GOING TO POT

Giggle if you want, says the doctor who will lead clinical trial of
marijuana. But the weed could ease the suffering of thousands

Dr. Mark Ware has heard the question before: "Have you ever smoked
marijuana yourself?" He just smiles. "Let's leave this to the patients."

Sometimes, it seems nothing can take the giggle out of marijuana research.

"You've got to have a sense of humour," says Dr. Mark Ware, who's about to
conduct a first-ever clinical trial to measure the effects of smoked pot
and pain. "I think I've heard it all and then somebody has another one."

Usually, he says, people snicker and ask if he has any samples to give
away. Then there are the friends who are eager to volunteer for his study.

And, of course, the inevitable question, asked at the press conference to
announce his ground-breaking study: "Dr. Ware, for the record, have you
ever smoked marijuana yourself?"

Ware, a McGill University researcher, smiled and shot back:
"Congratulations. You're not the first one to ask that. But you know what,
let's leave this to the patients."

Right now, the sole question for Ware is whether pot really lives up to
miraculous tales of pain relief. And that's no joke, he told a roomful of
reporters.

"We're talking about human suffering. We're talking about using cannabis as
medicine. Next question, please," said Ware, whose pilot study, approved by
Health Canada, is generating quite a buzz. It's the first peer-reviewed
clinical trial involving smoking weed. Heading a team of McGill
researchers, Ware will be seeking scientific evidence to back anecdotal
claims about cannabis as a pain reliever. Patients will be asked to smoke
three pipes a day - not in a hospital or laboratory setting but in their
own homes.

The year-long study is to start in January at the McGill Pain Clinic at the
Montreal General Hospital.

"This is not a joke, this is a landmark study," said Dr. Nicholas
Steinmetz, director of planning at the McGill University Health Centre.

The project, he added, is funded by a $235,000 grant from the Canadian
Institutes of Health Research, a branch of Health Canada.

The 36-year-old Ware got his first taste of marijuana as a child when his
nanny boiled the leaves for tea whenever someone got ill.

"It's quite a common remedy in Jamaica," he recalls. "People think nothing
of boiling it up and giving it to their 4-year-old for a fever or to (older
children) to help them study for exams.

"They use it to make kids smart," said British-born Ware, who grew up in
Jamaica, the son of a microbiologist mother from Guyana and a British
construction worker. His accent was formed by years of British boarding
schools.

These days, Ware, an assistant professor of anesthesia at McGill, occupies
an office the size of a closet at the Montreal General Hospital, an
impressive feat considering he's 6-foot-5.

Folding himself into a chair, he declares: "If cannabis is as good as
people feel it is, it will pass clinical trials with flying colours."

Ware has been interested in studying the effects of smoked marijuana ever
since he worked with sickle-cell anemia patients in Kingston, Jamaica. He
initially planned on becoming a country physician but experience on the
Caribbean island tweaked his interest in alternative and herbal remedies.

Patients with sickle-cell anemia suffer from recurrent, excruciating pain
and require high doses of analgesia, including morphine and codeine, "all
the strongest drugs," said Ware, who earned his medical degree at the
University of West Indies.

"I began to look around and see what Jamaicans were using," he said. The
answer was cannabis, the traditional folk medicine. Ware notes his interest
comes naturally, given that the side of his family that comes from Guyana
includes a long line of shamans.

"Is there some way in which cannabis can be conceived of as a medicine?" he
wondered. "Part of my medical training had always been that there are very
few diseases that we as doctors can cure. We try to relieve symptoms and to
comfort."

A large body of literature on cannabis and pain in animal models emerged in
the 1990s, but hardly any on humans. Wanting to fill that research vacuum,
Ware went to the London School of Hygiene and Tropical Medicine for a
masters program. His thesis involved designing a clinical trial to measure
the effects of marijuana on disease.

"I felt passionate about herbal medicines in general and cannabis therapy
in particular," said Ware. "A research question has to burn inside you
before you get excited enough to go though all of the crap you have to get
it done."

He just couldn't ignore patients' reports: "They say this stuff works. I
have to listen to that. If it helps them, maybe it can help others."

