THE CASE FOR MEDICAL MARIJUANA

"Basically, what I do is, I cause trouble. That's my function. If you
cause enough trouble eventually you effect change."

Meet Alan Young. Last summer the Osgoode Hall law professor launched a
constitutional challenge against marijuana laws on behalf of Chris
Clay, owner of a London, Ont., store called Hemp Nation. Clay, whose
merchandise included marijuana plants, was charged with trafficking
and cultivating a narcotic. While Young's client was found guilty,
Ontario Court Justice John McCart was tolerant, handing Clay a
relatively modest $750 fine and three years probation. In his
judgement, McCart said, "as it is commonly used, occasionally,
cannabis presents only minor.or subtle risks to the health of the
individual." This spring Young will represent Lynn Harichy, a multiple
sclerosis patient charged with possession after lighting a marijuana
joint in front of a London police station.

Young expects many new clients now that "buyers' clubs," supplying
marijuana to anyone with a doctor's recommendation, are opening in
Toronto, Oakville, Kitchener, Guelph, London and Peterborough. While
stressing he's not the organizer of these groups, he is willing to
defend them.

Young notes that, if his potential clients are charged, it would be
for trafficking, an indictable offence tried by a jury. "Dr. Henry
Morgentaler was providing abortions," he says. "Abortions were against
the law. He was tried seven times. He was never convicted." Calling
Morgentaler's rationale the Common Law Defence of Necessity, and
assuming all marijuana sales will be for medicinal purposes, Young
theorizes, "I suspect if I put enough AIDS and cancer patients into
the box, there aren't going to be a whole lot of juries that are going
to want to put these kids in jail."

Alan Young isn't alone in his campaign to make the decriminalization
of marijuana a health issue. In December, Ontario Justice Patrick
Sheppard stayed charges of cultivation and possession against Terry
Parker, a Toronto man who argued he needs the drug to combat his
epilepsy. Concluding Parker's rights were violated, Sheppard ordered
the police to return some of Parker's confiscated marijuana plants.
Sheppard wrote, "Deprivation to (Mr. Parker) arising from a blanket
prohibition denying him possession of marijuana, in the circumstance
of this case, does little or nothing to enhance the state's interest
in better health for this individual member of the community."

The Parker case was specifically referred to in January when a
Kitchener man received a light sentence for possession, partly because
of his diagnosed "chronic cumulative trauma disorder" and because the
Parker decision left the law in "a state of flux", according to the
judge.

Some advocates of medical marijuana are taking their case straight to
the government. Don Kilby, director of health services at the
University of Ottawa, is applying to Health Canada's Special Access
Program for permission to "prescribe" marijuana to Jean Charles
Pariseau, an AIDS patient who gained 20 pounds after smoking marijuana
as a last resort. Even in the law-and-order-conscious Reform party, MP
Jim Hart submitted a private member's motion proposing marijuana be
decriminalized "for health purposes, explicitly for the purpose of
providing pain relief for the terminally ill." All of these efforts
are playing out in the backdrop of an Angus Reid poll finding 83 per
cent of those surveyed support the legalization of marijuana for
medical purposes.

Marijuana advocates, and even those opposed, tend to agree on one
point: pharmacies should have a role in the medical marijuana issue.
"We have a perfectly good delivery system now through pharmacies;
they keep good records, they relate what people are taking to the
other things that they're doing and I should think that they would
still fulfil a role in these cases as well," says Barry Beyerstein of
the Brain Behaviour Laboratory of Simon Fraser University's department
of psychology, a member of the pro-decriminalization Canadian
Foundation for Drug Policy. "Pharmacists are already the custodians of
society of useful substances which also have some danger," concurs
Robin Room, chief scientist for the Addiction Research Foundation. "It
would be entirely appropriate for pharmacists to be saying, `Look, if
you're going to have medical marijuana, then it makes sense for us to
be the places that you get it.'"

While Room may deem their participation appropriate, pharmacy has been
quiet on the health politics of marijuana. Both the Canadian
Pharmacists Association and the Canadian Society of Hospital
Pharmacists have no position on the issue. "There's a lot that needs
to happen, or at least processes that need to happen, before the
pharmacist can even come into play, and that is a defined source, a
controlled source that meets regulatory requirements," says Bill
Leslie, executive director of the Canadian Society of Hospital
Pharmacists. Noelle-Dominique Willems, CPhA's director of government
and pub lic affairs, agrees, adding that like euthanasia it's an issue
that divides the profession. Says Willems, "If there's...a
Parliamentary committee that looks into it, which may happen if
practice becomes more frequent, then we would definitely, at that
point, at least prepare a position to talk about the role of
pharmacists, as we did with euthanasia."

