications from people I know.”
*Catherine’s name has been changed to protect her identity.
Photograph by Simon Turnbull
