ACCESS TO DRUG PROGRAM FAR FROM EQUAL

Typical Patient a Man, 47, From B.C. With Severe Arthritis

He is 47 years old and, chances are, he lives somewhere on British
Columbia's Sunshine Coast.

Under Health Canada's medical marijuana program, he is approved to
legally consume up to five grams a day of the pot he grows himself at
home.

Most likely, his general practitioner signed the forms he needed to
get the drug.

And on average, he is a "he" - men in the program outnumber women by a
ratio of about three to one.

As with a great number of medical marijuana patients, he uses the drug
to treat severe arthritis, although he may suffer from other conditions.

Data obtained by the Ottawa Citizen through the Access to Information
Act put this face to the typical medical marijuana patient for the
first time, 10 years after the federal government - under pressure
from a series of legal rulings - was forced to start allowing
seriously ill Canadians to apply to use the drug.

As Health Canada moves to overhaul the rules governing medical
marijuana, its own numbers show sharp disparities in the accessibility
and use of the drug across the country as patients scramble to find
doctors willing to prescribe.

Although all Canadians are supposed to have equal access to medical
marijuana, enrolment in the program varies greatly across the country.
Where you live and your doctor's attitude to marijuana will help
determine whether you receive approval from Health Canada to use the
drug to treat serious illnesses such as cancer, multiple sclerosis or
AIDS.

The geographic patterns contained in Health Canada's data show that
people from British Columbia are far more likely to have a marijuana
authorization - about 33 people out of every 100,000, compared to five
per 100,000 in Manitoba.

Between 2001 and 2007, the V0N postal code zone, which spans British
Columbia's Sunshine Coast - a ferry ride away from Vancouver - Gulf
Islands, part of Vancouver Island and the area around Whistler ski
resort, generated more applications under the government's Marihuana
Medical Access Regulations (MMAR) program than any other.

By contrast, in some well-populated swaths of Manitoba such as
Steinbach and parts of Brandon, not a single person has applied to the
program.

Marijuana advocates say it is the approach of doctors in different
parts of the country, not patient needs, that determines who is
getting medical marijuana.

They point to what they say are more permissive attitudes toward
marijuana in B.C. and better outreach by cannabis advocates to the
doctors who must ultimately decide whether to sign a patient's
application.

"British Columbia has a bit more laissez-faire attitude to marijuana
and a very good activist network informing doctors," says Matthew
Mernagh, 37, a Toronto marijuana user who, this spring, won a court
decision that effectively has toppled Canada's marijuana
prohibition.

After he was arrested for growing pot in his apartment in 2008,
Mernagh launched a constitutional challenge of Canada's drug laws.
Mernagh's case was based on a complaint common to many patients who
seek marijuana: the difficulty he had finding a doctor to sign
documents to let him legally use the drug - in his case, to treat
chronic pain and seizures caused by fibromyalgia and other conditions.

At trial, evidence was produced that suggested that less than one-half
of one per cent of Canadian doctors had signed the 33-page form for a
patient to apply to Health Canada's program.

"I find as a fact that the physicians of Canada have massively
boycotted the MMAR and their overwhelming refusal to participate in
the medicinal marijuana program completely undermines the
effectiveness of the program," wrote Justice Donald Taliano in his
April decision quashing the marijuana law.

The court agreed that the systemic refusal of doctors to approve
patients for marijuana was an infringement on their rights. Mernagh
was allowed to grow his own pot without Health Canada's approval, a
decision that - should it stand - effectively overrides Canada's
marijuana laws.

The court will hear the government's appeal of the decision in
March.

Mernagh might have had better luck with his doctor had he suffered
from cancer or even arthritis. Health Canada's data show that severe
arthritis is now the most common reason for applications to the
medical marijuana program.

This trend is a relatively new one, as Health Canada has been deluged
over the past three years by applications claiming severe arthritis as
the medical reason.

But in the first years of the program, it was HIV/AIDS patients who
were at the vanguard. Cannabis is an effective appetite stimulant and
can help curb neuropathic pain and control nausea caused by the
illness and AIDS medications.

By the end of 2007, HIV/AIDS patients accounted for the largest share
of applications for the MMAR, even though there were far fewer people
living with the infection than with cancer.

Estimates put the number of HIV/ AIDS patients in Canada at about
60,000. By contrast, there are more than 177,000 new cancer patients
diagnosed in Canada every year.

With the high uptake among HIV/ AIDS patients, medical marijuana use
is higher in areas with large gay communities. Vancouver's West End
and Toronto's Church-Wellesley area can both make credible claims to
being the most predominantly gay neighbourhoods in Canada. They also
boast some of the highest percapita MMAR enrolment rates in the country.

Urban doctors who see a lot of HIV/AIDS patients are more likely to be
informed about new therapies and open to trying new approaches, says
Lynne Belle-Isle of the Canadian AIDS Society, who wrote a 2007 paper
on access to the drug.

"Physicians who treat people with HIV are likely a little bit more
informed, and HIV advocates have been involved in the medical use of
cannabis for a long time," she said.

There is also more research on the use of the drug as a therapy for
HIV, Belle-Isle said, and the Canadian AIDS Society is the only major
disease organization that believes patients should have access to the
drug if it helps them.

But outside the gay communities, the data suggest participation in the
medical marijuana program is actually lower in urban areas.

It is a counter-intuitive trend that is likely due to the fact
patients in many larger cities have been better served by so-called
compassion clubs that dispense pot outside of Health Canada's program.

Some doctors are willing to write referrals to a compassion club but
won't agree to sign the forms required for the Health Canada program.

The clubs offer a wider variety of marijuana strains that, advocates
say, give better treatment options, compared to the single strain sold
for $5 a gram plus GST by Health Canada.

Had he convinced his doctor to sign his release, Mernagh, at age 37,
would number among the youngest approved marijuana patients. Indeed,
the Health Canada data dispatches the notion that young people are
applying to the program to score the drug legally.

People under age 40 accounted for fewer than 20 per cent of the
approved patients. Those in their 40s made up 38 per cent. About eight
per cent were older than 60.