Medical marijuana works, so why aren't more patients using it?

by Sean Minogue

Flickr: Vic

“Canada’s current system of marijuana prohibition does not work,” reads the federal Liberal party’s website. That fact is all too clear to anyone waiting for the landscape to change while enduring conditions like chronic pain, post-traumatic stress disorder or serious sleep issues.

The mounting evidence about the effectiveness of medical cannabis is hard to ignore. Last year, McGill University published a study on its long-term side effects on patients with chronic pain, finding there was no increase of “serious adverse events.” A 2014 study in New Mexico found that medical cannabis accounted for a 75 per cent reduction in symptoms associated with post-traumatic stress disorder.

And when it comes to sleep disorders, Dr. Atul Khullar, a senior consultant at MedSleep clinics, has found that medical cannabis works very well for certain patients. “A lot of problems we were seeing with psychiatric issues combined with sleep issues weren’t responding to traditional therapies, or the therapies weren’t tolerated,” says Dr. Khullar. “So we began cautiously using medical cannabis for some very resistant cases and found some good success.”

Medical versus recreational

The available research and positive patient experiences should hasten a change in federal legislation, but this hasn’t happened yet. Dr. Khullar believes one of the big issues could be the blurring of the various uses of cannabis.

“I think it’s two streams,” he says. “Are you using this recreationally or are you using this medically? They’re completely different, even if it’s the same product. This is the uniqueness of medical cannabis.” It’s also a unique problem for doctors who want to steer clear of the recreational market while also providing the best health care to patients.

The lack of clarity between recreational and medical is also problematic for those who self-medicate. While Forum Research learned that one in five Canadians smoked cannabis in the year leading up to its 2015 poll, even the most experienced cannabis user may still select strains that aren’t suitable for a given medical condition. And the lack of rigorous product identification and tracking in the recreational market can also mean a confusion of tetrahydrocannabinol (THC) or cannabidiol (CBD) levels – two very different cannabinoids that affect a patient's experience.

In Dr. Khullar’s view, cannabis is “not just one drug – it’s a series of drugs. The type and the way it’s taken can vary the effect as well.” Ideally, a medical professional with experience in prescribing medical marijuana would assist in the product selection, recommended dosage and method of ingestion.

Wikimedia Commons: ashton

Rethinking traditional medication

According to Health Canada data, there were 53,649 registered clients for licensed medical marijuana producers during the period from January 1 to March 31, 2016. More than double the figure of those registered between April 1 and June 30, 2015 (23,930), patients are gradually finding ways to access effective treatment despite the legislative waiting game.

Patient-first platforms like Plants Not Pills are helping to bridge the gap by connecting those in need with experienced physicians who thoroughly assess an individual's suitability for medical marijuana.

These efforts are broadening the options for those who are wary of powerful prescription medications that might not be effective, or – in the case of some painkiller opioids – potentially dangerous.

So why isn’t there a greater movement towards medical cannabis? Dr. Khullar believes training is part of the problem. Cannabis affects “a whole different system called the endocannabinoid system,” he explains. “There’s not a lot of overlap [with other medications].” For physicians used to prescribing sleeping pills, pain medication or antidepressants, this is a vast new area of knowledge that hasn’t yet been integrated into medical cannabis.

Conditions like chronic pain and PTSD may not respond to what’s currently available in the pharmaceutical industry. And while each medical treatment comes with its own risk-benefit ratio, Dr. Khullar says a number of his patients have been able to “get their life back” with medical marijuana.

“The chronic pain [treatment] was very successful. You get people off a lot of their very toxic medication and sedating medications. They’re much more functional.” And with PTSD, “these are people who just aren’t functioning,” he says. Medical cannabis “gives back some quality of life – less flashbacks, they’re sleeping better, they’re more rested.”

Progressive cannabis legislation will definitely be a game-changer for Canada, but it’s only one part of an evolving conversation between patients, doctors and governments. “I would tell people not to shut their minds to it, but be very aware of all the particulars,” says Dr. Khullar.