Source: Vancouver Sun (CN BC)
Author: Karen Gram, Vancouver Sun
Published: Monday, October 06, 2003
Copyright: 2003 Vancouver Sun
Contact: [email protected]
Critics say the bureaucracy is so taxing for the sick that medicinal marijuana is hardly worth it.
Phillipe Lucas is legally entitled to possess marijuana to cope with Hepatitis C, but getting it legally is about as tough as getting a drink from a prohibitionist.
If you have chronic back pain, are undergoing chemotherapy or dealing with another medical condition and want to see if "medicinal marijuana" might help, bringing the option up with your family doctor might seem a little awkward. Actually getting the stuff, it turns out, is even harder.
"The Office of Cannabis Medical Access is the biggest oxymoron there is," Lucas says. "It's not about access, it's all about denying or complicating access."
According to Lucas, one third of the members on the advisory committee to the OCMA represent organizations opposed to marijuana access, organizations like the RCMP, Canadian Chiefs of Police, Physicians for a Smoke Free Canada and the Canadian Medical Association. Only two members are medicinal marijuana users. The bureaucracy they have set up is so onerous for sick or disabled people, it's hardly worth it, he says.
Following the steps Lucas took to get access demonstrates the thicket that keeps patients from easy access -- medicinal marijuana may be technically legal, but it's far from an easy prescription to obtain.
Like all others applying to get medicinal marijuana provided by the government, Lucas had to first be authorized to possess it. That required a lengthy bureaucratic procedure which he will have to repeat every year, even though his condition won't have changed.
Hepatitis C is considered a category-three disease by the OCMA, neither terminal (category one), nor one of the specified diseases (category two), so Lucas had to get two specialists to fill out a very detailed application stipulating that the benefits of marijuana outweighed any risks and recommending a cannabis dosage. Few physicians are willing to do that, especially when the CMA and the colleges that licence doctors have both urged them not to.
"We are opposed to physicians distributing medical marijuana and in the vast majority of cases we are also opposed to physicians prescribing it," said BC Medical Association president-elect Dr. Jack Burak in an interview.
Burak said distributing marijuana poses safety issues such as break-ins and violence for doctors while prescriptions should not be written for medicines in which the doctor can not be sure of the bio-availability or concentration of drug.
"The prudent move would be to hold off until we have scientifically-based knowledge that this is efficacious and therapeutic," he said.
Lucas was already using marijuana he purchased from the Vancouver Island Compassion Club, which he runs. But he wanted to be part of the legal system, under which his use of marijuana would be recognized as medicinal. Following the paperwork, he was able to convince two specialists to sign on, though he knows of other patients that have had a harder time accomplishing this task. He was also required to submit two passport photos signed by his doctor verifying his identity.
As of August, 642 Canadians, 108 of them in B.C. including Lucas, had been granted authorization to possess. (Compassion Clubs, whose organic medicinal marijuana sales to sick and disabled Canadians are generally tolerated by police, serve eight times that number across Canada nearly 5,000, 3,000 of whom live in B.C.).
Medicinal marijuana is still on the fringes of medical therapies but it's been gaining a great deal of attention throughout the world as ill people report how it relieves their pain and symptoms, enhances their appetite or helps them sleep.
In Canada, Former Health minister Allan Rock spearheaded legislation permitting some ill Canadians to possess pot during the first years of the new millennium. Access and distribution was another story. Rock was replaced as health minister by Anne McLellan in January 2002 and she is not nearly as comfortable with medicinal marijuana as her predecessor.
"I feel a certain degree of discomfort around this issue," she told doctors at the annual meeting of the the Canadian Medical Association. McLellan wanted the clinical proof that marijuana helps without harming before she distributed it.
By the time she made those comments in August 2002, medicinal users were already frustrated. Months before she spoke to the doctors, in May, users had initiated court proceedings. What good does it do to be permitted legal possession without legal access? they argued.
In February 2003 Ontario Court Justice Lederman agreed, saying Health Canada Medical Marijuana Access Regulations (MMAR) were unconstitutional and therefore invalid, and that they only provided the "illusion of supply." Judge Lederman gave Health Canada six months to rectify the situation ordering the Health ministry to ensure medicinal users had access to marijuana within that time.
