Canada’s doctors are being a buzzkill on cannabis legalization

The Canadian Medical Association’s (CMA) position on medical cannabis is coming under scrutiny again as legalization looms. After calling a few months back for an end to the federal government’s medical cannabis program once weed becomes legal October 17, the CMA has modified its position. It now says it supports a review of the medpot program under legalization in five years.

Dr. Jeff Blackmer, the CMA’s vice-president of medical professionalism, told CBC News recently that the recreational system would let people who feel cannabis might be a benefit to them access cannabis on their own. 

“If anyone can go down to the local dispensary and get cannabis, there’s really no need for a separate medical authorization system.” 

Except Ontario won’t have dispensaries, at least legal ones, until next spring. And those provinces that will once legalization kicks in require customers to be at least 19 (21 in some provinces). Seemingly anticipating the argument, Blackmer expressed that pediatric patients should be seen as exemptions to the rule and granted special access to the recreational system. Same with people who need to use cannabis to be able to work. 

But all these special exemptions don’t sound so great to the patients and the parents of patients who have already fought against a rigorous system in order to gain freer access to the medical cannabis they need.

Health Canada says the government will continue to facilitate the medical cannabis program in Canada after legalization, with a review to come after five years. 

That review was always a part of the legalization Task Force’s recommendations, which Health Canada says should “facilitate research with the goal of improving our knowledge of the risks and benefits of cannabis.” 

The CMA claims “there is insufficient evidence on risks and benefits [of medicinal cannabis]… the proper dosage and potential interactions with other medications.” 

The group has been echoing these sentiments for a while. 

Dr. Michael Mohan, a family doctor based in Toronto who has referred patients for medical marijuana, notes that trusted studies on cannabis aren’t entirely unavailable for doctors. 

For example, cannabis products have shown effectiveness in improving nausea and vomiting in chemotherapy patients in small studies. Similarly, studies have shown a benefit for cannabis in treating certain types of epilepsy.

But he agrees that a lack of studies prevents doctors from using cannabis as a first-choice treatment option for conditions including depression, anxiety, insomnia, PTSD and chronic pain. 

“Unfortunately, there are very few large or high-quality research studies that clarify if cannabis is useful in these or almost any condition. Many doctors therefore consider medical cannabis an option of last resort,” Mohan tells NOW.

He’s hopeful legalization may have some positive impacts on the research side of things, which he says “has historically been hampered by its [cannabis’s] legal and political status.”

He points out that medical cannabis may also require different strengths and compositions than would be appropriate for recreational use. Prescriptions for medical cannabis could also allow patients to receive insurance coverage for costs.

Besides, just because a medical system exists doesn’t mean a doctor has to prescribe it. 

Sabrina Ramkellawan, president of the Clinical Research Association of Canada (CRAC), has spent 15 years working in clinical research, the last three as a leader in cannabinoid studies. 

Ramkellawan tells NOW she is not surprised by the CMA’s back and forth. She says “they were put in the position to be the gatekeepers for authorizing medical cannabis without the education, safety and guidance on how to dose due to lack of clinical trials.” 

Meanwhile, government regulations under the Access to Cannabis for Medical Purposes Regulations enabled companies to produce and sell medical cannabis without requiring the same scientific validation and clinical trials as other drugs. 

This was the only way for patients to legally access cannabis, but it disincentivized public funding available for cannabis research. 

That’s why Ramkellawan, who also does planning research at biopharmaceutical company TerrAscend, believes collaboration between Health Canada, physicians, pharmacists, health care providers, patients, patient advocates, researchers and scientists will be key for research development.

Many in the cannabis community and beyond are hopeful that large corporations who have already capitalized off the plant and those getting into the cannabis industry (there are rumours of Coca-Cola entering the scene) will help with the continued funding needed for research. 

As Ramkellawan notes, the type of randomized, long-term and large-scale studies that are lacking can be very expensive – a minimum $50,000 for small survey-based studies and upwards of $25 million for large-scale trials. The other challenge is that large-scale randomized clinical trials are also time-consuming.

Many Canadian and American cannabis companies have already funded medical research. CRAC recently held an event highlighting a SickKids study on epilepsy and cannabis sponsored by Tilray and Solace Health Network. 

Ramkellawan reminds us that while more studies are indeed important, we must also recognize and respect research that has already been done. 

There are currently some 48 studies being conducted in Canada. There are also licensed producers, hospitals and academic centres in Canada conducting independent cannabis clinical trials. 

Legalization should be the first step in gaining more medical knowledge about the plant, but not the last. 

“There are more than 100 cannabinoids to which we still have not unlocked the science and medical properties,” Ramkellawan says. “We have just scratched the surface of what cannabis can do.” | @nowtoronto

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