Others suggest a number of reasons why the profession hasn't spoken out.
Harold Kalant, professor emeritus of pharmacology at the University of
Toronto's faculty of medicine, says, "It would create headaches, because
they would have to keep extra records in the same way they do for narcotics
or for other controlled drugs. Secondly, it would increase the risk for
them of breakins to try to steal their stock. Thirdly, it may be that they
just don't want to get mixed up in a messy situation." Wayne Hindmarsh,
dean of the faculty of pharmacy at the University of Manitoba, and author
of a guide for parents called Drugs: What Your Kid Should Know, says that
security could be an issue. "You're going to bring in a different
clientele," he says. "You know, it's not just going to be marijuana.
There's going to be other types of drug users as well."

However, two of the lawyers involved think the profession is reticent
for other reasons. "I think pharmacists are pawns in all this," says
Young. "They're a conduit for the facilitation of medical and
governmental policy, and they don't necessarily lead it." Aaron
Harnett, legal counsel for Terry Parker, says there's simply no money
in it for pharmacists. "Marijuana costs seven dollars an ounce to
grow. It sells for $350 now, so Terry now can grow it for free (or
for seven dollars an ounce) and he can cut out the middle man, the
end man, everyone."

But even Young and Harnett agree that pharmacists should be involved
if the marijuana is for medically-approved reasons. Says Harnett, "The
60-year-old lady with glaucoma, she's not going to want to start
growing pot plants, but if her doctor says, `Give it a try. It may
save your eyesight,' she may want a legal source, where she can be
assured of its quality, and not have to get her hands dirty."

Sorting out the distribution issue is proving difficult. While Kilby
is optimistic federal regulators will approve his Special Access
Program request for medicinal marijuana, Ottawa lawyer Eugene
Oscapella, part of a lobby group supporting Kilby's efforts, is more
sceptical after Health Canada denied their first request. The health
department concluded that neither Kilby nor the listed "manufacturer,"
the patient's current supplier, had the proper licences under the
Controlled Drugs and Substances Act. "It's hard to tell what messages
we're getting from them, quite frankly," he says. "In one sense,
they're scrambling to find a way out of this mess. In another, we've
got a guy who's dying of AIDS and who's being forced to go to the
illegal market to get a drug that's saving his life."

But Dann Michols, director general of Health Canada's Therapeutic
Products Program, says many controlled substances have been approved
by the government, such as heroin and morphine, and "it isn't really
earth-shattering to think that perhaps marijuana as a substance might
have medicinal use." While Oscapella and others argue no manufacturer
will ever agree to cooperate in a marijuana application, Michols calls
that "supposition," arguing it could be supplied by a university, a
distributor, or even a grower.

"There are other substances that are controlled substances where
suppliers have obtained the necessary licences to obtain, process and
distribute the product, so it's not an insurmountable barrier if
someone wants to do it," he says. He adds that, if Kilby went outside
the country to obtain a supplier, the government itself might end up
distributing the product. "Probably we would have to set up a
mechanism whereby the supplier supplied us and we provided the
material to the physician here, but that too is doable," he says. "The
government of the importing country would have to be involved to
ensure control of distribution."

While Kilby works his way through the Special Access Program, he longs
for the day when patients would simply visit a pharmacy. "I'm sitting
in my office now in front of about 150 binders on drugs that are
accessed through (the Special Access Program), because you have to
keep records for these patients, you have to provide records back to
the pharmaceutical company, you have to inform the government. There's
a lot of red tape to go through."

Many of the smokers battling the court system would also like to see
doctors and pharmacists helping them get their supply. While Lynn
Harichy would like to cultivate it herself, "If you could get it at
pharmacies that would be great because it is a hassle in the winter to
grow it," she says. "They let us take all these other medicines,
you know, trial drugs, and the side effects are so bad. If I don't
smoke (pot), I'm going to be in pain and I just, I can't take that."

