MARIJUANA AS MEDICINE

What the law proscribes is now prescribed by doctors. But the plan has
growing pains, including a regulatory hodgepodge that satisfies no one.

Each morning, before even drinking a cup of espresso, Vincenzo Pizzi rolls
a marijuana joint and smokes it.

"It helps me control my pain," said Pizzi, who walks with a limp, a
constant reminder of a near-fatal car crash 18 years ago that put him in a
coma for three weeks.

Since he started smoking marijuana more than a decade ago, Pizzi has been
careful about where he lit up for fear of arrest. These days, however, he
doesn't have to worry about breaking the law.

Last October, Health Canada granted the 39-year-old Riviere des Prairies
resident the right to possess and grow marijuana for therapeutic purposes.
He's one of 38 Canadians who have been "authorized" to do so since the
Marijuana Medical Access Regulations came into effect on July 31.

Still, the authorization is small consolation. Pizzi can grow marijuana but
he is not allowed to buy it. And like many patients who use pot, he isn't
keen about having to cultivate it.

Pizzi's story is not just about government red tape, but highlights some of
the weaknesses with Health Canada's marijuana policy.

Health Minister Allan Rock has touted the new regulations as "innovative,"
saying they have made access to marijuana easier for many patients in
chronic pain. Critics, however, accuse Ottawa of tiptoeing around the
concerns of law-enforcement and the medical establishment, producing a
regulatory hodgepodge that satisfies no one.

What's more, Ottawa has contracted Prairie Plant Systems to grow marijuana
in a mine in Flin Flon, Man., even though it hasn't figured out yet how it
will distribute the weed to patients.

Pizzi acts like a tough guy, speaking in a voice hoarse from smoking
marijuana all day long. He chuckles when he hands out cards for his
part-time business, Cosa Nostra Snow-clearing.

When he was not volunteering his time cheering up the elderly at an
east-end seniors' residence, Pizzi spent much of the last year on the phone
with Health Canada bureaucrats.

He applied last February for an exemption to smoke marijuana. He was
granted it eight months later, but not until Health Canada required him to
first try a wide range of conventional painkillers - something he had
already done over the years.

He obliged anyway, taking the anti-inflammatory Vioxx, which eases bone
pain. Next on the list was Neurontin, an anti-convulsant that is usually
prescribed to epileptics. Finally, he tried the anti-depressant Desipramine.

"I felt like a guinea pig," Pizzi recalled. "They did nothing for me. In
fact, one drug made me constipated and another made me impotent."

Pizzi sustained a brain concussion in the accident and fractured several
vertebrae in his neck. His left leg was crushed, and is now 4 centimetres
shorter. Every day since the crash, Pizzi has experienced sharp stabbing
pains in his neck and back. Dark circles under his eyes hint at his
insomnia. If he moves his left leg ever so slightly while sleeping, he
wakes in agony.

"I tried all the different pain medications, but they didn't do me any
good," said Pizzi, who lives in a modest bungalow with his wife and two sons.

"When I was on morphine, all it did was put me to sleep. When I took
Percocets, they gave me panic attacks."

When he finally received his federal exemption in the mail on Oct. 9, the
moment was decidely anti-climactic.

The more he read it, the less clear it seemed to him.

"I've got two kids at home. Why should I have to grow marijuana? This is
like asking a cancer patient to produce his own chemotherapy drugs."

Health Canada has received 117 applications to date under the new
regulations, and each is carefully reviewed - a process that can take months.

Ottawa was forced to come up with the new regulations after the Ontario
Court of Appeal last year struck down federal marijuana-possession laws for
sick people. The court criticized the arbitrary manner in which Ottawa had
granted exemptions to patients, and gave the government one year to redraft
the law.

"The new regulations make access to marijuana for medical purposes clearer
and easier all around," said Jody Gomber, director-general of the
controlled-substances program at Health Canada.

In the absence of a government-approved marijuana supply, Pizzi buys pot
regularly from the Compassion Club on Rachel St. It's one of 10 clubs that
have sprouted up across the country in the last couple of years, operating
in a legal gray zone and under surveillance by police.

The Plateau Mont-Royal club sells marijuana to more than 50 steady
customers - people suffering from AIDS, cancer, multiple sclerosis and
other diseases. The tiny shop stocks a wide variety of marijuana that go by
colourful names like Blueberry, Northern Light and Zero Zero.

Police raided the club last year and arrested two men for possession and
trafficking. A judgment is expected in their case next Wednesday.

On a cold autumn afternoon, Pizzi stepped into the club, eager to buy some
marijuana to last him through the week. He took out eight $20 bills from
his pocket - enough money to buy 10 grams of Blueberry, a highly potent
brand. He disappeared into a back room with club volunteer Pierre Hamel and
emerged a minute later with his stash tucked in a coat pocket.

Hamel, a short, thin man, greets customers warmly. He sat down behind a
desk and reflected on the new regulations. They're overly bureaucratic, he
contended, and the requirement that the patient grow marijuana is absurd.

The regulations stipulate that an individual can grow up to 15 plants
indoors and store a sizeable quantity of 675 grams. Patients can carry on
their person up to 90 grams.

