Have we reached a verdict on medical marijuana?

With recreational cannabis on the horizon, implications for health care remain uncertain

Have we reached a verdict on medical marijuana?

The seizures started in 1959, when Terrance Parker was four years old.

‘Grand mals,’ they were called — a term that rose to prominence in the late nineteenth century and loosely translates to ‘a great evil.’

He could tell when they were about to happen. The hairs on the nape of his neck prickled in anticipation. A fear of the known, it was unlike any other, yet he could do little to prevent it.

As the electrical storm raced in his brain, his limbs jerked violently and his consciousness shredded. He would later be placed on an anticonvulsant therapy, and go through medications such as Dilantin, Mysoline, and Librium with little success.

The lobectomies, first performed at the Hospital for Sick Children, or SickKids, at age 14, and then 16, failed to effectively improve his symptoms. Parker’s prognosis appeared bleak.

At least, it did until he was introduced to cannabis by a worker at the Lakeshore Psychiatric Hospital. He would smoke a joint to get high and receive immediate, albeit brief, relief from the havoc that the seizures wreaked on his body. As he continued to smoke, however, something curious happened.

The seizures stopped.

“After 38 years of this terrible affliction, and hundreds, if not more than a thousand seizures, I can say that it is only with the assistance of marijuana that I have ever been able to fight through the [fear] and stave off an oncoming grand mal,” stated Parker, in a 1997 affidavit after he was arrested for the possession and trafficking of cannabis.

Parker was acquitted of all charges in 2000, after the judge declared his arrest unconstitutional on the grounds that it violated his rights to life, liberty, and security. It was at that moment that Terrance Parker became the first individual in Canada to use marijuana legally, for medical reasons. Regulated medical cannabis later became legal in 2001.

There are many individuals with stories like that of Parker — of discovering hope in this herbaceous flowering plant.

Although controlled clinical trials that determine a direct causal relationship between the use of cannabis and the frequency of seizures have been few and far between, there is mounting anecdotal evidence of its efficacy in treating epilepsy.

Exposure to cannabidiol (CBD), a non-psychoactive component in marijuana, has been linked to the reduction of seizure frequency in pediatric epilepsy and Lennox-Gastaut syndrome, a form of severe childhood-onset epilepsy.

Despite evidence being mainly anecdotal, Dr. David Juurlink, Head of Clinical Pharmacology and Toxicology at Sunnybrook Hospital and Professor in the Faculty of Medicine at U of T, believes a case can be made for the judicious prescription of cannabis.

According to Juurlink, cannabis is particularly useful for patients whose symptoms have improved with its use. It should be prescribed on a case-by-case basis, while also considering other drugs with similar effects.

Meanwhile, high-quality scientific evidence for the therapeutic effects of cannabis in the treatment of symptoms associated with multiple sclerosis (MS) like chronic pain, neuropathic pain, and spasticity — the tightness and stiffness of muscles preventing normal movement — has been well established.

In a 2007 study published in the European Journal of Neurology, 124 individuals with MS and spasticity were given a cannabis-based medicine containing CBD and the primary psychoactive component tetrahydrocannabinol (THC), while 65 individuals were given a placebo for a duration of six weeks. The results of this research gave cannabis the green light.

Studies published in 2004 and 2006 in the Multiple Sclerosis Journal had also found similar results, confirming the growing optimism that cannabis can be used to relieve symptoms associated with MS.

In a 2009 Nature study, researchers used similar methodologies to study the effects of cannabis for neuropathic pain in patients with HIV. The researchers found that the 28 subjects, who completed both placebo and cannabis treatments, experienced greater pain relief when they were treated with cannabis.

But despite what a quick Google search might tell you, cannabis is not a panacea for all diseases and disorders.

Dr. Tony George, Chief of Addictions at the Centre for Addiction and Mental Health and also Professor in the Department of Psychiatry, found that THC in marijuana actually worsens symptoms of psychosis in patients with schizophrenia, and could induce psychosis in those who have a family history of the disorder.

Surprisingly, isolating certain cannabinoids may have the opposite effect.

“CBD seems to oppose the effects of THC… and [CBD] is being studied for anti-psychotic, anti-depressant, and anti-addictive, and cognitive enhancing effects,” said George. “If that’s true, that could be a very exciting breakthrough in therapeutics in psychiatry, and it may be a potential pain strategy.”

Currently, there is simply not enough evidence to conclude that cannabis can effectively treat a myriad of mood disorders and other debilitating diseases. It has only been proven for a few diseases, and often in isolated cases.