Terry Parker, whose landmark victory is being appealed by the Crown,
says simply, "it's just been a real nightmare trying to get this
substance recognized for preventing epilepsy." Parker says because of
his illness he's become addicted to prescription drugs, and candidly
describes his treatment and its effects. "My skin is white as a ghost,
my teeth are grinding, my left leg and my left arm are all over the
place, my body is just convulsing. A couple of joints, smoke that,
within two to three minutes I've got instant relief... That's the
beauty about marijuana, the absolute beauty, and no pharmacist should
be shy about the subject." While Parker's case is under appeal, his
lawyer says other Crown Attorneys are withdrawing similar charges as a
result of the decision.

The Parker case, however, may have confused things even further,
according to Kalant, who was a Crown witness in the trial. "The judge
was acting essentially on compassionate grounds rather than on
scientific grounds," he says. "I think the judge was perhaps acting
more as a humane person than as an objective arbiter of the law. There
are probably valid medical uses for cannabinoids, but smoking pot is
rarely the way to do it."

That is the crux of the marijuana debate: does it have medical value
Advocates argue it's been used safely for thousands of years, and
point out there is no accepted lethal dose. Supporters of California's
Proposition 215, a referendum that decriminalized the use of marijuana
for certain medical treatments, argued the benefits of the substance
in treating cancer, anorexia, AIDS, chronic pain, spasticity,
glaucoma, arthritis, and migraine. They said a Harvard University
survey concluded one-half of oncologists would prescribe marijuana to
some of their patients if it were legal. A 1992 study from Georgetown
University's School of Medicine found 170 cancer specialists ranked
cannabis sixth in management of severe, post-chemotherapy nausea and
vomiting.

Few argue there are no risks. In a policy paper, the Addiction
Research Foundation found heavy cannabis use may have negative health
consequences, including respiratory damage (when smoked), impaired
coordination, altered hormone production and damage to the immune
system, although, "by any accounting," the health impact of marijuana
is much less than alcohol or tobacco. "There is credible anecdotal
evidence that some people are helped for some conditions by medical
marijuana," says the ARF's Room. "People are resistant to the idea of
medication that is smoked for both good and not so rational reasons."

Opponents argue there is no convincing evidence, credible or
otherwise. Raju Hajela, president of the Canadian Society of Addiction
Medicine (an affiliate of the Canadian Medical Association), says
marijuana is not a first-line treatment for anything, the adverse
effects from smoking are the same as from tobacco, and its withdrawal
symptoms are similar to those of heroin. In a Dec. 12 press release he
said those arguing that marijuana is not harmful are doing it to "feed
their own addiction." In an interview, he said, "The most common thing
that's observed in anyone who even casually smokes marijuana is the
amotivational syndrome that develops, that people lose interest in
their day-to-day life situations."

Wayne Hindmarsh has fought marijuana acceptance for years, and says
there's no evidence the drug is better than what's already legally
available. "We do know that marijuana does have a lot of toxic
principles, and we've got to be careful as to the message that we're
giving to younger kids," he says. "That's certainly the thing that
concerns me. If you could prove scientifically that the joint is far
better than any medication that's out there for a particular problem
then we would have to go with that, but that hasn't been proven, in my
mind."

Marijuana critics often point to two synthetic versions of one of
cannabis' active ingredients, tetrahydrocannabinol (THC): Marinol and
Cesamet. Michelle Foisy, HIV primary care pharmacist at Toronto's
Wellesley Health Centre, says while the drugs are marketed for cancer
patients, they have been given to HIV patients for nausea and
vomiting, and to help them gain weight. Patients with prior marijuana
experience often appreciate the effects, or continue smoking it
themselves, but other patients aren't as receptive. "There
certainly is a high percentage of people who say, `Forget it. I don't
want to feel high. I have to concentrate on my job.'" She doesn't
recommend the medicinal use of marijuana. "From a smoking standpoint,
on a chronic basis, I don't know that you're doing your patient any
good. You might be alleviating one thing but then inducing something
else."

But many patients and doctors don't like synthetic THC, saying it's
unpalatable and, if they're trying to control nausea to be able to
take oral medications, ineffective. "When people are taking 40 pills a
day or more, or on chemotherapy, they have so much nausea that they
can't even take those pills, including the synthetic form (of THC).
That's where we have the problem," says Kilby. "They're taking their
joints about half an hour before they take their pills and then there
is immediate relief of nausea and there's stimulation of their
appetite and they tend to be able to hold down, not only the pills,
but hold down some food as well."

