MEDICAL MARIJUANA REQUESTS SPIKE, WITH SEVERE ARTHRITIS MOST COMMON CLAIM

OTTAWA - The federal government has seen a staggering increase in the
number of requests for medical marijuana authorizations from
applicants claiming they have severe arthritis to legally obtain the drug.

Applications to Health Canada based on severe arthritis claims jumped
2,400 per cent between 2008 and 2010, far outstripping the number of
claims for cancer, HIV/AIDS and other serious diseases, a Citizen
analysis has found.

The spike in arthritis claims was part of an overall rise in
applications over the past three years, as more private clinics
specializing in marijuana began referring patients to pot-friendly
doctors willing to sign their forms.

But unless there has been an enormous, undocumented surge in arthritis
rates in Canada over the past three years, the data suggests that
patients or their doctors might be gaming the government's rules to
obtain medical marijuana more easily.

Arthritis was listed as the reason for 40 per cent of all applications
under the Marihuana Medical Access Regulations (MMAR) received so far
in 2011. That was double the rate seen in 2008, according to
electronic records released to the Citizen under the Access to Information Act.

Severe arthritis is one of the Category 1 illnesses that require
patients to obtain the signature of just a single doctor under Health
Canada rules. Cancer, multiple sclerosis, HIV/AIDS infections and
spinal cord injuries and disease and are also listed in Category 1,
but often have more obvious visible symptoms than arthritis.

Patients with other Category 2 illnesses such as hepatitis, glaucoma
or ulcerative colitis must go through the additional step of getting a
specialist to sign their applications, a process that can take many
months and does not always succeed.

Some marijuana advocates believe that patients are asking doctors to
sign off on the faster Category 1 condition of severe arthritis to
speed their applications.

"I think a lot of people are applying under arthritis even if they may
have a different condition," says Scott Gilbert, who runs the Hamilton
Medical Marijuana Centre. "They are going with whatever is the easier
one to get approved on."

Although a patient might otherwise qualify for authorization based on
a Category 2 illness such as fibromyalgia or Crohn's disease, a savvy
doctor familiar with the MMAR program might ask if the patient also
has arthritis, too.

Health Canada is currently conducting a review of MMAR and plans to
overhaul the way the program works, in part by transferring more
authority to doctors. The department says it is required to approve
applications that have been signed by a doctor and meet the conditions
of the MMAR. It has noticed the sharp increase in marijuana
applications but doesn't know why, exactly, the numbers are rising so sharply.

"Increasing awareness of the program among patient groups and treating
physicians is likely a key contributing factor," said Health Canada
spokesman Gary Holub in an email.

The department is also aware of the increase in arthritis claims, Holub said.

"The risk of abuse exists within the current system. That's why
changes are being proposed that will balance the legitimate needs of
patients, while reducing the risk of abuse."

Patients often complain that the refusal of doctors to approve their
applications is the greatest obstacle to entering the program. But the
surging number of applications suggest they are finding other ways to
get approved with the rules.

Many privately-run clinics are sprouting up across the country, with
in-house physicians to sign the 33-page Health Canada application form
or provide referrals to doctors who are willing.

The Do No Harm Clinic in Kelowna, B.C., for example, has helped
process applications for more than 500 patients over the past two
years. It serves patients who have been unable to find a doctor to
sign their forms and will provide a physician to consult with patients
anywhere in the country over the Internet.

A doctor who works at the clinic agreed to speak to the Citizen about
his practice on the condition he not be named, as he does not want to
deluged with requests from potential patients. The Citizen confirmed
his identity.

"Medical marijuana is not a prescription," he said. "I don't have to
touch the patient to see they have cancer."

But he says he will not list severe arthritis or other illness on the
application unless the patient can produce documentation of the
disease provided by a specialist.

"We would make sure you've seen a specialist," he said. "If you have
severe arthritis, are you telling me you wouldn't have seen a rheumatologist?"

He acknowledged, however, that some other Canadian marijuana clinics
are moving to what he calls the California model, where a patient
walks in off the street and gets a doctor to sign the forms on the spot.

"That kind of thing goes on," he says, but he notes patients can do
the same thing if they present with back pain to get a prescription
for Oxycodone, a powerful and addictive pharmaceutical painkiller.

The doctor volunteers his services but the clinic charges $400 to help
patients complete the Health Canada application form.

Gilbert's clinic in Hamilton works a bit differently, pre-screening
patients with cancer, HIV and other conditions and, where suitable,
sending them to doctors in the community known to be comfortable
prescribing marijuana.

While many of the clients he refers will buy their marijuana from
Health Canada's supplier, some will choose to name a staff member of
his clinic as their designated grower.

Health Canada's rules say one person can supply marijuana to only two
approved patients. That means for every two clients who ask him to
grow, Gilbert must hire another employee as a grower. He employs them
only temporarily, on a planting and harvesting days, a tactic he says
has the approval of local police and municipal authorities.

Before he opened his clinic in Hamilton in June, Gilbert was arrested
and charged with seven drug-trafficking offences related to a
so-called "compassion club" that he help run in Guelph, Ont. The
charges are still pending, he said.

Compassion clubs sell marijuana to sick people without Health Canada
approval, making them vulnerable to arrest and prosecution. There have
been raids of clubs in Toronto and Montreal, possibly forcing some
medical marijuana patients to turn to Health Canada to buy pot legally.

An increasing number of private clinics and services are working
within the system to arrange approval under Health Canada's rules -
some charging processing fees.

For $450 plus tax, the Medical Cannabis Resource Centre in downtown
Vancouver will hook up a patient with a doctor on Skype to confirm
identity. Like the Do No Harm Clinic, the centre still requires a
statement of diagnosis of a pre-existing condition from another doctor.

These clinics are trying to work around the problems in Health
Canada's rules to get marijuana to patients who need it, says Rielle
Capler of the Canadian Association of Medical Cannabis Dispenseries.

"Whether they're entrepreneurs or well-meaning physicians, they're
stepping in to fill these gaps," she said.

Capler says she's concerned about clinics asking large fees from
patients who are often too sick to work and living on fixed incomes.

"There are some that have been charging $500. But this is what it has come to."