UP IN SMOKE

Medical marijuana study by McGill University is the first of its kind
to prove the pain-relieving benefits of cannabis

Chris's pain relief lies in half a cookie made with marijuana, eaten
every two hours, plus one or two puffs off a joint on the hour and
the occasional pot lollipop.

Chris started using legal marijuana, furnished by Health Canada, to
dampen constant pain and improve sleep and mood, after a violent car
accident shattered the bones in his face.

He switched to pot once standard prescription drugs like Dilaudid and
OxyContin failed. Marijuana was his last hope.

Plenty of anecdotal evidence, some going back centuries, supports
cannabis use as an alternative to standard analgesic drugs; however,
clinicians and legislators have little evidence-based science to lean
on when it comes to medicinal marijuana.

But now an elegant study by the McGill University Health Centre
supports what patients have been saying all along: even small doses
of cannabis provide relief from chronic, neuropathic pain that's
often caused by nerve damage.

Led by anesthesiologist Mark Ware, director of clinical research at
the Alan Edwards Pain Management Unit at the MUHC, the study took
more than eight years from design to finish.

Since then, three other small studies on smoked pot have been held in
the United States. But McGill's is the first double-blind,
placebo-controlled trial conducted with outpatients who were allowed
to smoke marijuana in the leisure of their own homes, Ware said.

Participants had to have intractable post-traumatic or post-surgery
neuropathic pain that did not respond to conventional treatment.

Of 116 potential participants, only 23 were eligible and 21 finished the study.

Participants were divided into four groups and randomly assigned
marijuana containing four levels of tetrahydrocannabinol (THC), the
active ingredient: at 9.4 per cent, 6.0 per cent, 2.5 per cent, and zero THC.

Neither participants nor researchers were aware of who was getting
what strength.

By the end of the study, each patient had used all four THC strengths.

The study used herbal cannabis from Prairie Plant Systems (which is
under contract to Health Canada), and a zero-per-cent THC cannabis
from a U.S. company that extracted the ingredient from the leaves.
The various strains were repackaged into identical gelatin capsules.

Patients emptied the capsules into their pipes.

Researchers administered a fixed dose (25 milligrams) three times
daily -three single puffs -for five days, followed by a "washout"
period of nine days. Every two weeks they got a different strain of cannabis.

How easy was it to fool people into thinking they were smoking the real thing?

Interestingly, at the end of each cycle, participants who were asked
to guess which dose they received usually guessed wrong.

"They weren't very good. They were better at guessing once they had
received all four," Ware said. "They could think back so the accuracy
improved."

The study showed that even the lowest dose brought patients relief.

"They had very difficult pain syndromes to treat, so any reduction in
pain is an important step in achieving good pain control," Ware said.

The study showed that participants got the best pain relief from the
highest THC, but even using a placebo worked.

The difference between the placebo and high THC was small but
significant, Ware said. Patients reported less pain, better sleep,
less anxiety and better mood.

"This was a proof of principle trial where we were giving a very
small dose and we didn't allow the patient to use more if they needed
it," Ware explained. The level of THC in pot sold on the street or
available through Health Canada varies from to 12 to 15 per cent.

A study that allows the patient flexible dosing and longer exposure
would likely show better pain management, Ware said, but there are
safety issues.

Results of Ware's Canadawide study on the safety of cannabis used for
medical purposes (COMPASS) following 1,400 patients are expected
within months, he added.

Study results published in the Canadian Medical Association Journal
came with a commentary from Dr. Henry McQuay of Oxford University's
Balliol College, who noted: "This trial adds to the trickle of
evidence that cannabis may help some of the patients who are
struggling at present."

Chris, who was not part of the study, says he's grateful to have some
relief from pain "that doesn't ever go away. It's the new normal, six
out of 10 on the pain scale. This helps me in ways no other medicine can."

MONTREAL HOSTS PAIN CONFERENCE

Researchers from around the world are gathering in Montreal to
discuss advances in the science behind suffering and new treatment
possibilities.

The International Association for the Study of Pain is holding its
13th World Congress on Pain, the world's premier science meeting
devoted to pain research and treatment in Montreal until Thursday.