Medical Cannabis. Have We Gone to Pot?

Cannabis has been used for medical purposes for thousands of years; its use dates back to China in 3000 BC for various purposes including pain, spasms and seizure management. In the 1800’s an Irish MD brought tinctures of hemp to Europe from India, where he saw it used for a number of medical purposes; even Queen Victoria used it for labour pains! Sir William Osler, the “father of modern medicine”, referred to it as the “most satisfactory” treatment for migraines. Cannabis was available for use in the British and American Pharmacopeias from the later 1800’s until the 1920’s, when the reputation of the drug became negative, as it started becoming known as a drug used “by certain classes of people” for recreational purposes of getting high rather than just for medical use.

However, during the latter part of the 20th century, more pressure was being applied to government to legalize marijuana for medical purposes, as many people were finding relief from their pain, spasms, and other ailments from cannabis use. Thus in 2001, the Canadian government passed legislation to allow access to cannabis for medical reasons for certain medical issues, including spinal cord injury or disease causing pain or spasticity. People had to get physician’s authorization, and could apply to be allowed to grow their own, have someone grow for them, or get from a national supply from a government contracted source. The laws evolved over the years where in 2014, people could buy from any producer that Health Canada had licensed, as long as they had a physician authorization to do so, and later the law was reintroduced to allow people to apply to grow their own supply or designate someone to do so. The number of licensed producers in Canada has grown exponentially in the last few years, and there are now over 100. The list can be viewed on the Health Canada website. The process to apply for and obtain medical cannabis can be found on the website as well: https://www.canada.ca/en/health-canada/services/getting-cannabis-from-licensed-producer/accessing-from-licensed-producer.html.

In October 2018, the Cannabis Act was introduced, where now Canadians could access marijuana for recreational purposes as well. With the Cannabis Act, people may go to a store where cannabis products are sold that come from licensed producers. It is still illegal to obtain ANY cannabis product from a non-licensed producer, whether that be “street” cannabis, products grown at home or by a “friend” that are not authorized by the government, or ordering online products from a non-licensed producer, including ANY products (even straight CBD oil) from the USA.

Why is getting “medical” cannabis important vs going to a recreational source? There are a number of reasons. A key one is that with the medical route, you are working with your physician to help guide you what dosing, routes, and ratios of different ingredients should be used. There are 2 main medicinal ingredients known in cannabis: THC (which gives you the “high”), and CBD (which doesn’t have the “high” effect). Both of these substances have been shown to be beneficial for certain medical ailments, and often used in combination can have additive benefits. If going through the medical route, your physician can help guide you on getting started and which types of products to use. Additionally, with using the physician to help, the other treatments for the condition (such as neuropathic pain and spasticity in spinal cord injury) can be trialed and titrated. Other reasons include being able to “write off” the cost of medical cannabis on your taxes (you can’t do this if you just by from a store), applying to your insurance for at least partial coverage of medical cannabis, being able to use oral forms of medical cannabis in public places and in institutions such as hospitals and long-term care homes, likely slightly lower cost of medical vs recreational cannabis, and usually better selection of CBD containing products through the medical licensed producers.

So how does someone access medical cannabis? Discuss with your physician to see whether this is an appropriate medicine for your condition. There is some evidence for using cannabinoids in people with SCI and neuropathic pain or spasticity. There are cannabinoid medicines that can be obtained by prescription such as nabilione (Cesamet), which contains a form of THC only, or nabiximols (Sativex), which contains both THC and CBD. However, if it is deemed by you and your physician that you should trial medical cannabis, then you would need to register with a licensed producer and your physician would need to complete a medical document to authorize you to access medical cannabis. ANY physician or nurse practitioner can do this, but it should be a health care professional that knows your medical condition and has worked with you to help manage your symptoms, so that he or she can be sure that a holistic and evidence based approach is taken to help you manage these symptoms. IF your physician or nurse practitioner is not comfortable with helping guide your medical cannabis treatment, then consideration can be given for referral to a clinician that has the expertise in this area and symptom management for your condition. As with any medical therapy, this should be done IN COLLABORATION with your primary care physician and your specialist physicians. With all of your medications or treatment you are receiving, you should be very aware of what you are using, and inform all of your health care providers of exactly what you are using such as content of THC or CBD, amount used etc. Be sure that all of your health care providers receive the appropriate communication from your physician who is authorizing your medical cannabis.

With changes in health care delivery, it is essential for you to be vigilant in the collaborative efforts of your care providers by enhancing the communication and information sharing.  The long term benefit will assist you in health maintenance and quality of life…you are in charge.