According to George, thus far, there are only indications that cannabinoids have positive effects on post-traumatic stress disorder, anxiety, depression, or glaucoma, and evidence to support these indications is not substantive.

Yet, preliminary research is promising and may pave the way for its unrestricted use.

With the impending legalization of recreational cannabis, however, there are some concerns over what will become of Health Canada’s medical marijuana program. “The problem is that the current approach by the government is sort of full speed ahead, without doing the due diligence to find out the facts,” said George.

“There [are] only about 30,000 or 40,000 people using in a country of 35 million people,” he explained. “I don’t know what the future of medical marijuana is, but if you’re someone who is a patient or family member, or a healthcare professional that’s invested in that, I think there is some reason to be concerned.”

There’s major dough in dope — how should the government use it?

To effectively combat substance abuse, marijuana tax funds should primarily be invested in prevention and education

There’s major dough in dope — how should the government use it?

On November 10, the Canadian federal government announced an excise tax plan that will be implemented when marijuana is legalized next summer. The plan proposed an excise tax of $1 per gram, or 10 per cent of the producer’s sale price, with the higher amount of the two being charged.

The plan is still in its consultation stage, and there are sure to be many changes over the next few months. Hopefully the fact that education and prevention tactics provide better long-term solutions to addressing substance abuse than punitive mechanisms will guide future discussions about the tax plan. Moving forward, marijuana legalization should be approached mainly as an issue of public health — the revenue from legalization can play a major role in ensuring appropriate solutions to substance abuse are implemented.

In a November 2016 report entitled “Legalized Cannabis: Fiscal Considerations,” the Parliamentary Budget Officer estimated that sales tax revenue for legal marijuana could be as high as $959 million in its first year. While it is unlikely that this figure will be reached due to initial legalization costs, it doesn’t include potential revenue from an excise tax. Sales and excise taxes combined could make the almost $1 billion goal an achievable reality.

Meanwhile, substance abuse continues to be a costly problem for the government and citizens alike. The Canadian Centre on Substance Abuse (CCSA) claims that substance abuse and addiction isn’t an isolated problem — it burdens our health care, law enforcement, and criminal justice systems, as well as our overall productivity as a society. This doesn’t even begin to cover the unquantifiable human costs of substance abuse either, such as decreased life expectancy or disruption of family life.

In 2006, the CCSA released a report titled “The Costs of Substance Abuse in Canada 2002.” The results were harrowing: the total annual societal costs of substance abuses was $39.8 billion. Our flailing health care system has struggled to keep up with substance abuse issues for years. A 2014 CCSA study, “The Impact of Substance Use Disorders on Hospital Use,” showed a 22 per cent increase in hospital costs for substance abuse-related issues from $219 million in 2006 to $267 million in 2011. This included $14 million in hospital costs along with a 39 per cent increase in days spent in the hospital for marijuana users.

These reports speak to a need for a more effective and efficient system to combat substance abuse and addiction problems. While it would be misleading to equivocate the repercussions of marijuana abuse and those associated with hard drugs, the sheer amount of revenue the government will be bringing in from marijuana legalization can be redirected to alleviating the problems associated with substance abuse in general.

The current tax plan calls for a 50-50 split of the revenue between the federal and provincial governments. Provinces spoke out against this plan immediately, stating that they deserve a bigger portion of the revenue given that they are responsible for most of the work and costs associated with implementing legalization. Municipal governments have also argued that, because they cover almost 60 per cent of Canada’s policing costs, the revenue should be directed to cities to help offset them.

Both of these claims mention the enforcement aspect of legalization, which remains a part of the government’s marijuana regulation strategy. Yet if there is one thing the ‘War on Drugs’ has taught us, it is that cracking down on drug use via highly punitive enforcement measures is an inadequate solution. This approach has proven ineffective at reducing substance abuse and has burdened the criminal justice system, incarcerating people at alarming rates while failing to confront and deal with the root causes of drug use.

Punitive measures can also be extremely costly. A 2005 report by the Health Officers Council of British Columbia found that for every $5 spent on treatment, the federal government spent $95 on enforcement. There are substantial costs, financial and otherwise, associated with incarceration in particular.

