BC Business- B.C.'s Pot Players: The Physician

To mark the recent legalization of recreational marijuana, we check in with some of the key players in the B.C. cannabis world. From pot growers to government officials to medical professionals, meet the people helping move the industry forward and keep British Columbians safe. Today’s subject is Caroline MacCallum, medical director of Greenleaf Medical Clinic

A strong advocate of cannabis for medical treatment, Caroline MacCallum says her patients brought the idea to her. MacCallum grew up in Newfoundland, where she earned a pharmacy degree and began medical studies. After graduating from internal medicine at UBC in 2013, she worked at several clinics. There she met people with a range of health problems who had turned to cannabis because other treatments didn’t work.

MacCallum was skeptical of the lack of scientific evidence. “But patients were telling me that it was working,” she says. Deciding to help people access safe medical cannabis, MacCallum saw how powerful it was: “People who might have come to me with 10 problems, it was helping a lot of the conditions, a lot of the symptoms, and we were able to whittle down their prescription list.”

Today, she is medical director of the Greenleaf Medical Clinic in Langley, where she has seen some 3,000 patients. Canada’s first medical cannabis clinic, Greenleaf opened in 2011. It charges patients a fee and uses only Health Canada–approved cannabis to treat illnesses ranging from chronic pain and cancer symptoms to migraine and addiction.

“We weigh the risks and the benefits, and we educate, and we monitor for drug interactions,” says MacCallum, who is also a clinical instructor with UBC’s department of medicine, an adjunct professor with the faculty of pharmaceutical sciences and an associate member of the palliative care division. She recently won ethics approval from the university to turn Greenleaf into a patient registry. With consent, she can now explore what cannabis varieties work for particular diseases, she says.

Among other research efforts, MacCallum is working with several groups that aim to launch randomized clinical trials studying cannabis’s effect on neurological and psychiatric conditions such as seizures and traumatic brain injury. This year, she co-authored what she calls the first paper of its kind, for the European Journal of Internal Medicine, on medical cannabis administration and dosing.

See full article here.

The Walrus- Pot Is Legal. Is It Time to Redefine Sobriety?

For nearly her entire adult life, thirty-year-old Megan Kimberling identified as straightedge. The Californian didn’t smoke, take drugs, or drink alcohol, and she was hesitant to even use prescription medicines. Kimberling felt that being straightedge gave her more control of her life. But then, in 2014, an experience with a stalker left her mentally and emotionally drained. She was soon diagnosed with posttraumatic stress disorder (ptsd) and a doctor prescribed her an antianxiety medication. Desperate to feel better, she started taking it, although she felt this could affect her straightedge lifestyle. While her mental health and wellness were important to her, so was her sobriety. The antianxiety medication worked to alleviate her ptsd symptoms—paranoia, anxiety, mood swings, and heightened emotional responses—but she never grew comfortable with the idea of taking daily medication. Eventually, she began to explore alternative treatments, soon discovering the much-praised cannabidiol (cbd), the major non-intoxicating component in cannabis, which has been used to treat anxiety. “I could either go back on anti-anxiety medication, or I could try cbd,” she explains, saying that she made her choice while steadfastly maintaining that, at least with cbd, she could still identify as sober.

Stories evaluating the health and wellness benefits of cannabis have dominated the news cycle in the lead up to legalization (and will likely do so after October 17 as well). Recreational cannabis as we once knew it—often disparagingly associated with stoners or hippies—is undergoing a significant makeover. Licensed producers and affiliate companies have become heavily invested in tailoring their experiences and products to women or affluent, hip millennials with disposable income. A similar rebrand of cannabis happened in Kimberling’s current home, California, and it’s entirely conceivable that there will soon be a time when cannabis is just another part of the booming wellness market. Already, Canada is poised to be the world’s largest exporter of medical cannabis and, according to The Economist, early estimates on what Canadians will spend in the cannabis marketspace this year is anywhere from $4.2 to $6.2 billion. The global wellness industry is said to be worth over $3.72 trillion (US) as of 2015, representing more than 5 percent of global economic output, according to the Global Wellness Institute. “The alternative and complementary medicine market is expected to generate a revenue of (US) 196.87 billion by 2025,” according to a 2017 report by Grand View Research. It’s no wonder that companies are clamouring to redefine marijuana.

