SMOKE UNDER FIRE

Critics Say The Bureaucracy Is So Taxing For The Sick That Medicinal
Marijuana Is Hardly Worth It

Phillipe Lucas is legally entitled to possess marijuana to cope with
Hepatitis C, but getting it legally is about as tough as getting a drink
from a prohibitionist.

If you have chronic back pain, are undergoing chemotherapy or dealing with
another medical condition and want to see if "medicinal marijuana" might
help, bringing the option up with your family doctor might seem a little
awkward. Actually getting the stuff, it turns out, is even harder.

"The Office of Cannabis Medical Access is the biggest oxymoron there is,"
Lucas says. "It's not about access, it's all about denying or complicating
access."

According to Lucas, one third of the members on the advisory committee to
the OCMA represent organizations opposed to marijuana access, organizations
like the RCMP, Canadian Chiefs of Police, Physicians for a Smoke Free
Canada and the Canadian Medical Association. Only two members are medicinal
marijuana users. The bureaucracy they have set up is so onerous for sick or
disabled people, it's hardly worth it, he says.

Following the steps Lucas took to get access demonstrates the thicket that
keeps patients from easy access -- medicinal marijuana may be technically
legal, but it's far from an easy prescription to obtain.

Like all others applying to get medicinal marijuana provided by the
government, Lucas had to first be authorized to possess it. That required a
lengthy bureaucratic procedure which he will have to repeat every year,
even though his condition won't have changed.

Hepatitis C is considered a category-three disease by the OCMA, neither
terminal (category one), nor one of the specified diseases (category two),
so Lucas had to get two specialists to fill out a very detailed application
stipulating that the benefits of marijuana outweighed any risks and
recommending a cannabis dosage. Few physicians are willing to do that,
especially when the CMA and the colleges that licence doctors have both
urged them not to.

"We are opposed to physicians distributing medical marijuana and in the
vast majority of cases we are also opposed to physicians prescribing it,"
said BC Medical Association president-elect Dr. Jack Burak in an interview.

Burak said distributing marijuana poses safety issues such as break-ins and
violence for doctors while prescriptions should not be written for
medicines in which the doctor can not be sure of the bio-availability or
concentration of drug.

"The prudent move would be to hold off until we have scientifically-based
knowledge that this is efficacious and therapeutic," he said.

Lucas was already using marijuana he purchased from the Vancouver Island
Compassion Club, which he runs. But he wanted to be part of the legal
system, under which his use of marijuana would be recognized as medicinal.
Following the paperwork, he was able to convince two specialists to sign
on, though he knows of other patients that have had a harder time
accomplishing this task. He was also required to submit two passport photos
signed by his doctor verifying his identity.

As of August, 642 Canadians, 108 of them in B.C. including Lucas, had been
granted authorization to possess. (Compassion Clubs, whose organic
medicinal marijuana sales to sick and disabled Canadians are generally
tolerated by police, serve eight times that number across Canada nearly
5,000, 3,000 of whom live in B.C.).

Medicinal marijuana is still on the fringes of medical therapies but it's
been gaining a great deal of attention throughout the world as ill people
report how it relieves their pain and symptoms, enhances their appetite or
helps them sleep.

In Canada, Former Health minister Allan Rock spearheaded legislation
permitting some ill Canadians to possess pot during the first years of the
new millennium. Access and distribution was another story. Rock was
replaced as health minister by Anne McLellan in January 2002 and she is not
nearly as comfortable with medicinal marijuana as her predecessor.

"I feel a certain degree of discomfort around this issue," she told doctors
at the annual meeting of the the Canadian Medical Association. McLellan
wanted the clinical proof that marijuana helps without harming before she
distributed it.

By the time she made those comments in August 2002, medicinal users were
already frustrated. Months before she spoke to the doctors, in May, users
had initiated court proceedings. What good does it do to be permitted legal
possession without legal access? they argued.

In February 2003 Ontario Court Justice Lederman agreed, saying Health
Canada Medical Marijuana Access Regulations (MMAR) were unconstitutional
and therefore invalid, and that they only provided the "illusion of
supply." Judge Lederman gave Health Canada six months to rectify the
situation ordering the Health ministry to ensure medicinal users had access
to marijuana within that time.