In contrast, education and prevention programs deal with reducing harm by destigmatizing substance abuse so that people can get the help they need. This approach can be highly beneficial, particularly when it supersedes harsher measures. An example of this is Vancouver’s Four Pillars drug strategy, which has been successful in preventing the spread of infectious diseases, overdose deaths, and public drug use by focusing on the combined principles of harm reduction, prevention, treatment, and enforcement. This strategy recognizes the need for policing while emphasizing a preference for non-punitive measures where possible. In this model, police officers connect non-violent offenders with health services instead of incarcerating them, a method that has been commended by the city’s Drug Treatment Courts.

Accordingly, the federal government should devise a tax plan that prioritizes funding education and prevention programs over law enforcement strategies — not just for marijuana, but for all substances. Adopting this approach to countering substance abuse and addiction and using marijuana tax revenue to finance it has the potential to increase public awareness about marijuana and how to use it safely. It could also lower the need for extensive policing and other enforcement costs. Legal substances, which will soon include marijuana, are the most abused in Canada — almost four times as much as their illegal counterparts — and it makes sense to use the money reaped from legalization to prevent harmful misuse.

If the federal government wishes to make the best use of marijuana tax revenues, they must prioritize investing those funds in the fight against substance abuse and addiction. Diverting more funding to law enforcement is unlikely to achieve this goal. Fortunately, the consultations for the excise tax framework are ongoing, and I would encourage students to get involved in the process. Individuals and groups who wish to present their own ideas about the framework can review the relevant documents at the Department of Finance website and send written comments by email until December 7.

Ramsha Naveed is a third-year student at Trinity College studying Political Science.

 

 

 

 

 

“Legalizing Marijuana” event discusses problems in legislation

Education, increased demand, equity among problems

“Legalizing Marijuana” event discusses problems in legislation

In anticipation of the federal government’s plan to legalize marijuana next summer, an event titled “Legalizing Marijuana: How to Get it Right?” was hosted on November 14 to discuss important issues surrounding legalization, including how to educate consumers and how to deal with large increases in demand. The event was organized by the U of T Political Science Alumni Association and took place at St. Michael’s College.

The panel, moderated by CBC News reporter Jacqueline Hansen, featured Bill Blair, current MP and former Toronto Police Chief; the Honourable Yasir Naqvi, Attorney General of Ontario; Michael Lickver, Executive Vice President of marijuana financing company Cannabis Wheaton; and Dr. Kwame McKenzie, CEO of Wellesley Institute, an urban health think tank.

Canada’s plan to legalize marijuana states that the federal government will be in charge of monitoring the quality of cannabis, while the provinces and territories will decide how it’s sold, at what price, and the age limit. Ontario is proposing to sell marijuana in 150 stand-alone stores managed by the Liquor Control Board of Ontario while imposing an age limit of 19.

Speaking on the age limit, Naqvi emphasized that there would be no criminal record for underage youths caught breaking the law. Rather, the focus of the restriction is on “prevention and education… We want to make sure that we work with young people and convince them not to use the product.”

On the subject of education, McKenzie stressed that we still have a long way to go in terms of learning about the effects of marijuana.

“Can you take cannabis and then go work in a daycare? How much cannabis can you take before you go work on that building site? I’m not completely sure that we’re sure of the answers. There are some big issues out there that we need to know more about.”

“This isn’t a problem created by legalization,” argued Blair in response. “We’re not proposing to merely legalize. We’re lifting a prohibition… [and] you’re going to see a very significant public education campaign,” he added.

Lickver, speaking from an industry perspective, said that despite the government’s efforts, it is going to be “insanely difficult” to educate the public on the difference between black market cannabis and government-licensed cannabis due to the heavy restrictions on advertising.

According to Lickver, the government’s emphasis on establishing brick-and-mortar stores will also make it harder to promote legal cannabis, which he says will pose a convenience problem. “If I’m a consumer — and that doesn’t have to be hypothetical — I don’t want to go to a government-run store if it’s going to be less convenient for me than the guy who lives at the end of my hallway that I’ve been grabbing from for the past 20 years… Eventually we have to reach the UberEATS of cannabis”

According to Lickver, legalization could result in millions of new customers, thus greatly increasing the demand for cannabis.

“It’s really just a race now in terms of a land grab to ramp up production to ensure that there aren’t World War II era bread lines going down the street when these CCBO stores first open.”

According to McKenzie, emphasis on physical stores would make it difficult for marginalized populations to access legal cannabis. “My worry is that the lack of reach and distribution could lead to the criminalization of marginalized populations,” he said.

McKenzie further suggested that a solution to this problem could be using the extensive, albeit illegal, network of marijuana dispensaries that already exist. In response to this, Naqvi stated that “governments don’t work with illegal industries.”