With the deadline just days away last July, McLellan announced the ministry would distribute the marijuana it had been growing in a Flin Flon, Man., mine shaft through the patients' physicians. The doctors balked, so did their medical associations and colleges sending out letters saying they disapprove of doctors distributing or prescribing.
The hush around the subject is such that none of the doctors contacted for this article would talk on the record about prescribing or distributing marijuana.
Lucas got his doctor to fill out a detailed application, then swore before a lawyer that he wouldn't use any other cannabis while using the government's supply. He applied for seeds and cannabis, but the government notified him he had to choose one or the other.
In the end he chose the cannabis and his doctor completed the form saying he should have it. Lucas says his doctor (whom he wouldn't name for fear he'll be reprimanded by the Canadian Medical Association), didn't want to receive the cannabis at his office so they created a lengthy paper trail, arranging for it to be sent to the Vancouver Island Compassion Club. Including phone calls, the procedure required four or five consultations with the doctor.
"To think that someone critically ill would have to go through this," he said. "I think this whole program was set up to fail."
That's what Hilary Black of the B.C. Compassion Club thinks too. "The whole thing has been a bit of a saga," she says. "A bit of progress, then some back pedaling and then sabotage."
In the process of putting the court-ordered program in place, the government has alienated the doctors, ignored the expertise offered by the compassion clubs and frustrated patients, says Black.
To top it off, approved users can't rely on the supply because McLellan says she will immediately stop the program if the government wins a court appeal.
"Health Canada is doing what is necessary to appear to be fulfilling the program demands while setting up a program destined to fail," says Black.
If the government really wanted sick Canadians to be able to relieve their suffering with marijuana, they would give doctors the power to prescribe it and have the compassion clubs which have years of experience, distribute it, says Black.
Instead, it has unduly stressed the very people it is supposed to be helping, she says, adding compassion clubs handle the whole thing much more "compassionately." She argues that patients shouldn't have to go through a completely different process for medicinal marijuana than they would for any other medicine."
George Bailey, 50, has been getting his medicine from the B.C. Compassion Club for six years, ever since an inflammatory bowel disease and six surgeries collapsed his immune system and left him with chronic pain, nausea and occasional seizures. Compared to Lucas, Bailey, a former psychiatric nurse, felt positively supported in his marijuana use.
When he decided to try cannabis, The Compassion Club gave him a package of information including a one-page application requesting his doctor to spell out Bailey's medical diagnosis.
Because of security issues, the Compassion Club won't give clients the names of doctors who have signed forms in the past. It just recommends clients keep trying if their first doctor refuses.
On the form, the club asks if the doctor recommends pot for the patient's symptoms. If not, why not? (The club staff will still sell marijuana to a person with a verified medical condition if the doctor doesn't recommend it, as long as the reason is not medical.) Then the doctor has to stamp it, sign it and fax it to the Compassion Club. The club staff then phone to confirm the veracity of the form and put the patient on a waitlist for an orientation.
Currently, the waitlist is two months long. The club already serves 2,700 members and is having space problems. However, it is having trouble getting city approval to expand into the empty space at offices of B.C. Person's with AIDS. Black surmises the problem may have to do with the illegality of its operation. The club has been unofficially tolerated by the police ever since the Victoria club was raided, taken to court and given a conditional discharge and a commendation for providing a needed service.
Once Bailey's signed form arrived, he had an orientation in which club staff taught him safe and effective use of cannabis. He learned that the effects of Indica strains are physical, good for pain relief and relaxation or insomnia while Sativa strains work on the mind, to relieve depression and head-aches, increase energy, stimulate the appetite and increase creativity.
The club sells nine or 10 strains, some of which are organic, some grown indoor, some outdoor, some pure strain and some crosses.
He learned that smoking the marijuana brings relief in 30 to 60 seconds while eating it or using a tincture can take one-two hours making it more difficult to know how much to take. He was advised to take a few puffs and wait 15 minutes before deciding if he needs more.
He was advised not to operate heavy machinery while impaired by cannabis especially Indica strains which can be sedating. Mixing it with alcohol could cause vomiting.
Lucas got none of this guidance from Health Canada, though some of it can be found through a link on Health Canada's Web site. He just had to sign a form saying he is aware that marijuana has not been tested for the Food and Drug Act for safety or effectiveness.