Patients around the world have been telling doctors the same thing.

"But anecdotes aren't enough. We need scientific evidence that it's not
some placebo effect," Ware said.

D D D

Along with pain specialist Gary Bennett, psychologist Ann Gamsa,
epidemiologists Stan Shapiro and Jean-Paul Collet, Ware hopes to prove that
marijuana deserves a spot on pharmaceutical shelves next to other
medicines. Cannabis is already used to modulate pain, nausea and appetite
in some HIV/AIDS patients.

The body also produces its own cannabenoids, which are cannabis-like
opiates, said Ware, leaning forward to explain about receptors that are
present in the brain, brain stem, the spinal cord and the molecules that
bind to them. It functions similarly to the body's endorphins, known for
producing the classic runner's high.

"And perhaps pain is a disruption in that pathway. Smoking dope is a way of
acting on that pathway," he said.

It's been tested before as derivatives or isolated extracts, in patches,
pills and other preparations, so why is this study so important?

"It's the first time we've been able to study it in the way it's being used
in its environment," Ware said. "The study is designed to mirror, as much
as possible, real-life conditions."

Patients suffering from acute, chronic pain caused by nerve damage will be
recruited from the McGill Pain Centre. The 32 recruits will get four sorts
of marijuana, one type per week, to be smoked in a pipe.

"As odd as it may sound, looks like we're going to have to apply for a
medical device license to use a pipe for cannabis," Ware said with a smile.

Patients will get the first dose of the week at the clinic.

"We'll follow them for an hour. We'll have a fridge stocked with goodies.
And then we'll send them home with enough cannabis to last for the
remaining five days," he said.

Subjects will get exemptions, or perhaps a letter identifying them as
participants in a clinical trial. Details are still being worked out. The
pot will be packaged to look like prescription drugs.

Coincidentally, Ware's study got the go-ahead just as Canada is on the
verge of relaxing its laws on pot for medical purposes. Nearly 300
Canadians have exemptions to smoke marijuana for health reasons.

New rules are expected to go into effect Tuesday. Those with exemptions
will now be able to designate their own marijuana producers or to grow it
themselves. It's not known how many have applied for a permit under the new
regulations.

Meanwhile, the government's own producer, Prairie Plant Systems of Flin
Flon, Manitoba, is expected to provide grass for research purposes as of
December.

But Ware, who didn't know whether Canadian stock would be ready for his
project, already contracted marijuana from a U.S. grower.

D D D

Marijuana remains an illegal substance. Ware won't tackle the legalization
debate. It's a simple plant, he says, let's get over the stigma.

"Now is the time for the trial of cannabis to come out of the courtroom and
into the clinic. Time to put some hard data behind the almost miraculous
tales of what cannabis has been able to do," said Ware, who was refused
Canadian funding for similar study proposals twice before.

Jamaica also rejected the study, perhaps in fear of recrimination from U.S.
National Institutes of Health which provides funding for medical research
in Jamaica.

"The biggest challenge is trying to talk about studying smoked cannabis as
a drug and being taken seriously," Ware said, his bookshelf loaded with
literature on marijuana use.

Ware wouldn't be here if it weren't for federal Health Minister Allan
Rock's announcement two years ago that he was "prepared" to fund studies on
the medicinal uses of cannabis.

Rock delivered with the Canadian Medical Marijuana Program. But the money
came through only recently.

Throwing his jacket back on, Ware said he is most grateful for the opportunity.

It's more than a vindication of his efforts. It also means he has work in
Montreal for years to come, an important detail for a man married to a
Montrealer, former CBC TV reporter Sue Smith.

Ware sought a position at McGill because the university is in his wife's
home town. The couple have two children and are awaiting a third.

"Montrealers seem very attached to their city," said Ware, throwing his arm
around his wife's shoulders.

With top funding in place, cannabis has become Ware's life work.

The pilot study is to supply data for the design of a larger clinical trial.

"Watch this space. We've got results coming down. This is just the beginning."

- - For more information, go to http://www.lindesmith.org/medicalmarijuana/