That rebranding, however, can sometimes backfire—particularly if it plays into old stigmas about sobriety and drug use. In early September in Toronto, for instance, California-based weed company Dosist, which has trademarked the phrase “delivering health and happiness,” threw a ten-day wellness pop-up recently with the tagline “plants over pills.” But such ableist marketing tactics run the risk of demonizing prescription-medicine use. That hasn’t stopped cannabis companies from deliberating spreading a sense that the drug is somehow better than. Google the word cannabiscoupled with just about any disease, and you’ll find a cannabis company that has mixed beautiful design aesthetics with some marketing copy on how the plant can cure what ails you. cbd is at the centre of this wellness push, gaining huge mainstream popularity. The extract comes from the cannabis plant, which contains more than 60 active cannabinoid compounds, but cbd seemingly doesn’t have any intoxicating properties. Research has shown that cbd is an anti-inflammatory, and when used with other medications, it can help reduce seizures in cases of epilepsy, it can help with anxiety, and it can also help treat chronic pain. Reports have also suggested cbd could help some drug users prevent relapse.

Analytics firm New Frontier Data has predicted that cbd sales will nearly quadruple over the next four years, from $535 million (US) in 2018 to over $1.9 billion (US) by 2022. Right now, the marketplace is flush with a variety of cbd products, including capsules, sprays, topicals, concentrates, oils, edibles, and tinctures, and the products can range widely in price from under $10 to over $100, largely depending on dosage (these items are technically illegal to purchase until October 17, unless you are a registered medical patient who has an authorization from a licensed health care practitioner). As cbd’s popularity rises, however, there are deeper questions at play than its estimated market value. Beyond the question of whether it works for them, some cbd users, like Kimberling, are facing bigger questions, including, but not limited to: Am I still sober? Or, put another way: Does using cbd count as a strike against recovery or a substance-free lifestyle? This can lead into particularly tricky terrain as many people turn to cannabis products as a solution for all manner of ailments—from mental health to addiction. As we reckon with cannabis legalization as a country, perhaps what we really should be asking ourselves is how we’re going to redefine the traditional meaning of sobriety.

Zach walsh is an associate professor of psychology at the University of British Columbia. He believes that sobriety is a complex concept. As we discuss what it means, he stops me to ask: “Are you sober when you’re asleep? Are you sober when you’re tired? There’s all kinds of shifts in consciousness, and some of the shifts in consciousness that happen without drugs can be similar to the ones that do happen with drugs.” With so much focus on terms like clean and sober, the nuances of these questions are often overlooked. But they’re also a critical part of reexamining the stigma against drug users—and, depending on the person, what it means to live as the healthiest, happiest version of yourself.

“That philosophy of having to be sober from all substances is a very old and often outdated and puritanical way of looking at substance use,” says Zoë Dodd, a Toronto-based activist and harm-reduction worker. While some argue that anything resembling a drug should never be part of a recovery journey, others believe that something like cbd doesn’t impact sobriety. Dodd belongs to the latter camp, and she emphasized to me that somebody who is dependent on one drug is not necessarily dependent on all drugs. From Dodd’s experience working on the front lines, people who are working on their recovery have always been the best to determine and define what their recovery should look like. If that recovery includes cbd, then she thinks it can work and doesn’t make them any less sober.

This way of thinking, however, is often at odds with traditional recovery models, such as twelve-step programs like Narcotics Anonymous and Alcoholics Anonymous. Even though studies have shown that people cannot become physically dependent on cbd, some people in recovery spaces have reported being ostracized from their communities for choosing to use a cannabis product like cbd. The twelve-step model, originally created in 1938 by Bill Wilson, started with the Alcoholics Anonymous program. The program had developed through Wilson’s own lived experiences, which meant that much of the content of the original twelve-step program was rooted in Christianity. While the twelve-step model is one of the longest-standing methods of addiction treatment, parts of it have been updated and reinterpreted since its original release nearly eighty years ago. One thing that has stayed constant, though, is that it asks its participants to follow an abstinence-based model that involves includes admitting the need for help, relinquishing control to a higher power, accepting help, examining your flaws and past transgressions, and seeking to make amends for the mistakes of your past.

