FEDS SCREWED UP ON POT
Liberals Blowing Smoke On Medical Marijuana Study -- The Evidence Has Been In For 25 Years
For many connoisseurs of altered reality, the pungent sweetness of the marijuana plant heralds a gentle, spacy universe where time lingers and reflection is a multilayered experiment.
But the much-maligned herb also offers less sublime possibilities. Those who suffer physical torment talk of it as a salve -- a calming, pain-easing medicine more important for its ability to make life bearable than for its invitation to a fifth dimension.
Centuries after healers discovered the plant's therapeutic charms and decades after scientists learned how to test it, our federal government still refuses to legalize its use by thousands suffering from cancer, AIDS and multiple sclerosis.
Despite an Ontario judge's recent decision that denying citizens medical access to the substance is unconstitutional, and despite many appeals, federal health minister Allan Rock has made no move to make the situation easier for sick people.
While he suggested a year ago that he might allow access, last week he derailed the legalization question by announcing the government's intent to establish guidelines for clinical trials.
This move, seemingly dramatic and bold, is considered by many a cynical manoeuvre to lend the appearance of sophistication and compassion to a stalling operation.
Marie Andree Bertrand, a member of the government's famous Le Dain commission that in the early 1970s recommended the decriminalization of pot, says that to insist on more study of the plant before allowing medical use is to "laugh in the face of the Canadian public."
The research, she says, was done and paid for 25 years ago.
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The bushy, hardy plant known as cannabis sativa has been used medicinally across the globe for thousands of years. In 1971, the Le Dain commission cited a series of classified U.S. army studies from the 50s showing a number of potentially valuable therapeutic effects from the use of synthetic cannabinoids for everything from fever and epilepsy to high blood pressure.
Says the commission's Bertrand, "We spoke of all the symptoms that would be alleviated by cannabis," contradicting what she calls "lies" emanating from public health authorities.
"The minister is reinventing the wheel. This is full of bullshit."
As well as Le Dain, a host of prestigious groups including the American Public Health Association, the British Medical Association, the Canadian AIDS Society, the Canadian Medical Association and the Canadian Hemophilia Society have endorsed medical marijuana.
A 1997 editorial in the New England Journal Of Medicine even stated that to demand evidence of therapeutic efficacy for pot is "hypocritical."
"The noxious sensations that patients experience are extremely difficult to quantify in controlled experiments," the journal stated. "What really counts for a therapy with this kind of safety margin is whether a seriously ill patient feels relief as a result of the intervention, not whether a controlled trial proves its efficacy."
Most scientific research on pot has been limited to testing oral tetrahydrocannabinol ( THC ), the ingredient that causes smokers to get high, but THC is only one of the plant's many chemical constituents.
The best evidence about smoking pot concerns its use in preventing nausea among cancer patients undergoing chemotherapy.
A series of six studies conducted by American state health departments in the 1980s, involving nearly 1,000 patients, showed that pot worked better than conventional prescription anti-nausea drugs and oral THC ( marketed today as the synthetic pill Marinol ) in alleviating chemo's queasy downside.
Just last October, a study published in the New York State Journal Of Medicine looked at 56 cancer patients receiving chemo for whom conventional anti-nausea drugs were not working.
Smoking pot, it turns out, did the trick in nearly eight out of 10 cases, with no serious negative side effects. In light of this kind of info, a good number of cancer doctors are now quietly recommending a joint now and then to their patients, despite the drug's illegal status.
The list of uses for the much-beloved weed goes on. The problem is that much of the evidence is anecdotal, so healing by weed hovers in limbo -- good enough for doctors and a host of scientific associations, but insufficient to sway regulators.
Its use in Canada thus remains strictly verboten under the Controlled Drugs And Substances Act, which prescribes six months in prison and a $1,000 fine for those caught taking a whiff to ease their aches and pains. This despite December's ruling by Ontario judge Patrick Sheppard in favour of Toronto's Terry Parker, an epileptic.
Benedikt Fischer, a scientist with the Addiction Research Foundation ( ARF ), now part of the Centre for Addiction and Mental Health, is surprised that Rock's announcement hasn't addressed the "legal circumstances and regulation currently governing -- or not clearly governing at all -- the issue of medicinal marijuana use."
He cautions that the timetable of any further research is going to be long-range. "Rock hasn't specified what medical or health indications they're looking at. Even if they started the trial process tomorrow, it will take four or five years before we see any substantive results or data coming out of it."
Doctor Andrew Weil, director of the University of Arizona's program of integrative medicine and a renowned authority on psychoactive drugs, allows that some clinical trials should be repeated but stresses that "on the basis of what we know at the moment, marijuana could be authorized for uses in medicine."
Perhaps the most significant advantage weed offers, Weil says, is the fact that its use entails no side effects. The effects of other, conventional treatments are sometimes so serious that patients have to stop taking them despite their suffering.
"It is so non-toxic -- relative to the pharmaceutical drugs that are used routinely -- that you may as well look for ways to use it, because we don't have anything else in medicine that is so non-toxic."
Canada is perhaps the last industrialized western democracy to officially recognize pot's medicinal benefits, even lagging behind our neighbours to the south, where seven states and the District of Columbia have approved such uses.