With the deadline just days away last July, McLellan announced the ministry
would distribute the marijuana it had been growing in a Flin Flon, Man.,
mine shaft through the patients' physicians. The doctors balked, so did
their medical associations and colleges sending out letters saying they
disapprove of doctors distributing or prescribing.

The hush around the subject is such that none of the doctors contacted for
this article would talk on the record about prescribing or distributing
marijuana.

Lucas got his doctor to fill out a detailed application, then swore before
a lawyer that he wouldn't use any other cannabis while using the
government's supply. He applied for seeds and cannabis, but the government
notified him he had to choose one or the other.

In the end he chose the cannabis and his doctor completed the form saying
he should have it. Lucas says his doctor (whom he wouldn't name for fear
he'll be reprimanded by the Canadian Medical Association), didn't want to
receive the cannabis at his office so they created a lengthy paper trail,
arranging for it to be sent to the Vancouver Island Compassion Club.
Including phone calls, the procedure required four or five consultations
with the doctor.

"To think that someone critically ill would have to go through this," he
said. "I think this whole program was set up to fail."

That's what Hilary Black of the B.C. Compassion Club thinks too. "The whole
thing has been a bit of a saga," she says. "A bit of progress, then some
back pedaling and then sabotage."

In the process of putting the court-ordered program in place, the
government has alienated the doctors, ignored the expertise offered by the
compassion clubs and frustrated patients, says Black.

To top it off, approved users can't rely on the supply because McLellan
says she will immediately stop the program if the government wins a court
appeal.

"Health Canada is doing what is necessary to appear to be fulfilling the
program demands while setting up a program destined to fail," says Black.

If the government really wanted sick Canadians to be able to relieve their
suffering with marijuana, they would give doctors the power to prescribe it
and have the compassion clubs which have years of experience, distribute
it, says Black.

Instead, it has unduly stressed the very people it is supposed to be
helping, she says, adding compassion clubs handle the whole thing much more
"compassionately." She argues that patients shouldn't have to go through a
completely different process for medicinal marijuana than they would for
any other medicine."

George Bailey, 50, has been getting his medicine from the B.C. Compassion
Club for six years, ever since an inflammatory bowel disease and six
surgeries collapsed his immune system and left him with chronic pain,
nausea and occasional seizures. Compared to Lucas, Bailey, a former
psychiatric nurse, felt positively supported in his marijuana use.

When he decided to try cannabis, The Compassion Club gave him a package of
information including a one-page application requesting his doctor to spell
out Bailey's medical diagnosis.

Because of security issues, the Compassion Club won't give clients the
names of doctors who have signed forms in the past. It just recommends
clients keep trying if their first doctor refuses.

On the form, the club asks if the doctor recommends pot for the patient's
symptoms. If not, why not? (The club staff will still sell marijuana to a
person with a verified medical condition if the doctor doesn't recommend
it, as long as the reason is not medical.) Then the doctor has to stamp it,
sign it and fax it to the Compassion Club. The club staff then phone to
confirm the veracity of the form and put the patient on a waitlist for an
orientation.

Currently, the waitlist is two months long. The club already serves 2,700
members and is having space problems. However, it is having trouble getting
city approval to expand into the empty space at offices of B.C. Person's
with AIDS. Black surmises the problem may have to do with the illegality of
its operation. The club has been unofficially tolerated by the police ever
since the Victoria club was raided, taken to court and given a conditional
discharge and a commendation for providing a needed service.

Once Bailey's signed form arrived, he had an orientation in which club
staff taught him safe and effective use of cannabis. He learned that the
effects of Indica strains are physical, good for pain relief and relaxation
or insomnia while Sativa strains work on the mind, to relieve depression
and head-aches, increase energy, stimulate the appetite and increase
creativity.

The club sells nine or 10 strains, some of which are organic, some grown
indoor, some outdoor, some pure strain and some crosses.

He learned that smoking the marijuana brings relief in 30 to 60 seconds
while eating it or using a tincture can take one-two hours making it more
difficult to know how much to take. He was advised to take a few puffs and
wait 15 minutes before deciding if he needs more.

He was advised not to operate heavy machinery while impaired by cannabis
especially Indica strains which can be sedating. Mixing it with alcohol
could cause vomiting.

