It’s time to start using the M-word
In many ways, Marion Albaum of Toronto, 38, is your typical Canadian mom. She cheers at her son’s minor league hockey games and creates brightly coloured cakes for her daughter’s sleepover parties. Photos of anniversary dinners and birthdays plaster her Facebook page. Not pictured are the nights she spends in hospital with a feeding tube and hovering team of nurses and doctors nearby.
Marion suffers from fibromyalgia and Crohn’s disease. Independently, these two conditions are debilitating. Combined, the pain can be blinding and all encompassing. Marion’s treatment history includes opioids and other prescription drugs. But when her dependence on opioids proved too destructive — she started to shake and sweat if her dose wasn't constantly increased — her doctor suggested cannabis.
Like the more than 40,000 Canadians who are legally entitled to take cannabis for ailments, and thousands more doing it under the table, Marion swears marijuana is a lifesaver. She says the herb has helped her skirt a major addiction because it’s safer and less toxic than her other pharmaceutical options. She says it makes her a functional parent, wife and friend again. Luckily for Marion, her doctor was open to considering cannabis in the context of an overall treatment strategy. Many clinicians in Canada are not comfortable discussing cannabis with patients, let alone prescribing it.
Medical cannabis advocates like Dr. Shoichet and Ms. Balneaves say they understand physician hesitancy, but to say there is not supportive evidence is incorrect. Evidence of its benefits are seen everyday when severely ill or disabled patients are able to function again.
Clinicians and researchers from McGill, Dalhousie and UBC tell Hospital News the short-term solution to the current schism in the medical community includes more funding for clinical research and increased medical education of the existing research. Under the newest regulations, physicians and nurse practitioners are the gatekeepers to legal cannabis.
“It is not sitting well with many physicians that they are now effectively prescribing a product for which they have little control — or knowledge to guide them — on the dose, concentration, and variety of cannabinoids,” says Dr. Colleen O’Connell, assistant professor at Dalhousie Faculty of Medicine and the research chief at the Stan Cassidy Centre for Rehabilitation in Fredericton, New Brunswick.
Recent studies show that physicians have disproportionate concerns about the addictive, psychiatric, respiratory and other health hazards of marijuana compared to what is indicated in the scientific literature.
“As a physician who has had the opportunity to research medical marijuana, I have a greater comfort with the products available than an average physician. When I support a patient’s prescription, that includes monitoring for effect and outcomes as well as non-pharmacologic approaches to symptom management,” says Dr. O’Connell.
Dr. Mark Ware says it’s time to take the blindfold off and quit standing at the sidelines. Dr. Ware, a practising pain physician at the McGill University Health Centre, researches the safety and effectiveness of medicines derived from cannabis (cannabinoids). He hopes to enhance research and medical education through the non-profit Canadian Consortium for the Investigation of Cannabinoids (CCIC).
He says one way to increase research is to demand support from the newly licensed medical cannabis distributors.
“They are now the ‘new pharmaceutical industry’, so I believe they have an obligation to fund research,” says Dr. Ware. “It may be difficult to see multiple large scale phase 3 clinical trials in the next five to 10 years. But we are operating with limited evidence and growing clinical need. They can fund helpful studies now.”
At least one medical cannabis producer has stepped up to the challenge with a study focused on osteoarthritis.
Dr. O’Connell would like to see studies identify which cannabinoids, and in what concentration are beneficial for what conditions.
Studies have already shown a reasonable proof of concept, says Dr. Ware. Cannabis helps patients with nausea, spasticity, mood disorders, and appetite loss to name a few. Whether that evidence base is sufficient for a professional is often a matter of medical judgment.
Western University’s Dr. Richard McLachlan, professor of neurology, is currently investigating the usage of marijuana among epilepsy patients and recording their observed benefits and any adverse effects. He turned to research after more of his patients were asking for him to help them obtain it legally.
“In the 19th century, cannabis was one of the few treatments for epilepsy thought to be effective. There are a number of studies of animal models of epilepsy done before 1980, which give support to the possible use of cannabinoids to control seizures and some that indicated it might make seizures worse. There are few studies after 1980 and none in patients because, as far as I can tell, authorities made it too difficult to carry out such research,” says Dr. McLachlan.
This information is provided from excerpts taken from http://hospitalnews.com read the whole article here.