In recent years, though, harm-reduction strategies have become more present in the public consciousness. Such strategies introduce a set of practical tactics, ideas, and programs to reduce the negative consequences associated with drug use. Harm-reduction workers use a spectrum of strategies, including safer use, managed use, abstinence, and also helping meet users “where they’re at,” rather than shaming and helping them get to where they need to be. Toronto-based Zee, requested his full name be withheld to protect his privacy, has tried a twelve-step program and harm-reduction strategies to address his lifelong battle with crystal meth and mdma use. He says that he tried Narcotics Anonymous but immediately felt uncomfortable. As an alternative to cannabis, he asked his psychiatrist if he could try cbd,, which, he says, he soon learned helped to “keep him sane.” After his psychiatrist gave the green light, he used cbd and attended the twelve-step program, but only for a few sessions. The recovery group never felt like a safe space; he felt like he couldn’t open up about using cbd, for fear of judgement.

“There’s a huge stigma,” for people who are interested in using things like cbd in their recovery, says Caroline MacCallum, a doctor and the medical director of Greenleaf Medical Clinic in Langley, British Columbia, which helps assesses patients across Canada for their eligibility under Health Canada’s Access to Cannabis for Medical Purposes Regulations. She explains that some research has shown cbd is not addictive and notes that many addictions play on the brain’s reward system. cbd doesn’t do that. Since that’s the case, MacCallum asks, could it be as benign as an antidepressant? “Some people would say sobriety is zip, zero, nothing. But that’s a tough act to follow,” says MacCallum, adding that a person’s recovery journey is between them and their physician to decide. “I think it’s really important to treat the whole person, and if somebody’s struggling.…I would want to set [my patients] up to win.”

As someone who has struggled with their own recovery issues, drug and alcohol related, I know first hand that recovery is a personal journey. After being diagnosed with Complex Post-Traumatic Stress Disorder (c-ptsd ), stemming from a life long cycle of mental and emotional abuse, I would go through periods of dissociation, bouts of anxiety, and times where I would have difficulty sleeping. A pal suggested I try a cbd-based edible to find calm—as it had worked for them. Like Kimberling, I just wanted to feel better. When I discovered cbd did indeed work for me, I researched capsules for everyday use. I’ve been taking them ever since, and they’ve played a significant role in my trauma recovery. But I, too, have often found myself wondering if I am still able to identify as sober when I use cbd in my day-to-day life, even though I don’t use hard drugs anymore. Walsh believes this is where the trouble lies—we’re giving the moral power to define sobriety to the wrong people. “So are you breaching your abstinence by using cbd?” he asks. “That’s entirely up to the people who define abstinence.” We need to start moving to a place where people can own their recovery and define sobriety for themselves.

One former cbd user, Sam, who also lives in California and asked that we use his first name only to protect his privacy, tells me that he wishes recovery spaces would move to a model where everything is tailored to the individual and becomes more context informed. “I don’t think sobriety means the same thing to every single person,” he says, “It’s a very personal decision, and I think when we get into these very puritanical ideas that only certain people are sober, that starts to suggest that only certain people can access recovery and access these spaces, which I think is actually really dangerous.” His comments bring up a good point: people of all ages, races, genders, and cultures are affected by substance-use disorder, and some people need to access specific medications for the rest of their lives to stay alive. The same goes for people who may use cannabis products like cbd to treat anxiety or trauma-related issues like ptsd. Does this mean we shouldn’t support them in their sustained, long-term recovery? Or, more pointedly: Why is cbd, and even cannabis, often framed as a hip wellness product for certain members of society—namely those who can afford to help elevate it as an economic commodity?

The rise of cbd as wellness alternative in Canada it set to force a discussion around sobriety. In the coming months, we will, as a country, have to reexamine and redefine just how exactly we view sobriety. I’m hopeful these conversations will help widen the spectrum of sobriety and break down barriers of who gets to define it—and why. If we approach these conversations with openness, and without stigma, it’s possible we can make true change for good. As cbd gains popularity, we must give people the capacity to examine, evaluate, and possibly amended their own health, wellness, or recovery journey in a way that feels right for them. Yes, we need better medical understanding of cannabis and its related products, and yes, we also need training in the harm-reduction model. But we also need compassion, and the courage to rethink old definitions.

See full article here.

Maclean's- Are there any after-effects or hangovers to cannabis?

Yes, but no worse than sleep aids. Not everyone gets groggy the next day, and, naturally it depends on how much you consume. Both scientifically and anecdotally, there’s no clear consensus here: One (quite old, rather small) study found cannabis indeed affected performance of simple behavioural tasks the day after, while another reported the differences were minimal at most. For every smoker who swears they get weed hangovers, there’s another who will scoff that the “stoned-over” is an overblown myth.

