by Debra Harper

“Opioids overuse is the worst man-made epidemic in modern medical history; two people an hour are dying of opioids misuse in the United States, and, proportionally, the problem is likely as bad, if not worse, in Canada.”

~Dr. Gary Franklin, leading expert on workers’ compensation and medical director of the Washington State Department of Labor and Industries (source)

That has to be a wake up call for doctors, patients and society as a whole. There is a safer solution staring us in our collective face, yet the medical profession en masse, seems so reluctant to even entertain the idea of using cannabis as a substitute or adjunct to opioid therapy. There are thousands of results from studies, data collection, and anecdotal evidence displayed when searching for cannabis reduces opioid use that one wonders why it would not be considered and prescribed and monitored to see if it helps alleviate this epidemic. Zero deaths in thousands and thousands of years of use – what do we have to lose?

Medical marijuana reduces use of opioid pain meds, decreases risk for some with chronic pain: Patients using medical marijuana to control chronic pain reported a 64 percent reduction in their use of more traditional prescription pain medications known as opioids.

University of Michigan study, U-M School of Public Health and Medical School.   (source)

cannabis-opioid-poppyDoctors are discouraged from prescribing cannabis for any condition, despite the fatality rate for cannabis use is zero – always has been. The fact physicians will prescribe a deadly painkiller before prescribing cannabis, is one of the astounding mysteries of modern medicine.

Colleen Barry: professor, Johns Hopkins Bloomberg School of Public Health, co-director of the Johns Hopkins Center for Mental Health and Addiction Policy Research
(source)

A main reason cannabis has not been well received by the medical community is, until the Licensed Producers got in the game, there was absolutely no money used to lobby governments, educate doctors, advocate for patients, and do all the work required by pharmaceutical companies to get their products to market.

This orphaned medicine was left to find it’s own way into the hands of those who need it, and it does that well. Why do some patients risk the threat of jail to use this medicine? Why have numerous patients spent thousands of dollars to launch court challenges to establish their basic human right to use this medicine and open it up to all in need? Why hasn’t the medical community taken note of these facts and realize there must be something to the effectiveness of cannabis as medicine. But no.
For most health care providers, marijuana is an afterthought. We don’t see cannabis overdoses. We don’t order scans for cannabis-related brain abscesses. We don’t treat cannabis-induced heart attacks. In medicine, marijuana use is often seen on par with tobacco or caffeine consumption—something we counsel patients about stopping or limiting, but nothing urgent to treat or immediately life-threatening.
In hospitals across the country, patients writhe in agony from alcohol withdrawal, turn violent from crystal meth, and struggle to breathe after overdosing on prescription opioids. These are the cases that keep health care providers on edge. These are the patients we follow closely. When our pagers go off, we hurry to the bedside, give medications, alert security or even begin resuscitation.
With marijuana? Not so much.
Nathaniel P. Morris: resident physician in psychiatry at the Stanford University School of Medicine.
SCIENTIFIC AMERICAN: A Doctor’s Take on Pot

opioidblogsizeThe argument heard most often is there have not been enough studies done on cannabis to warrant it’s use. That may have been true decades ago, but it is not true today. Thousands of studies have been conducted around the world and researchers from The U.S., Israel and many other countries have dedicated years to studying cannabis. A database of studies can be seen on the International Association for Cannabinoid Medicines (IACM) website, or Scientific Publications: Center for Medicinal Cannabis Research, University of California, just for starters. One of the earliest significant studies, Report of the Indian Hemp Drugs Commission was commissioned in 1894, and the research has never stopped.

Pioneers such as Dr. Ethan Russo, Dr. Lester Grinspoon and Dr. Raphael Mechoulam have worked with cannabis for decades and continue to so to this day as well.
Among those concerns are the absence of scientific evidence on the benefits of medical cannabis and the challenging role being given to physicians and other healthcare providers when a patient requests access to medical marijuana……
Physicians should be aware however, that many Colleges prohibit or strongly discourage their members from dispensing, providing, or accepting delivery of marijuana for medical purposes (e.g. British Columbia, Alberta, Newfoundland and Labrador, Saskatchewan, Prince Edward Island, Québec, Manitoba, and Yukon). Physicians are advised to consult with their College before agreeing to accept the transfer of marijuana from a licensed producer.
CMPA Guidance
 Here is some recent insight into how Canadian Medical Association (CMA) members view cannabis according to a poll:

cannabis-and-painkiller-overdose1Physicians are divided on how pot should be regulated: 43 per cent believe there should be a single regulatory regime (meaning no distinction between medicinal and non-medicinal use), while 39 per cent back a dual regime.

• Doctors think it’s a bad idea to have marijuana sold in pharmacies and they want the federal government to ensure the quantity of THC is labelled and even regulated.

• Sixty-five per cent of doctors disagree with mail service being used to distribute non medical marijuana, and 57 per cent disagree with pharmacies being used for distribution. Fifty-six per cent think existing non-health care structures like liquor stores should sell it and 47 per cent think legal storefronts (dispensaries) are suitable for the purpose.

• Doctors are equally split on whether people should be allowed to grow their own non-medical marijuana.

• Asked where people should be allowed to consume non-medical marijuana, 80 per cent said their homes, 36 per cent said designated public places and 43 per cent said wherever tobacco is permitted.

• Forty-five per cent of doctors said Canadians over the age of 21 should be able to buy legal marijuana and 35 per cent said the age should be 18 or 19.

http://vancouversun.com/news/national/doctors-weigh-in-on-pm-trudeaus-plans-for-marijuana-legalization

 

We do not know if the effects of marijuana consumed under those conditions are due to a medical or therapeutic effect due to the intrinsic pharmaceutical property of marijuana or whether this is a placebo effect. As a physician, I personally do not care. In my view, if somebody is dying they should be able to participate in whatever it takes to relieve their suffering as long as it does not hurt anybody else.

Dr. Keith Martin: Parliamentary debate on M-381, the legalization of marijuana for health and medical purposes, March 4 and May 25, 1999.

Back in 2001, I was invited to speak at the University Of Calgary: Complementary Medicine Speaker Series where I attempted to enlighten a theatre packed with medical students. It was encouraging to see up and coming new doctors interested in cannabis medicine and gave me some hope for the future. Those students have long since graduated, and are hopefully part of the building momentum in the medical community who are open and receptive to discussing cannabis medicine with their patients.

Debra Harper

 

Further Reading:

(Post previously appeared at CanEvolve)