FEDERAL GUIDE ON MARIJUANA: DON'T SMOKE IT

Medical Users' Manual Thin On Practical Advice, Long On Warnings

Health Canada is set to release a user's manual this week for a drug it has
long opposed: marijuana.

The unprecedented move has been triggered by the courts, which compelled
Health Canada this month to begin distributing government-certified
marijuana to a group of patients who take the substance to alleviate symptoms.

The department must also release a manual on how to use its dope -- but a
draft version of the document shows patients will get little practical
advice about ingesting marijuana and lots of warnings against using it at all.

"Administration by smoking is not recommended," says the 59-page document,
which is modelled on drug product monographs, standard for approved
medicines. "Marijuana can produce physical and psychological dependence and
has the potential for abuse."

The March 30 draft document, obtained under the Access to Information Act,
warns that smoking marijuana can be more dangerous to the lungs than
tobacco, but provides patients no practical alternatives.

"We're not recommending, in fact, that marijuana be used," said Suzanne
Desjardins, a Health Canada scientist who helped produce the manual.

"It's a drug we don't recommend. If people want to use it, then we're
saying, well, don't use it by smoking it. ... There's no study that
demonstrates (in) what form it should be used."

The manual specifically advises against administering marijuana to children
up to 16 years of age or to those 65 years or older because "the potential
for harm is likely to outweigh benefits." Nursing and pregnant women are
similarly urged to steer clear.

Users who do choose to smoke are warned that "smoking should be gentle and
should cease if the patient begins to feel disoriented or agitated .. naive
smokers should take great care and be supervised."

The document, headlined "Information for Health Care Professionals," warns
of potential panic attacks, psychosis and convulsions in some cases.

"If disturbing psychiatric symptoms occur at the prescribed dosage, the
patient should be closely observed in a quiet environment and supportive
measures, including reassurance, should be used."

Users are also advised that traces of marijuana remain in the urine for
weeks and may turn up in drug tests carried out by employers or police.

Apart from brief sections citing scientific studies on taking marijuana
orally -- baked in a chocolate cookie, for example -- or rectally as a
suppository, the manual offers no techniques to avoid smoking.

Experienced, health-conscious users have long turned to tinctures and
vaporizers as alternatives to smoking dope, which delivers the main active
ingredient, THC, quickly but can harm the lungs.

Vaporizers heat the marijuana to release THC for inhaling without any
burning. Tinctures can be produced by soaking marijuana leaves and buds in
alcohol, which extracts the active ingredient. Drops of the tincture can
then be used in cooking or under the tongue.

Health Canada does not approve the use of marijuana, saying clinical
studies are needed first to demonstrate whether it is effective as a
medicine. However, court decisions have forced it to allow select patients
to use marijuana on a compassionate basis.

The Health Canada user's manual, which will be sent to doctors and posted
on the Internet this week, will be accompanied by a two-page information
sheet for patients written in layman's language, Ms. Desjardins said.