So who’s right? “It all depends on how you’re using it and if you’re using too much,” says Dr. Caroline MacCallum, medical director of Greenleaf Medical Clinic in Vancouver. A medical patient, for example, will likely start with 1 to 2.5 mg dose of THC, slowly build up their tolerance and never experience a weed hangover. “But it’s different for a recreational user,” she says, “because they’re targeting a euphoric state and using more THC to get there.” You can’t dose any product if you don’t know what’s in it, she warns, and while most strains’ THC level falls between two and 20 per cent, others like the infamous shatter can contain up to 80 per cent. Oils and edibles are worse—both in their excessive potency and because impatient users tend to re-dose before effects kick in. MacCallum recently saw a brownie with 400 mg of THC, which is 200 times what she’d prescribe.

Just like every other hangover, the more you consume, the more likely you are to suffer after-effects. Though she’s only encountered it a handful of times, MacCallum says patients complain of mental fog, slowness and fatigue. Compare this to pounding headaches and vomiting caused by alcohol, however, and maybe a stoned-over is not so bad. “It’s not the same as alcohol, it’s not even the same as Benadryl,” says MacCallum, who notes many patients prefer cannabis to other sleep meds.

If you get unlucky and find yourself hurting the morning after, here’s a discouragingly familiar prognosis: drink lots of water, wait it out, and try to moderate better next time.

October 10 for Maclean’s.

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CBC- Phasing out medical cannabis would leave pediatric patients in the lurch

The Canadian Medical Association has floated the idea of eliminating the medical cannabis access system

Physicians in Canada are prescribing cannabis. They have been doing so for years, and will likely continue to do so after recreational cannabis is legalized this fall. But the Canadian Medical Association (CMA) says that doctors in Canada want to see the phasing out of the medical cannabis access program once pot is legalized. And no doubt, some do.

But this position is shortsighted, for all sorts of reasons. First off, over 13,000 of the CMA's own members are currently prescribing cannabis in their practices, and over 296,000 Canadiansacross the country regularly use cannabis for a medical condition.

The CMA's position on cannabis for medical purposes is that there is "insufficient evidence on risks and benefits, the proper dosage and potential interactions with other medication." However, this view ignores thousands of peer-reviewed journal articles and studies that provide evidence of the efficacy of cannabis use for some medical conditions — chronic pain, as one example. While we do not deny that more clinical studies are needed, surely the publishing of over 10,000 peer reviewed articles signals that the use of cannabis in medical treatment is not some fringe endeavour.

There are numerous risks in eliminating a medical stream of cannabis access — risks that include things like the loss of guidance around dosing and administration, contraindications to cannabis use, screening for dependency risk and potential drug interactions. Essentially, it ignores the realities physicians are facing on the ground.  

Cannabis for pediatric patients

But there's one critical topic that has been left completely out of consideration regarding the issue of narrowing cannabis access to just the recreational stream: youth under the legal age of access.

Currently, pediatric populations can access cannabis legally through the Access to Cannabis Medical Purposes Regulations (ACMPR), which does not specify a minimum age of access. While most provincial physician colleges recommend not prescribing to young people under the age of 25, it is up to physician discretion.

But if we were to dissolve the ACMPR, there would be no mechanism for physicians to prescribe cannabis for pediatric patients. The Cannabis Act, which will legalize recreational marijuana in October, makes it a criminal offence to give cannabis to minors and includes a maximum penalty of up to 14 years in prison. So if cannabis is phased out of the medical stream, and access for children and youth is prohibited under the recreational stream, how will these young patients get access to the cannabis treatments they need? The CMA, to our knowledge, has yet to acknowledge this quagmire.

Many families currently rely on cannabis to treat a variety of issues affecting their children, such as epilepsy, autoimmune diseases and cancer. There are also families that turn to cannabis for conditions that lack therapeutic options and are not understood — rare genetic conditions such as Dravet syndrome, for which a recent randomized controlled trial showed positive results.

Parents have rightly expressed concern and frustration with the CMA's position. Some worry that particular cannabis products available from licensed producers — products that appeal to medical consumers — will be eliminated under a single stream of non-medical access.

