Doctors find more questions than answers about medical marijuana

By JT McVeigh,

J.T. McVeigh photo Dr. John Hamlon, program direction at the University of Toronto Pain Medicine Residency spoke to area doctors to unravel the mysteries of introducing medical cannabis into treatment of pain management. The talk comes after Collingwood's first medical cannabis clinic opened.

Medical cannabis use is very much in the news, but not without some enormous challenges, particularly for the family physician.

The government has been forced to provide access and has off-loaded this access to doctors, but Health Canada still says that they have not reviewed the data and refuses to provide approval for use.

Now, Ontario doctors have to find a way to deal with patients looking for relief from chronic pain.

Dr. John Hanlon, the inaugural program director of the University of Toronto Pain Medicine Residency spoke to area doctors by invitation of Canadian Cannabis Clinics. A medical cannabis clinic recently opened in Collingwood, headed by Thornbury physician Dr. Linda Morel.

"It's hugely unfair to doctors to be put in this position," said Hanlon. "I think that it will change in time, I'm not a big fan of "big Pharma," but at least with their money and their power we will get larger data and information on what strains to use and hopefully better preparations, like a ventolin inhaler, so that it looks more like medicine."

"Rolling a joint is not medicine, I don't care what anyone says."

Hanlon's research has proved positive evidence that in some cases, cannabis is a much better tool for pain management, however there are caveats.

Unlike an opioid, Oxycontin for instance, where the results are felt immediately, there is some preparation with cannabis. There are three hybrid strains of the product, and dosage is highly individualized.

On the upside, there aren't the dangers associated with traditional pain medications, where the effectiveness of long-term opioids presents particular risk, especially for addiction.

Hanlon allowed that opioid misuse accounts for two deaths a day in Ontario.

"There are two plants commonly used in medicine, the poppy plant and marijuana, and despite poppies being presented as pretty pills by "big Pharma," it is, indeed, the most dangerous," said Hanlon.

Compounding the controversy and confusion is the proliferation of dispensaries popping up throughout North America.

"You can go online and find a naturopath in British Columbia who, for $500, will forward you a medical document to get cannabis from a dispensary," said Hanlon. "There's no doctor, no medical history and no relationship with the person giving you the drug."

Legally it is an enormous grey area for the police. Medically, it could be a nightmare.

"The recreational stuff is going to be super high THC, blow-your-mind kind of stuff, and the medical cannabis will be lower THC, so there are very different preparations. The people seeking to get high are not going to be happy with the medicinal stuff," said Hanlon.

Regardless of the medical opinion, the recreational product will get you right in the pocketbook.
"When the government legalizes recreational marijuana, they are going to tax the hell out of it," said Hanlon. "That's what will drive people to the medical stuff, to avoid the taxes. It's already happening in Colorado."

But, will doctors feel comfortable prescribing cannabis or be willing to refer their patients to a medical cannabis clinic?

"People's attitudes are changing. It's not as if they want to see grandma high, but it's because they're desperate." said Hanlon. "Now that 90-year-old lady may become confused or have poor balance with the cannabis, but she certainly is not going to have respitory depression and she certainly will not die from cannabis. That's the big difference."