Home Looking for the green lining: a view of Canada?s medical marijuana system

Looking for the green lining: a view of Canada?s medical marijuana system

by admin November 29, 2010

As a young law student, Francois Arcand had his future set up. What Arcand could not have planned for was the massive arteriovenous malformation that burst inside his brain in 1989, when he was only 20 years old. The ruptured vessel, which was caused by an abnormal and usually congenital connection between veins and arteries, left Arcand paralysed on the right side of his body.

Eventually, Arcand was able to regain some movement and learned to talk and walk again, but the scar tissue that built up around the malformation left him severely epileptic by 1990. Arcand was left experiencing measurable seizures 24 hours a day.

The mixture of medications Arcand was taking helped alleviate some of the convulsions that accompanied each episode, but did not help to reduce the amount of epileptic seizures that still occurred in the brain. Arcand could only describe his condition as constantly “thinking trhough cotton wool.” The incessant epileptic episodes were taking a toll on him.

“It made my life basically a living hell. People used to think that I was actually dying of AIDS. I couldn’t eat,” explained Arcand. “I looked like a skeleton.”

With a simple suggestion from his mother that he try marijuana for his epilepsy, Arcand’s life changed dramatically in 1998.

The birth of a medical marijuana system

In 1997, Terrance Parker was fighting his way through the Ontario justice system following his arrest for the cultivation and possession of marijuana. Parker, an epileptic since childhood, had been using marijuana as a treatment to reduce the frequency of his seizures.

By 2000, Parker’s case had been heard by the Ontario Court of Appeals. In July of that year, Justice Marc Rosenberg struck down the prohibition against marijuana since it infringed on Parker’s right to liberty and security of person. The courts granted the federal government one year to modify the law and to grant medical users, like Parker, access. In the following year the federal government and Health Canada implemented the Marihuana Medical Access Regulations to allow access to those that suffer from “grave and debilitating illnesses.”

In order to be licensed under the MMAR program, applicants must fall into one of two categories. The first category consists of patients with multiple sclerosis, spinal cord injury or disease, cancer, HIV/AIDS infection, a severe case of arthritis or epilepsy. The second category is reserved for patients who have a debilitating symptom or illness that is not included under the first category and that is confirmed by a specialist. A category two patient must also have sought all other possible treatments but found that marijuana is the only one that works.

As of January 2010, 4,884 patients in Canada hold an Authorization to Possess card which allows them to use dried marijuana. Of all the provinces and territories, Ontario, the location of the groundbreaking decision, has the most patients with 1,873. British Columbia with 1,372 patients and Nova Scotia with 619 round out the top three. Quebec falls fifth on the list behind Alberta, with 321 patients holding a card.

While the federal government may see the current system as an adequate solution to the questions posed by Parker’s case, others have seen the MMAR program as a Band-Aid to save the prohibition on marijuana.

“Health Canada didn’t wake up one day and realize that there are millions of people benefiting from marijuana and decide to help them,” said Adam Greenblatt, founder of the Medical Cannabis Access Society. “The courts forced them in to this and they’ve taken a very reluctant approach.”

From a suggestion to treatment

Following his mother’s suggestion in 1998, Arcand sought out information on using marijuana to treat his epilepsy. After consulting with his neurologist he turned to the street to find a dealer. Using marijuana cut down the amount of epileptic seizures he experienced but did not eliminate them. An additional benefit of the drug was that his appetite returned to normal.

“I went from a man that weighed 120 or 135 pounds back to 165 pounds, which is the weight I weighed before the brain hemorrhage,” said Arcand.

After Parker’s case opened up a legal way to access medical marijuana, Arcand was sure that he would be given a licence. However, none of the doctors or specialists were willing to fill out the necessary forms and prescribe a dosage to enrol him in the MMAR program. They preferred to give him a letter attesting to his condition so that he would be able to purchase marijuana at a compassion club, a location set up to distribute medical marijuana.

Arcand turned down the letters because compassion clubs are not part of the federal program and because they are susceptible to raids and other legal ramifications. In the end, he found a physician willing to enroll him in the program in 2002. Arcand’s intuition also turned out to be right since this past summer a wide-scale raid hit the compassion clubs of Quebec that accepted letters signed by physicians.

Compassion clubs are not legally allowed, but police normally permit them to function as long as they remain transparent and maintain a strict set of rules regarding membership. Many clubs enforce a daily purchase limit for members and keep prices relatively high to prevent the possibility of resale on the streets.

Health Canada stresses to MMAR patients that compassion clubs are illegal and that their program is the only legal venue to fulfil their prescriptions. Patients have the option to buy ground marijuana from Health Canada, grow their own plants, or designate a grower that will supply enough for their prescription.

A new world of cannabinoids

The question of how to supply himself with enough medical marijuana led Arcand to Greenblatt and his organization in 2009. MCAS either pairs MMAR patients with a designated grower or will teach card holders how to supply themselves. Greenblatt, who is a designated grower himself, immediately had Arcand try a number of cannabis strains. After some experimentation, Arcand had the perfect mixture to treat his condition.

Arcand’s prescription calls for him to consume 20 grams a day in various ways including smoking, vaporizing and eating products made with cannabis. It would be a staggering amount if the strains were laden with tetrahydrocannabinol, a cannabinoid otherwise known as THC that causes the sensation of being high, a feeling most people associate with marijuana.