And while cost continues to be a significant barrier for medical cannabis patients, without a medical cannabis access stream, it is unlikely cannabis will ever be covered by health insurance plans. The cost for many children (and adults) using cannabis daily or near-daily can exceed $1,000 per month. 

Studying medical cannabis

Finally, while we have been seeing research interest grow in pediatric uses of medical cannabis, there's a risk that this interest in this area will dry up with added regulatory and legal barriers to studying medical cannabis. That is, unless a new legal pathway is drawn for medical access for minors. 

Other professional health care bodies, such as the Canadian Nurses Association and the Canadian Pharmacists Association, continue to support a separate medical stream for cannabis. The Canadian Pharmacists Association, in fact, launched a foundational cannabis course in 2017, a program that has since expanded to keep its members up to date with the changing regulatory landscape and evidence around cannabis as medicine.

The CMA, however, continues to lag behind. The therapeutic use of cannabis is not taught in medical schools, and many physicians simply do not feel equipped to authorize medical cannabis for their patients due to their lack of education on the subject. Eliminating the medical access stream will likely make this worse.

And pediatric patients — and their parents — will be the ones who struggle most. While we continue to advocate for, participate in and lead the development of ongoing research around the medical and instrumental uses of cannabis, when it comes to the CMA's position on the medical cannabis program in Canada – please consider the children.

Jenna Valleriani and Caroline Maccallum, September 8, 2018 for CBC News

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Canadian Living- 5 common myths and misconceptions about cannabis use

As cannabis is legalized in Canada, we know you have questions—and we know there’s a lot of misinformation out there. We sat down with two doctors to chat about cannabis usage. 

Since the 1960s and 1970s, cannabis has had a negative stigma attached to it—coinciding with North America’s “war on drugs.” But, a relatively new understanding on the benefits of the plant is making people curious about just how good (or bad) cannabis can be, especially now that it will be legalized in Canada this October. We sat down with Dr. Caroline MacCallum of the Vancouver General Hospital and the Greenleaf Medical Clinic and Dr. Biljana Kostovic, a pain specialist based in Toronto, to clear up some of the myths and misconceptions about the use and associated effects of cannabis.

CAN CANNABIS SMOKE BE WORSE THAN SMOKING TOBACCO?

We know that smoking cigarettes can cause lung cancer, but what about smoking cannabis? While THC (the euphoria-causing cannabinoid in the plant) is a relatively safe drug, smoking cannabis can be hazardous, as confirmed in a study by the British Lung Foundation. Dr. MacCallum believes that smoking anything can be harmful—thanks to the production of carbon monoxide. The best way for patients to protect their lungs while still consuming cannabis products is via a vaporizer, which heats cannabis at a lower temperature without smoke. Dr. MacCallum says that many studies have shown that there's little-to-no carbon monoxide produced when using a vaporizer.

 

WHY DO SOME PEOPLE GET ANXIOUS WHEN THEY CONSUME CANNABIS AND OTHERS ARE MORE RELAXED?

When people feel anxious it usually has to do with the particular strain they are consuming and the percentage of THC in that strain. “People want to go out and try cannabis, but they don't even know where to begin,” says Dr. Kostovic, which results in choosing or being diagnosed a strain that isn’t tailored to a person’s particular desires. She recommends having a conversation with your doctor, who can then recommend who you should speak to in a specialized clinic that deals specifically with cannabis. You can also educate yourself about the effects of THC and CBD (a more relaxing and pain-relief-specific cannabinoid in the plant) and decide which ratio of actives is right for you. One great resource is Lift & Co’s website which has a list of clinics and reviews. A good rule of thumb is that if you’re after more of a “high” or are treating appetite loss, cannabis strains with higher THC and lower CBD are where you want to start. Whereas if you’re managing pain, anxiety and want to relax, higher CBD strains are a better option.

 

CAN CANNABIS AFFECT YOUR BRAIN DEVELOPMENT?

number of studies have been released that indicate that exposure to cannabis in still-developing brains could have an impact on development. The College of Family Physicians of Canada, have said that cannabis should not be used in those 25 years of age and under, though the studies are often conducted on recreational use instead of medical. Dr. MacCallum notes that usage tends to be higher in recreational users, and this could also contribute to the overall effects. “Brain development is particularly important because it's thought that it really goes on until the age of 25,” says Dr. MacCallum. “But there's no hard and fast rule that on a specific day your brain stops developing.” Bottom line? “These studies deal with large amounts of THC and with that, developmental and cognitive dysfunction can occur,” says Dr. MacCallum, “I can’t say it's all reversible or it's permanent, but I also believe there are a lot of variables, unfortunately.” At this time we just don’t have enough evidence to say anything one way or the other. Your best bet is always to speak with your own personal physician.

