The Data

PUTTING A FACE TO THE PATIENTS

Numbers Reveal Sharp Disparities In Accessibility And Use Of
Drug

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
about three to one.

Like 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 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 allow seriously ill Canadians to apply to
use the drug.

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

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 helps determine
whether you get approval 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 5
per 100,000 in Manitoba.

Between 2001 and 2007, the V0N postal code zone spanning British
Columbia's Sunshine Coast, the 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, even in 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's the approach of doctors in different
parts of the country, not patient needs, that determines who is
getting marijuana. They point to what they say are more permissive
attitudes toward marijuana in B.C., where there is also better
outreach by cannabis advocates to the doctors who 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 has effectively 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 the
documents he needed to legally use the drug.

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 marihuana program completely undermines the
effectiveness of the program," wrote Justice Donald Taliano in his
decision quashing the marijuana law in April.

The court agreed that the systemic refusal of doctors to approve
patients for marijuana was an infringement on patients' rights.
Mernagh, who uses marijuana to treat chronic pain and seizures caused
by fibromyalgia and other conditions, 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 given on applications to the
medical marijuana program. This trend is a relatively new one, with
Health Canada deluged over the past three years by arthritis
applications.

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, even though there were far fewer people living with
the infection than 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 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 gayest neighbourhoods in Canada. They also boast some of the
highest per capita 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 that 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 than rural
ones.

It is a counter-intuitive trend that is likely due to the fact that
patients in many larger cities have been better served by socalled
compassion clubs that dispense pot to patients 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 than 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 dispatch 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 over age 60.

[sidebar]

MEDICAL MARIJUANA BY THE NUMBERS

4,884

Number of Canadians authorized to possess marijuana (as of January
2010)

Age of the youngest patient, a boy with epilepsy, living in Quebec's
Beauce region, authorized for 1 gram per day, referred by a
pediatrician.

Age of oldest patient, a man in downtown Vancouver with severe
arthritis, authorized to consume five grams daily, referred by a
general practitioner.

Largest allowed dosage, in grams per day. It was approved for a
45-year-old man with spinal cord injury and disease, living near
Kelowna, B.C.

[sidebar]

Top medical reasons for marijuana applications, 2007-11

Severe arthritis 7,445

Other (Category 2)* 4,032

Chronic pain 2,194

Spinal cord injury 2,130

Spinal cord disease 1,583

Cancer 1,387

Multiple sclerosis 1,254

AIDS, HIV infection 1,130

Epilepsy 394

Hepatitis B or C 276

* Category 2 patients have debilitating symptoms of a medical
condition not covered by Category 1 for which conventional treatments
are considered or ineffective. These applications require an
assessment by a specialist. Category 1 patients are authorized to
possess marijuana to treat symptoms of cancer, HIV/ AIDS, epilepsy
seizures, spinal cord injury or disease, and severe arthritis. They
require approval by only one doctor.