However, the four strains that Arcand is currently using all have low levels of THC, and one strain in particular blocks any THC he may have consumed. Few people know that there are at least 85 cannabinoids that have been isolated and found to have a number of different effects on users. Arcand and other medical users are not in search of high doses of THC but are looking for the other cannabinoids that could alleviate some of the symptoms of their illnesses.

“I’m beating the odds and I’ve never felt better right now. It’s all thanks to the cannabinoids,” said Arcand. “It’s not thanks to the THC.”

Health Canada is currently only providing one strain of medical marijuana, Cannabis satvia L. Indica, to patients in the MMAR program. In 2002 Health Canada awarded a contract to grow that particular strain to Prairie Plant Systems Inc., a Saskatoon-based pharmaceutical plant-growing company. This particular strain has a moderate amount of THC, about 10.5 to 14.5 per cent, and is rigorously tested to make sure it is safe. Each lot of marijuana is irradiated to ensure that the microbial content is low since most patients have compromised or lowered immune systems.

After using the four strains in addition to his regular medication for epilepsy, Arcand has found a treatment that works for him. “For the first time in 21 years, after finding the right strain of cannabis, I’ve stopped having seizures completely,” said Arcand. “I’ve never had my head more clear.”

An imperfect system

Michael Pearce is well versed in how long it can take to become a licensed MMAR patient. Pearce has suffered from chronic pain for over three decades because of a case of inflammatory arthritis of the spine, called ankylosing spondylitis. It took seven years to find a doctor willing to sign the necessary forms to make him part of the MMAR program. Once Pearce is entered into the program, he must renew his card every year like every other patient. The result is a backlog of applications and renewals that eventually slow down the entire process.

“The program that we have right now with Health Canada and the federal government is a broken program,” said Pearce. “It takes far too long to get the cards, it takes far too long get our renewals done, it takes far too long to get the documents done.”

Pearce now helps other potential patients find the right doctors that are willing to sign the MMAR documents.

Health Canada has said that they are addressing the issue of delays in processing and are trying to reduce wait times back to eight to 10 weeks. However, Chad Clelland, director of online and community relations for the website Medicalmarijuana.ca, has seen delays of eight to 10 months. While Health Canada may say they are getting better in terms of processing, he believes a significant change can be made when it comes to renewals.

“One thing that they’re strongly considering is that if you’re a category one with a condition that won’t necessarily improve they’re looking at making it a three to five year renewal,” explained Clelland. “But if somebody had cancer and they go into remission and they’re not needing the treatment they’re getting, that might be a different scenario.”

The limited number of doctors willing to sign the MMAR forms has also posed a problem for patients seeking treatment. Across Canada only 2,373 physicians have signed for a patient more than once. By January 2010, Quebec only had 182 doctors sign for their patients, compared to 939 in Ontario, the leading province. For Dr. Yves Robert, secretary of the Quebec College of Physicians, the trouble with medical marijuana is the lack of knowledge regarding its use.

“The problem we have right now under the current special program for medical marijuana is that it is not a drug that can be prescribed because there are no standards for production. There are no standard dosages, and the medical indications are not clearly identified by the evidence of that,” explained Robert.

MMAR forms cannot be completed without a proper prescription, which results in patients being left out of the program. However, many doctors are willing to sign a letter that confirms a diagnosis, which would grant patients access to a compassion club.

Clelland sees the pressure from the medical colleges on physicians as a problem, but notes that patients and doctors are beginning to open up a dialogue.

“I think the biggest backlash that [doctors] get is from the College but I think with increasing numbers … it’s a conversation that is happening,” said Clelland.

The lack of recognition on Health Canada’s part regarding the possible benefit of various cannabis strains is also seen as one of the program’s flaws. The official Health Canada position is that marijuana is not approved as a therapeutic drug in Canada and that there is no scientific evidence that validates its therapeutic value. The only proof attesting to its effectiveness of various strains has come from anecdotal reports.

Greenblatt, who introduced Arcand to a variety of cannabis strains, has noted that the product supplied by Prairie Plant Systems Inc. is inferior to anything he has grown as a licensed medical marijuana grower.

“The shortcoming is that marijuana as a commodity has evolved to a point that Health Canada’s program won’t acknowledge,” said Greenblatt. “The trimmed, strain specific, manicured buds that cannabis consumers are used to seeing are not coming out in the Prairie Plant System product.”

Greenblatt was also surprised to see that when he became a licensed grower, the only instructions that were provided to him by Health Canada were on how to ship cannabis without being detected by Canada Post. He explained that Health Canada should be teaching patients how to become self-sufficient by growing their own plants in a safe way.

“Right now I’m happy…”

Now living in Ottawa, Arcand is 42-years-old and terminally ill. Surgeons were unable to remove all of the malformation and the scar tissue has begun to build up in Arcand’s brain. In February, the growth, now more than five cubic centimetres in size, pushed out and fractured his skull. Arcand uses a strain of cannabis that is incredibly effective at reducing pain, so much so that he was able to stop taking the morphine he was prescribed.

“The pain that I was in was so immense that I don’t know what I would have done if I had to keep on living with it. The morphine couldn’t do anything,” said Arcand. “Right now I’m happy, I’m not in the kind of pain that I was [before] medical cannabis.”