“If you’re going to do it, you have to start somewhere. And you’ll never have perfection on day one…Yes, the timeline has been tight, but where there’s a will there’s a way.”

The federal government plans to legalize marijuana by July 2018.

The new war on drugs

Students advocate for drug reform in Canada

The new war on drugs

From April 19–20, the United Nations will be holding a General Assembly Special Session (UNGASS) to discuss global drug policy for the first time since 1998. U of T students from the Canadian chapter of Students for Sensible Drug Policy (CSSDP) hope to be in attendance.

Canadian Students for Sensible Drug Policy (CSSDP)

The Canadian chapter of the CSSDP focuses on harm reduction and a scientific approach to drug policy, say Daniel Grieg, a leader within the organization, and Kyle Lumsden, a dedicated member.

In an email exchange with The Varsity, Greig emphasized that restrictions of scientific inquiry into psychedelics hinder medicinal development.

“Drugs are inappropriately classified in present policy.  For example, psychedelics are currently being explored… for their therapeutic properties and are also contributing to research in how we think about consciousness and the brain.  If it does turn out that psychedelics are useful and safe medicines, then we will be effectively withholding treatment from people suffering from mental illness,” he said.   

Greig emphasized the importance of lifting barriers to research. “Ultimately, we need to not only minimize the negative impacts of drug policy, we also need to maximize the possible benefits. Harms are things such as the disproportionate criminalization of the poor and people of colour, as well as the unnecessary deaths caused by lack of available knowledge. The benefits are such things as useful research tools, the development of more effective mental health treatments and tax revenue.”

Lumsden outlined the focus of his interest in drug policy reform: “The widespread harm of alcohol and violence associated with black markets for illegal drugs pose the greatest threat to society and can be improved with evidence based public policy. Multiple studies show that when police have a successful takedown of a drug network, there is a spike in violence afterwards due to a vacuum of power; other criminal groups compete for their share of the market indefinitely.” 

Nazlee Maghsoudi is the strategic advisor for the CSSDP, the knowledge translation manager for the International Centre for Science in Drug Policy (ICSDP), and a U of T graduate. She said that the reality is that “prohibition has endangered young people” despite the war on drugs rhetoric, which claims to be aimed at “keeping children safe.” 

Maghsoudi believes that UNGASS is “drug policy’s moment in the sun, in terms of approach.” According to Maghsoudi, the UN’s drug policy approach has grown outside of the UN because “the global drug policy regime is divorced from human rights” even though non-progressive countries execute their inhabitants for possession or consumption. 

She also believes that there are many barriers to reaching the consensus needed for the construction of an international framework through the UN.

Canada’s opioid problem

According to an article in the Globe and Mail article, “Canada is the world’s second-largest per capita consumer of opioids and the fallout is being felt across the country. The article indicates that between 2009 to 2014, at least 655 Canadians died as a result of fentanyl, a powerful opioid that is available by prescription and is also manufactured in clandestine labs and sold on the street.” 

Tara Gomes, a scientist working for the Ontario Drug Policy Research Network (ODPRN) describes pain as “difficult to manage” and that there “isn’t a lot of training for it in medical school.”

It’s not that opioids should not be used, but once someone shows addictive tendencies doctors should be able to refer patients to a case-dependent addiction treatment. Tara Gomes emphasized “there is a place for these drugs in clinical practice,” Gomes said.

Prescriptions

The Triplicate Prescription Program (TPP) and Prescription Review Program (PRP) were created in part to address the opioid prescription problem facing Canada. 

Wende Wood, a pharmacist and a graduate from the Ontario Institute for Studies in Education, recently moved to Alberta, where the TPP is currently in effect. According to the College of Physicians and Surgeons’ website, “TPP collects prescribing and dispensing data for listed drugs. When the data meet certain criteria, physicians and others involved in the care of the patient are alerted, provided with information and directed to resources to support them in providing safe care.” 

Saskatchewan has a PRP that performs a similar function. 

Wood said that these prescription monitoring programs have not caught on because providing three copies of the same prescription is tedious for doctors to fill out. 

Marijuana and Toronto’s dispensaries

Under the current framework, marijuana is legal as a prescribed medication. To obtain this prescription, one must register for a mail order from a licensed producer, or obtain a doctor’s prescription for a health-related issue, whioch must be taken to a local dispensary. 

The dispensaries are not authorized by Health Canada.