 

IS IT POSSIBLE TO OVERDOSE ON CANNABIS?

The short answer is no, you can’t overdose on cannabis. There have been a few calculations about how much cannabis you’d have to take to overdose or die, and the amount leans towards the absurd—especially when you consider how quickly you’d have to consume it. If you have felt weak, out of it, increasingly anxious or too high, there’s a good chance you have consumed too much—but the danger of overdosing is so slim so as to be almost impossible. These symptoms are often conversationally referred to by users as “greening out,” and the term describes a situation where a person feels sick after smoking or ingesting too much cannabis. Symptoms often include going pale or turning green, starting to sweat, feeling dizzy and nauseous. Dr. MacCallum reports that while there have been no reported deaths due to overdose or toxicity of cannabis, she admits that these issues and side effects are not always the wanted or desired effect, and may turn some people off.

 

CAN YOU BECOME ADDICTED TO CANNABIS?

Despite popular belief, yes, it is possible to become dependent on cannabis. Approximately 9 per cent of people who use marijuana will become dependent on it. Marijuana use disorders are often associated with increased dependence, which is often a proxy for addiction—though you can be dependent without being addicted, even though the terms are often used interchangeably. But if you feel withdrawal symptoms (irritability, physical discomfort, cravings) when not using marijuana, it’s possible you have a marijuana use disorder. Dr. MacCallum notes that for these patients, it’s important to talk to a physician and feel empowered when and if they are trying to limit their use or stop using cannabis completely.

August 17, 2018 as seen in Canadian Living.

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SCMP- How Canada legalising recreational marijuana could vault country to forefront of cannabis research

Medical marijuana studies are set to explode in Canada after the use and sale of cannabis become legal in October. It is only the second country, after Uruguay, to fully legalise the drug for recreational purposes

From October 17, Canadians will be able to light a cannabis cigarette with complete impunity. The North American nation will become only the second country, after Uruguay, to fully legalise marijuana use for recreational purposes. The move will make good on a campaign promise from Justin Trudeau, who swept into the prime minister’s office in 2015 guaranteeing a new liberalised, socialised Canada. That means Canadians will be able to purchase, grow and smoke to their heart’s content, and the national medical community will have free rein to study the plant’s potential health benefits.

Currently, cannabis is only legal for medicinal purposes, and citizens need a prescription to buy it from a handful of licensed sellers; however, the reality is far from that. Walk down any commercial street in Vancouver or Toronto, and you’ll be hard pressed not to pass the storefront of a cannabis dispensary that will sell you various types of weed with no questions asked.

Vancouver’s University of British Columbia (UBC) welcomed in the new era recently by announcing its first ever professorship of cannabis science. The goal is to investigate the potential role that cannabis-based research could play in managing the opioid crisis and addictive disorders.

In Hong Kong, the use and sale of cannabis is banned under the Dangerous Drugs Ordinance, which came into effect in 1969. While seizures and use among teens have been reportedly on the rise recently, convictions for serious drug offences in Hong Kong have been falling steadily since 2008.

According to the most recent United Nations World Drug Report, an estimated 238 million people use cannabis on a regular basis, making it the most widely used drug worldwide. The UN called the production of marijuana a “global phenomenon”, noting there have been reports of cultivation in 135 different countries.

In Canada, the last barrier to fall is the stigma associated with smoking marijuana. Long seen as a gateway drug or part of a counterculture movement, its push into the mainstream of Canadian culture is almost complete.

Zach Walsh, an associate professor at UBC’s department of psychology and co-director of the Centre for the Advancement of Psychological Science and Law, is one of the researchers on the cutting edge of studies into marijuana’s potential medical benefits.

“One of the benefits of legalisation is that it does remove that stigma,” Walsh says. “Soon it will be something that you can openly talk about with various health care providers and professionals. You will be able to talk about it more openly with your family, and that new, open dialogue is what we need to maximise the benefits and minimise the harm.”

Walsh has published and presented widely on topics related to medical cannabis and mental health. He is also the lead investigator of ongoing studies into the therapeutic use of cannabis, including a clinical trial of marijuana for sufferers of post-traumatic stress disorder (PTSD).

