ARTHRITIS CLAIMS PUSH HUGE SURGE IN DEMAND

Patients with other ailments may resort to citing severe arthritis on
applications in effort to get medical marijuana more easily

The federal government has seen a staggering increase in 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 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 may 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 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 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 has
arthritis, too.

Health Canada is 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 within 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 over the
Internet with patients anywhere in the country.

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
be 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 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
"compassion club" he helped run in Guelph. 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 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."