LEGALIZED POT: MORE SMOKE THAN FIRE

Canada is now the first Western nation to legalize marijuana for medical
uses. The new regulations allow the prescribing of marijuana for the
terminally ill, those with specific medical conditions (such as multiple
sclerosis patients with severe pain) and seriously ill patients who have
failed "conventional treatments."

The decision to allow the weed is monumental -- and irrelevant.

That marijuana was illegal in the first place makes sense to the casual
observer. After all, pot is a street drug that is both addictive and, with
sustained use, harmful.

It's a compelling argument -- and one borne of ignorance. The reality is
that many street drugs (often illegal for recreation) are allowed for
medical use. Consider that possessing cocaine is a crime. But, in a health
care setting, cocaine is an anesthetic; I have never seen an emergency room
that didn't have liquid cocaine.

Morphine, codeine and heroin are used for pain relief. In fact, morphine is
one of the most basic and effective drugs used to treat pain. Several years
ago, two prominent physicians wrote a book titled the ABCs of Palliative
Care. They had harsh words for doctors reluctant to prescribe morphine for
the dying, going so far as to suggest these colleagues were "part of the
problem."

Why the ban on marijuana? "It's all politics," explains a pharmacist friend.

Contrast marijuana and codeine. Marijuana is a relatively innocuous drug.
Codeine is a modified morphine chemical. It takes an estimated 1,500 pounds
of marijuana to achieve a lethal dose -- smoked in under 15 minutes.
Codeine overdoses may require just a bottle or two of pills. Marijuana is
banned. Codeine is not only widely available in prescription drugs (like
Tylenol 3), but can be purchased over the counter in low doses.

Indeed, marijuana should never have been blacklisted. That decision
reflects bad politics, not good medicine.

Not everyone sees it that way. A former president of the Canadian Medical
Association criticized the federal government's action, suggesting that
allowing marijuana for medical purposes was a first step toward
decriminalization. In medical circles, it's a commonly argued point -- but
is it convincing? After all, we have always allowed morphine for end stage
renal cancer and cocaine for nose bleeds, but has this bolstered in any way
the efforts to decriminalize street drugs? Would medical marijuana?

Last week, the federal government corrected a past wrong. The
self-congratulations have already begun. Speaking at the July announcement
of the regulatory changes, Allan Rock, the Minister of Health, declared:
"Today's announcement [of the revised rules] is a landmark in our ongoing
effort to give Canadians suffering from grave and debilitating illnesses
access to marijuana for medical purposes. This compassionate measure will
improve the quality of life of sick Canadians, particularly those who are
terminally ill."

I have no philosophical objections to lifting the ban, but will it really
result in better, more compassionate medical care?

Anecdotal evidence appears plentiful -- and photogenic. TV news reports
often portray patients who offer amazing testimonials to the power of pot.
Proponents of legalization frequently tout two uses for medical marijuana:
in the management of pain and as an anti-nausea medication.

The reality is that marijuana probably doesn't have much use in either
capacity.

In a review of all randomized controlled trials comparing the efficacy of
cannabinoids with conventional drugs published in the British Medical
Journal, marijuana proved to be no more effective than codeine at pain
relief -- but had several undesirable side effects. As well, most of these
studies were done in the 1970s, before the development and better
utilization of several pain killers (such as NSAIDs) in use today.

In a review of 30 studies involving cannabinoids as a treatment for
chemotherapy-induced nausea and vomiting, marijuana was reported to be
effective for moderate nausea, but not for severe symptoms. Since the bulk
of these studies were done, newer medications have been developed that
unquestionably have better ability to control the side effects of chemotherapy.

Not surprisingly, then, in a recent editorial of the British Medical
Journal, Professor Eija Kalso suggests: "The current information is that
the adverse effects of cannabinoids outweigh their effectiveness."

Make no mistake: alleviating the pain and suffering of patients is a noble
and vital pursuit. What remains unclear is that medical marijuana will
contribute anything to the arsenal physicians already have at their
disposal. Of course, there is always the potential for marijuana to have
unforeseen applications. Perhaps a future Nobel laureate will one day cite
Allan Rock in his acceptance speech.

More likely, however, the practical implications of legalized pot will be
more smoke than fire.

Dr. David Gratzer is the author of Code Blue: Reviving Canada's Health Care
System, which was awarded last year's Donner Prize.