One of the most high-profile debates currently focuses on military veterans and first responders, such as police officers, firefighters and ambulance crew members, using marijuana for PTSD.

A recent Scientific American article noted many states in the United States have relaxed laws allowing soldiers and frontline workers to get prescriptions of the drug. However, without full federal legalisation and with a Republican in the White House, the medical community has one hand tied behind its back.

Marijuana for Trauma, an Alberta company, has been using cannabinoid therapy since 2013 to help treat veterans with operational stress injuries.

The drug is said to offer a host of benefits for PTSD sufferers, including a decrease in re-experiencing trauma and hyper-arousal, and less avoidance of situations that remind the patient of the traumatic event.

“It allows people to process the event and helps them move on from it,” Walsh says.

Dr M-J Milloy, a scientist with the British Columbia Centre on Substance Use and assistant professor in the division of Aids in the medicine department at UBC, says the clinically proven list of medical marijuana treatments remains quite short.

Health Canada has only given the green light for cannabis (or cannabinoids, which include THC) to be used as an appetite stimulant for anorexia caused by chemotherapy; for muscle spasms associated with multiple sclerosis; and for anorexia caused by HIV-Aids.

The UBC professorship, which is being funded by the Canopy Growth Corporation (an Ontario-based medical marijuana company) will help with some of Milloy’s research into how legalising marijuana will affect the opioid crisis.

Milloy says one of the benefits they’ve seen already in studies is how marijuana is being used as a way to help dampen the damage done by the prevalence of narcotics and hard drugs in modern society.

“There is an increasing amount of evidence that [some] people with chronic pain who are using opioids … are able to switch from using opioids to cannabis,” he says.

Milloy adds that there is huge potential to try to fight the opioid crisis by using medical marijuana in various forms to help users cope with addiction. He believes there will be many positive ripple effects, including a drop in the number of people contracting various diseases transmitted via intravenous drugs.

When it comes to anecdotal evidence and testimonials, the types of ailments that can supposedly be treated by marijuana is wide-ranging: everything from carpal tunnel syndrome and insomnia to Crohn’s disease and arthritis.

However, until the clinical world can complete enough studies, a lot of the benefits of cannabis will remain qualitative.

One demographic in Canada that already seems to be benefiting from medical marijuana is the elderly population.

Don Briere, president of Weeds Glass and Gifts – a company that boasts 17 cannabis dispensary shops across Canada – estimates that close to a third of patrons who visit his stores are 55 years old or over. Briere, 66, who is based in Vancouver, says it will only be a matter of time before the clinical trials start to fill in the holes that anecdotal evidence can’t.

“[Old people] have more aches and pains than young people,” he says, noting that arthritis is a common ailment mentioned by elderly customers who visit his stores. “Also, [there are] people who are older and active, or who play hockey, or something along those lines, [that are] looking for pain management.”

Briere notes that some old people are more comfortable taking topical forms of marijuana, which means there is no effect on the brain. Liquid forms of straight THC are also popular, which means marijuana can be consumed without being smoked, he says.

Walsh says after full legalisation, the medical community – doctors especially – will have to come to terms with a new world of patient demands that may fly in the face of their schooling.

“It depends on how open-minded and flexible [the doctors] want to be. They were trained to believe that cannabis didn’t have medical value. But a recent survey of current medical students shows a definite improvement in the amount of education they get when it comes to endocannabinoids,” he says.

“To be fair, when many current practising doctors were being trained, they were being trained in the 1990s or earlier; the science wasn’t there, and neither was the social acceptance.”

Caroline MacCallum, a Vancouver-based internal medicine specialist, has focused on complex pain at a number of hospitals. She is a clinical instructor at UBC’s faculty of medicine, and the medical director for Greenleaf Medical Clinic, where she’s assessed and developed cannabinoid treatment plans for more than 2,000 patients using legal medical cannabis approved by Health Canada.

MacCallum says she embraced marijuana when she was working as a pharmacist, noting that patients with complex chronic diseases had sometimes tried between 10 and 20 different medications looking for relief.

“There is very little, if any, education about cannabis in most medical schools,” she says. “I think that is changing, or will need to. I have medical students, residents and fellows who spend a few days with me in the clinic to learn about medical cannabis.