Lucas got none of this guidance from Health Canada, though some of it can
be found through a link on Health Canada's Web site. He just had to sign a
form saying he is aware that marijuana has not been tested for the Food and
Drug Act for safety or effectiveness.

When Bailey needs marijuana, he goes to the club on Commercial Drive, shows
his membership card to the receptionist, gets a number and is ushered into
the waiting room where the nine or 10 strains available that day are posted
with their price per gram.

Bailey uses 11/2 grams a day of a pure Indica strain called Legends
Ultimate Indica which promises good pain relief and sleep. It costs $9 per
gram. Often, he says he will ask the staff for advice on a good strain for
his complaints. And since resistance to a particular strain can develop,
their advice is valuable. He says he usually buys enough for a week, but on
this day, he can only afford two grams.

It can be tough to find the money for it on a disability pension, and
marijuana is not covered by the B.C. Medical Plan nor any extended health
plans, but the relief is worth the expense to Bailey.

When he pays, his particular purchase is recorded in the computer so that
staff can go back and see his record of purchases and make knowledgeable
recommendations.

Bailey didn't apply for government authorization to possess nor to receive
government pot because he believes the process is discriminatory. No other
prescription holder is treated this way, he says.

"I feel like I can come here, access quality medicine and quality wellness
therapies from the club's wellness centre and not be hassled. . . . For me,
it comes down to trust. I trust this facility."

Black says the government is willfully ignoring the compassion clubs
expertise despite her best efforts to offer it. She has spoken to the
advisory committee and Health Canada representatives several times and
given them documents with reams of information.

She says she believes experts need to be consulted on such topics as where
to get good product, the value of organics, the dangers of contamination
and other issues and argues that Prairie Plant Systems, which won the
government growing contract, had no experience with pot. PPS, she says,
grow the pot non-organically, despite the purity needs of users with immune
deficiency issues, and selected an unused shaft of an active mine for the
plantation making heavy metal contamination more likely.

As well, the seeds used to grow the government plants were seized during
police raids and contained such a wide mix of strains, it is impossible to
use for research.

McLellan has said she disapproves of medicinal marijuana before the
research is complete and she will abandon the program if she wins in court.
In the meantime, she also cancelled one of only two sanctioned studies. The
one proceeding will examine marijuana's effect on pain. The one cancelled
after costing $2 million would have looked at its effects on hunger and
appetite in AIDS patients.

And Lucas?

After waiting six weeks for his supply which cost $5 per gram (compared to
$10-$25 on the street market) to arrive by courier, Lucas got his hands on
some of it through another source and discovered that the quality of the
government stash is so bad he cancelled his order.

The pot contained only three per cent THC, the active ingredient, it was
overly dry and powdery and included leaf and stem, rather than the pure bud
sold by compassion clubs that have a THC content of 12 to 15 per cent.
Other license holders, as disappointed as Lucas, have sent theirs back
demanding a refund.

[sidebar]

DO'S AND DON'TS

- - Legal medicinal marijuana users, also known as license holders, have the
right to own up to 30 times their daily dose at one time.

- - The law does not say they can or cannot smoke it anywhere they want, but
if they do smoke it in public and are apprehended, they can show their card
saying they are excluded from the prohibition laws and they should be
released. Phillipe Lucas, of the Vancouver Island Compassion Club and a
license holder, recommends discretion when smoking in public. He wouldn't
smoke marijuana where tobacco is forbidden.

- - Using marijuana medicine in a hospital or medical setting can be
negotiated if the user is able to articulate good arguments. Lucas once had
to spend eight hours in at Victoria General Hospital while they did tests
on his liver. He was permitted to use marijuana in his four-person ward as
long as he used a vaporizer which heats the cannabis to a vapor to be
inhaled through a tube. There is no residual smoke.

- - Medicinal users can travel with their stash as long as they stay in
Canada. But don't try to take it across the border to the U.S.

- - Medicinal users can grow their own supply, but the regulations are very
complicated -- stipulating for example that the pot be grown indoors or
outdoors and the number of plants permitted. Lucas says he grows his on his
deck and brings it inside each evening. He isn't sure if it is considered
indoor or outdoor-grown.

- - Medicinal users must re-apply for their license every year. For those in
the third category, that means they must have consultations with two
specialists who fill out the forms. Sometimes, it can take eight months to
get an appointment with a specialist.