In Israel, revelations that police have provided an elderly asthma sufferer with a monthly dose of dope for six years, with special permission from the health ministry, led the government to form a committee to establish guidelines for doctors prescribing marijuana.
Clinical tests are also under way in Britain, but in some other European nations therapeutic use is already allowed.
Alan Young, a law professor at Osgoode Hall, attributes the logjam to Canadian fear of American disapproval. "That's what holding things up, because the rest of the industrialized world has more or less given up on its quest to criminalize marijuana use."
Governments, he says, have not funded studies, so they are correct in asserting that there are no really compelling, large-scale, valid double-blind studies.
"It's by their own indifference and negligence that those studies don't exist. For them to deny access to marijuana because of the absence of valid, medically accepted studies is the height of hypocrisy," says Young, who worked on the Parker case and represented AIDS sufferer James Wakefield, who lost his suit against the feds to get medical pot.
"What occurred on March 3 ( Rock's announcement ) was an exercise in politics at its worst level, in the sense that it was an announcement made simply to stall and to create the illusion that this government does truly care about the plight of sick people.
"I see this as at least a five-year project, minimum. Cannabis sativa is a very remarkable, very mysterious plant, and putting aside the 400 or so chemicals we have identified, there are 60 different cannabinoids."
Certainly, marijuana research is not going to be straightforward. Independently replicating results from clinical trials will be a problem, since the precise chemical makeup of the drug varies greatly from plant to plant.
Will the supply be handled by drug stores or street-corner pushers?
"Those details are being worked out by officials who are working hard on developing a plan, and as information becomes available we'll make it public," says Rock spokesperson Derek Kent.
Umberto Iorfida, president of the National Organization for the Reform of Marijuana Laws ( NORML ) in Canada, imagines that Rock's scheme will probably allow for permits to be issued to both growers and dispensers of medicinal pot.
This could take the form of existing buyers clubs like the B.C. Compassion Club Society ( a nonprofit group that provides cannabis to 650 members ) or large drugstore chains, which could be provided with permits that would enable them to purchase from growers. Perhaps there would be a body akin to the wheat pool that would measure and label THC content on packaging.
"Certainly, they ( the government ) are not going to grow it and dispense it," suggests Iorfida, who has no doubt that existing growers will end up supplying the weed.
Marijuana is currently being grown for medical use in greenhouses in the Netherlands, though these are not licensed by the government. Then there are a handful of other official growers, like a U.S. government farm at the University of Mississippi and a British firm, GW Pharmaceuticals.
"When it comes to cultivating marijuana, the underground community knows more than the botanists and pharmacologists, and we should be tapping into that information," says Young.
One private grower that may figure here is Brown Bear Medicinals, a co-op organized by Brian Taylor, the mayor of Grand Forks, BC, one of the first outfits in Canada to apply for an industrial hemp licence. Taylor says the co-op is also applying to cultivate medicinal cannabis for the Compassion Club and/or clinical trials.
"We'd like to be a supplier in the next little while to patients in both the special access as well as trials and research," Taylor says.
"We have a vision of how access could happen over the next little while, with controlled groups supplying through the medical community, with either prescriptions or letters of recommendation or research studies. I think there's a way we can include a whole bunch of people who have been left out in the cold up until now."
Ottawa's plans to move on this issue come as little consolation to people suffering from AIDS and other illnesses, who don't want to wait four or five months before finding out whether they'll receive compassionate access under rules already in force that allow certain critically ill patients to obtain drugs that have not been approved.
As for Rock's clinical trials, Compassion Club founder Hilary Black says, "The people who really need access now are not going to be alive in a couple of years -- they're fading fast."
Health Canada's Kent, however, insists that the research plan "would be flexible enough to ensure that those who require marijuana for medicinal reasons would be accommodated."
But why can't people currently using pot for medicinal reasons be granted an exemption?
Kent cautions, "We're working at determining where medicinal-quality marijuana can be located, where it could be legally available. We're looking at obtaining a product that's of good quality and originates from a licit, licensed supplier. And we have to bear in mind that that has to be used in a proper scientific context."
Young counters that there are by definition no licensed suppliers. "They're the only institution that can license a manufacturer, so they keep setting themselves up for failure by saying, 'We don't have the clinical trials, we don't have a licensed manufacturer.' That's all a product of our government's policy."
As for "proper scientific context," the ARF's Fischer notes that clinical trials -- or science, if you will -- can't answer everything. He says, "At the end of the day, we may have a few trials that indicate no significant superior value of marijuana over other existing conventional therapies, and we'll still have a huge list of unanswered questions.
"At some point, the government will have to address the issue of compassionate use, even in the lack of hard scientific evidence."
In the meantime, local organizations aren't waiting for the studies to be mounted. Outfits like Black's Compassion Club and the for-profit Medical Marijuana Resource Centre here in Toronto are openly selling pot to medicinal users who show doctors' letters confirming they have one of several life-threatening or debilitating conditions alleviated by pot intake.
Black says the club's supply comes from 15 growers the club has contracts with. "We can go see their grow rooms so we know it's being done cleanly, without any chemicals.
"If Rock wanted to show good faith, he would put a stay on any criminal proceeding right now that has anything to do with medical use, and that would show that this is real and not just political fluff."