There's one other reason why some prefer cannabis to drug company
products, according to Beyerstein: "Marinol is very expensive, and
marijuana is very cheap." Kilby notes the appetite stimulant he
usually prescribes for AIDS patients, Megace, costs up to $3,000 a
month, and is not covered under Quebec's drug plan.

Even if marijuana use was allowed, would physicians prescribe it
appropriately? Before giving a patient marijuana, Hindmarsh says he'd
want to know, "What physicians have dealt with him? I'm not saying
anything against general practitioners at all, but has (the patient)
been treated by specialists? Have they exhausted all the possibilities
that are available?" Alan Young scoffs at the suggestion. "I have to
work on the assumption that doctors are going to do their job
properly, and if not it's a matter for the College of Physicians and
Surgeons. Doctors can prescribe a lot of narcotics, and that isn't a
reason to take away that power from them."

Whether doctors will ever get the opportunity is another matter; 25
years after the Le Dain Royal Commission advocated decriminalization,
penalties for possessions can still result in a criminal record, and
the maximum penalty for trafficking is life imprisonment. While some
police force officials in Ottawa and Vancouver have downplayed
marijuana possession as a priority, its use, medical or not, carries a
risk. "If the law's there we're going to enforce it," says Gilles
Brunet, national coordinator of the RCMP's drug awareness program. "If
it's still a criminal offence we can't ignore it. I don't think
things change because of (the Parker decision)." Some say government
policy could change under new Health Minister Allan Rock, who has
already shown support for the herbal medicine industry. In an
interview with the Ottawa Citizen, Rock said he would "look seriously
and with an open mind at the evidence in deciding on whether the
government should get out of the way and permit the use of a substance
for medical purposes." Another Liberal MP, Toronto doctor Carolyn
Bennett, has come out in favor of cannabis use by multiple sclerosis
patients. "(Allan Rock), of all ministers of health, is probably in
the best position to make a change to the law," says Aaron Hamett.
"Nobody, I think, who looks at the issue carefully, wants to put
someone in a jail cell for a month because they've got an ounce of
marijuana."

If there are any legal changes, pharmacists will have some work to do.
Hindmarsh concedes it's "not really a major part of our curriculum. I
teach toxicology here at this university to the pharmacy students, and
that's sort of the last area to be covered." Though their curricula
would likely differ, decriminalization advocate Beyerstein agrees. "It
would be a good idea to do a little bit of postgraduate work, because
that probably wasn't covered in the standard curriculum, but that
information is certainly widely available," he says. "They're
professionals, that's what they do well, and I think that
information should be made available to them through their continuing
re-certification or professional education."

What virtually everyone can agree on is that, with buyers' clubs,
requests to government for marijuana and a growing line of court
cases, the idea is not going away soon. The question for pharmacists
is what position they'll take. "You have a lot of parents that are
concerned about their children, and they're not going to give up
quietly," says Hindmarsh. "My only hope would be that the debate is a
good debate that is based on scientific principles and not just on
feelings."

Says Harnett, "I imagine we can return to a time when the pharmacist
would also be the producer of some of the herbs and medicines. I take
it that's where their origin comes from."

(SIDEBAR)

BY THE NUMBERS

From the Addiction Research Foundation report, Cannabis, Health and
Public Policy, published in December, 1997. The policy paper
concludes, "The justifiable concern with the health effects of
cannabis is not incompatible with a less punitive legal response to
the user."

* Portion of Canadian adults reporting cannabis use some time during their
life: 1 in 4

* Portion of Ontario junior high and high school students who used cannabis
in the past year: 1 in 4

* Percentage of Ontario Grade 11 students: 42

* Estimated annual health care costs in Ontario resulting from cannabis
use: $8 million

* Resulting from alcohol use: $442 million

* From tobacco use: $1.07 billion

* Maximum penalty for first-time possession of cannabis (under 30 grams of
marijuana or 1 gram of hashish): $1,000 fine and/or' six months in prison

* Maximum penalty for a second offence: $2,000 and/or 12 months in prison

* Maximum penalty for trafficking marijuana: life imprisonment

* Number of criminal convictions for cannabis possession since 1965: 700,000

* Percentage of drug-related charges in 1995 that involved cannabis: 64

* Per capita ratio of cannabis arrests in the rest of Ontario compared to
Metropolitan Toronto: 3:1

* Percentage of those convicted of cannabis possession admitting subsequent
use a year after their trial: 92

* Likelihood a cannabis user will be prosecuted in any given year: 1 per
cent

Checked-by: Patrick Henry