“But there’s definitely a place to learn more formally about the science of the endocannabinoid system, and also practical clinical knowledge about [cannabinoids] CBD and THC dosing, routes of administration, evidence, contraindications (withholding treatment because it’s harming the patient), monitoring, side effects, product safety and consistency, and more.”

July 15, 2018 as seen on South China Morning Post.

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Arthritis Society to launch employer toolkit for medical cannabis coverage

New program will help address employee needs around affordability of necessary medication

As a forward-thinking advocate for the needs of Canadians living with arthritis and related chronic pain conditions, the Arthritis Society today announced that it is leading the way by introducing a program and toolkit to help employers cover the costs of cannabis for medical purposes for employees through their company-sponsored employee benefit plans.

The innovative new program will provide a cost-effective, sustainable and progressive way of ensuring that scientifically validated use of prescribed medical cannabis can be supported through a company’s benefit plan in the same way as other prescription drugs.

Since 2001, medical cannabis has been a legal treatment option in Canada for certain health conditions, including arthritis. More than half of Canadians who use cannabis for medical purposes do so to help manage arthritis symptoms.

The Arthritis Society has worked with a team of well-recognized patients, physicians, benefits consultants and other experts in the field to help develop the program. As of February 1, 2018, the Arthritis Society is providing medical cannabis coverage for its employees, their spouses and dependents, under its employee health benefits plan. Under the program, the Arthritis Society will provide coverage up to $5,000 per year, which is a meaningful level of reimbursement for a broad range of health conditions including chronic pain.

The Arthritis Society and its partners will study the impacts of the new program, and will invite other organizations who adopt similar programs to share their results in an aggregate report to identify key learnings and further refine the approach. This effort supports the Arthritis Society’s ongoing commitment to promoting arthritis-friendly workplaces.

Supporting resources for employers will be released after President and CEO Janet Yale presents at the Conference Board of Canada’s Marijuana At Work conference taking place in Toronto this week. The conference, already sold out, will include a workshop with some of the Arthritis Society’s panel of experts to share the model with progressive employers interested in adding medical cannabis to their own benefit plans.

For information about including medical cannabis in an employee drug benefit plan, contact Cheryl McClellan at 416-979-7228. For more information on the Arthritis Society’s work in support of research and education about medical cannabis, please visit arthritis.ca/medicalcannabis.

Janet Yale, Arthritis Society president and CEO:

This initiative speaks to our commitment to respecting and meeting the needs of our employees, and more broadly to ensuring that Canadians living with diseases like arthritis have fair and affordable access to the treatments they need. By modelling that principle through our own benefits plan, we are leading by example, signalling to other Canadian employers that adapting their plans to accommodate medical cannabis is not only possible, it’s necessary. 

 

Mike Sullivan, CEO, Cubic Health:

We feel privileged to be involved with The Arthritis Society as they continue their leadership role in developing a sustainable and evidence-based approach to offering medical cannabis coverage to plan members who have failed on traditional therapies. We hope the framework they have pioneered will be a model for other employers who are looking to offer coverage to members who can benefit from another therapeutic option within their plan.

 

Dr. Caroline MacCallum prescribing physician:

I am optimistic that other employers will follow the Arthritis Society’s lead by adopting similar, inclusive, medication benefit programs. This will continue to reduce the stigma of medical cannabis, and more importantly improve access and affordability for safe supply of medical cannabis for those living with chronic pain.

 

Dr. Michael Verbora, prescribing physician:

Providing coverage for medical cannabis is important in removing financial barriers for patients attempting to improve their health through cannabinoid therapy. As more providers begin to bring in coverage for patients suffering from chronic health conditions, I strongly believe we will see a healthier, happier society that relies far less on potentially harmful pharmaceuticals.


About The Arthritis Society

The Arthritis Society is a national health charity, fueled by donors and volunteers, with a vision to live in a world where people are free from the devastating effects that arthritis has on lives. Begun in 1948 with one very clear goal – to alleviate the suffering of people crippled by arthritis – that same volunteer-led passion carries on today in communities across Canada. Through the trust and support of our donors and sponsors, the Arthritis Society is Canada’s largest charitable source of investments in cutting-edge arthritis research, proactive advocacy and innovative solutions that will deliver better health outcomes for people affected by arthritis. The Arthritis Society is accredited under Imagine Canada’s Standards Program. For more information and to make a donation, visit arthritis.ca.

February 13, 2018 as seen at Arthritis Society.

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