When Bailey needs marijuana, he goes to the club on Commercial Drive, shows his membership card to the receptionist, gets a number and is ushered into the waiting room where the nine or 10 strains available that day are posted with their price per gram.
Bailey uses 11/2 grams a day of a pure Indica strain called Legends Ultimate Indica which promises good pain relief and sleep. It costs $9 per gram. Often, he says he will ask the staff for advice on a good strain for his complaints. And since resistance to a particular strain can develop, their advice is valuable. He says he usually buys enough for a week, but on this day, he can only afford two grams.
It can be tough to find the money for it on a disability pension, and marijuana is not covered by the B.C. Medical Plan nor any extended health plans, but the relief is worth the expense to Bailey.
When he pays, his particular purchase is recorded in the computer so that staff can go back and see his record of purchases and make knowledgeable recommendations.
Bailey didn't apply for government authorization to possess nor to receive government pot because he believes the process is discriminatory. No other prescription holder is treated this way, he says.
"I feel like I can come here, access quality medicine and quality wellness therapies from the club's wellness centre and not be hassled. . . . For me, it comes down to trust. I trust this facility."
Black says the government is willfully ignoring the compassion clubs expertise despite her best efforts to offer it. She has spoken to the advisory committee and Health Canada representatives several times and given them documents with reams of information.
She says she believes experts need to be consulted on such topics as where to get good product, the value of organics, the dangers of contamination and other issues and argues that Prairie Plant Systems, which won the government growing contract, had no experience with pot. PPS, she says, grow the pot non-organically, despite the purity needs of users with immune deficiency issues, and selected an unused shaft of an active mine for the plantation making heavy metal contamination more likely.
As well, the seeds used to grow the government plants were seized during police raids and contained such a wide mix of strains, it is impossible to use for research.
McLellan has said she disapproves of medicinal marijuana before the research is complete and she will abandon the program if she wins in court. In the meantime, she also cancelled one of only two sanctioned studies. The one proceeding will examine marijuana's effect on pain. The one cancelled after costing $2 million would have looked at its effects on hunger and appetite in AIDS patients.
After waiting six weeks for his supply which cost $5 per gram (compared to $10-$25 on the street market) to arrive by courier, Lucas got his hands on some of it through another source and discovered that the quality of the government stash is so bad he cancelled his order.
The pot contained only three per cent THC, the active ingredient, it was overly dry and powdery and included leaf and stem, rather than the pure bud sold by compassion clubs that have a THC content of 12 to 15 per cent. Other license holders, as disappointed as Lucas, have sent theirs back demanding a refund.
DO'S AND DON'TS
* Legal medicinal marijuana users, also known as license holders, have the right to own up to 30 times their daily dose at one time.
* The law does not say they can or cannot smoke it anywhere they want, but if they do smoke it in public and are apprehended, they can show their card saying they are excluded from the prohibition laws and they should be released. Phillipe Lucas, of the Vancouver Island Compassion Club and a license holder, recommends discretion when smoking in public. He wouldn't smoke marijuana where tobacco is forbidden.
* Using marijuana medicine in a hospital or medical setting can be negotiated if the user is able to articulate good arguments. Lucas once had to spend eight hours in at Victoria General Hospital while they did tests on his liver. He was permitted to use marijuana in his four-person ward as long as he used a vaporizer which heats the cannabis to a vapor to be inhaled through a tube. There is no residual smoke.
* Medicinal users can travel with their stash as long as they stay in Canada. But don't try to take it across the border to the U.S.
* Medicinal users can grow their own supply, but the regulations are very complicated -- stipulating for example that the pot be grown indoors or outdoors and the number of plants permitted. Lucas says he grows his on his deck and brings it inside each evening. He isn't sure if it is considered indoor or outdoor-grown.
* Medicinal users must re-apply for their license every year. For those in the third category, that means they must have consultations with two specialists who fill out the forms. Sometimes, it can take eight months to get an appointment with a specialist.
Related Articles & Web Sites:
Canadians for Safe Access
Cannabis News Canadian Links
Health Canada's Reefer Madness
Health Canada Medical Marijuana Could Be Better
Government Cannabis Unfit for Humans
Government Pot's The Pits: Patients