"Most sick people are too weak to grow marijuana," Hamel said. "They can
barely take care of themselves, let alone tend to a marijuana plant."

The regulations foresee such a Catch-22, and allow for a "designated"
person to grow marijuana on the patient's behalf. However, the designated
grower must submit to a background police check going back 10 years and can
only cultivate marijuana for one patient - conditions that hardly encourage
volunteers, Hamel suggested.

Gomber, of Health Canada, defended the ban on buying pot as prudent.

"We're talking about a substance that is actually prohibited by law, and
these regulations are in place to remove the legal prohibition under
certain circumstances."

Under the old system, the decision to grant an exemption was left largely
to the discretion of the Health Minister. The new regulations specify three
categories of patients. The terminally ill - those who have less than a
year to live - belong to the first category.

Those suffering from cancer, AIDS, HIV infection, MS, spinal cord injury or
disease, epilepsy and severe arthritis are considered category-2 patients.

Pizzi, who doesn't have any of those diseases, is a category-3 patient.
Health Canada created the third category for patients who are in
excruciating pain, but whose ailments don't fall under the first two
categories.

At first glance, the third category appears to be quite inclusive. Not so,
Hamel said, noting category-three patients require the medical opinions of
at least two doctors. This could lead to contrary opinions for some
illnesses like fibromyalgia, a muscle disorder causing chronic pain and
fatigue, that's often hard to diagnose.

In such a circumstance, a patient might be denied the right to use pot
despite having tried in vain all the conventional pain treatments, Hamel said.

Early next year, Prairie Plant Systems is expected to harvest 185 kilograms
of marijuana. What Health Canada will do with the weed is uncertain,
because many doctors are unwilling to prescribe it.

During a visit to Flin Flon last August, Rock declared that "logic led us
to the conclusion that we should have a formal government supply."

But critics on both sides of the marijuana debate criticize Rock's strategy
as illogical - for different reasons.

"It's completely ridiculous," said Dr. Yves Lamontagne, president of the
Quebec College of Physicians. "Are we going to become authorized dealers?"

There are two strikes against marijuana, the medical establishment argues.
First, it's illegal under the Criminal Code. Second, it has never been
approved by Health Canada as a prescription drug. That is important for
physicians, because approved drugs must have detailed information on
potential side effects as well as the optimal dose.

Doctors are particularly worried about the prospect of being sued by
patients, a fear raised last month by the Canadian Medical Protective
Association - the largest medical malpractice fund in the country.

"This was a legal problem that was imposed on the federal government by the
Ontario court, and instead of looking at it from the legal point of view,
they dumped the whole thing in the physicians' back yard," Lamontagne said.

There is compelling anecdotal evidence marijuana can relieve nausea induced
by chemotherapy, and can stimulate appetite in those suffering from the
wasting effects of cancer and AIDS. Marijuana is not without its
side-effects, however. While cannabis is far from the most potent
painkiller, it can cause confusion and sedation.

Sensing that it might have skipped a step in the process, Ottawa has
commissioned nearly $1 million in clinical marijuana trials. Dr. Mark Ware
will lead one of those studies at the McGill Pain Clinic in the Montreal
General Hospital.

Part of Ware's research is to determine exactly how the active chemical
ingredient in marijuana - known as THC, or tetrahydrocannabinol - works in
relieving pain. Ware will also seek to find out whether higher or lower THC
levels make a difference.

Ware's year-long study is to start in January, and results from that trial
and others might not be available for the next couple of years. Until then,
doctors will be in the dark as to the safety and efficacy of marijuana, yet
Health Canada will be asking them to prescribe it.

At the Compassion Club, Hamel dismisses the fact that the Flin Flon grass
will contain between five and six per cent THC. In Hamel's experience, MS
patients benefit the most from pot with 10 per cent THC.

"Five-per-cent THC is too weak," he said. "It will force people to smoke
too much marijuana unnecessarily."

Hamel suggested that the compassion clubs are best suited to dispense
marijuana, not to mention the most amendable to the idea, yet Ottawa does
not trust them to fulfill that role.

Health Canada is hoping that if doctors don't co-operate, perhaps
pharmacists might get involved. Gomber confirmed that pharmacies "would
definitely be among the routes being considered, because they do have a
distribution system in place."

In Quebec, the province's order of pharmacists is now drafting a legal
opinion on precisely that question.

"I would say that pharmacists must play a role," said Paul Fernet,
president of the order. "When it comes to the control of pharmacology and
medicines, that's something that pharmacists do very well."

Still, Fernet conceded that some pharmacists might be leery of stocking
weed, if only because they might be the targets of armed holdups.

Ware, of the McGill Pain Clinic, sympathizes with those frustrated with the
new regulations, but he said they're a "brave step in the right direction."

"We're in a very important transitional phase at this point: with the
cultivators working to produce cannabis for medicinal purposes, with the
(marijuana) exemption under development and with a number of other
initiatives underway, such as research ... to try to fill the blanks in the
picture."

For Pizzi, however, the bureaucratic and legal wrangling are proving to be
a costly exercise. He has used up a $10,000 personal line of credit to buy
pot from the Compassion Club.