'IT HELPS ME GET THROUGH THE PAIN'

Wide Range of Medical Marijuana Users Find Relief in Pot, Despite Doctors' Misgivings

Ian Layfield in Victoria swallows cannabis-infused oil capsules he
makes himself, frying olive oil with pot leaves, then straining it
with cheese cloth and pouring it into gel caps. He also mixes cannabis
into a topical cream he rubs into his left foot and ankle, which was
crushed in October 2006 after being rolled over by a grader.

Margaret Marceniuk of Edmonton inhales her medical marijuana through a
pharmaceutical puffer and a head-shop pipe.

Tamara Cartwright vaporizes her pot with a machine called a Volcano,
then inhales three to four bags of the vapour while locked away in her
bedroom, away from her toddler.

Todd Kaighin, an HIV patient in downtown Toronto, largely smokes
traditional joints, while Janice Cyre outside Edmonton presses her
marijuana leaves into steeped tea. Many users also nibble on the odd
brownie or cookie baked with cannabis leaves, pot-infused oil or canna-butter.

All have their federal licences to legally take medical marijuana to
help dull pain, boost appetite and curtail nausea or diarrhea
associated with multiple sclerosis, colitis, severe arthritis, HIV or
fibromyalgia. But all laugh disdainfully at the dried marijuana grown
by the federal government in a mine in Manitoba, describing it as
"dust" or "catnip in a bag" that has little therapeutic benefit and
brings headaches.

They either buy their medical pot illegally through compassion clubs
or legally grow their own plants in their basements, with some
occasionally and reluctantly forced to buy from street dealers when
their supply runs low.

Marceniuk, who recently moved to a small community west of Edmonton,
has never smoked cigarettes and didn't rebel as a teenager by getting
high on pot.

She refused to try medical marijuana for her constant pain while
working as a schoolteacher and wasn't keen on using it while her two
sons were still living at home.

But since she's been on disability for seven years, Marceniuk has
slowly incorporated marijuana into her daily routine to help her with
the debilitating effects of multiple sclerosis. She's one of 108 with
the disease in Alberta - 480 across Canada - who can legally use
marijuana under Health Canada's medical marijuana program, according
to 2001 to 2007 data.

Diagnosed with MS at age 28, Marceniuk has experienced blindness,
migraines, balance issues, chronic pain and fatigue. At 55,
conventional medications only hold the pain at bay for so long.

"I have breakthrough pain," said Marceniuk, who is currently on 13
medications, including one conventional painkiller. About seven years
ago, she started using marijuana, first with Sativex, a legal
synthetic marijuana she inhales in a puffer form similar to an inhaler
for asthmatic patients.

Her doctor prescribes it like any other pharmaceutical and doesn't
have to apply to Health Canada for a medical marijuana licence or use
triplicate subscriptions, which are needed for opiates and narcotics
such as morphine that have the potential for misuse or abuse. A vial
of Sativex lasts about one month for Marceniuk, who inhales four puffs
for each daily treatment. Three to four hours later, the associated
high brings relief and dulls the pain.

But the Sativex didn't seem to help that much until Marceniuk began
smoking dried marijuana in a pipe, about once a week. The relief from
smoking was almost immediate, and the doctor believes the smoked leaf
opened pathways that allowed the synthetic compound to work better.

"It doesn't get rid of the pain completely. As my son says, it makes
me not care about the pain," she said. "It helps me get through the pain."

Marceniuk can legally take both forms of marijuana, since she has
received approval from the federal government, but it took her two
years to find a doctor willing to spend the time to fill out the
lengthy forms for a licence. In January 2010, figures from Health
Canada suggested 153 Alberta physicians supported marijuana
prescriptions, compared with 685 in B.C. and 939 in Ontario.

Marceniuk smokes her pipe only at home, occasionally supplementing
with cannabis-infused brownies made with special oil.

When out with friends, she takes Sativex, a more socially acceptable
option that can be discreetly used in the washroom and leaves no odour.

She purchases her pot illegally from a compassion house in Vancouver
she visits once or twice a year.

"The stuff coming from the government is literally just dust,"
Marceniuk said. "I'm not impressed by it."

Nor are others, who say when the government harvests its crop, workers
separate the cannabis leaves and buds from the crystals, the
snowflake-like compounds that grow on the bud and contain most of the
active ingredient called tetrahydrocannabinol, or THC. The extracted
THC is then made into a tincture or liquid form, and sprayed back onto
the plant so that the THC levels are standard in all the product, at
about 12.5 per cent, according to the Health Canada website. But
critics say tests have shown levels far lower, at 6.0 per cent. They
suggest variety in strength and plant types is important for patients
with different medical needs.

Marceniuk doesn't know how many grams she uses each day, but likely an
amount that falls safely inside the Health Canada guidelines of one to
three grams of dried marijuana. A typical joint contains between 0.5
and 1.0 gram of cannabis plant matter, Health Canada states.

But the guesswork is part of what troubles physicians like Edmonton's
Dr. Rufus Scrimger, who has worked as an oncologist for 25 years.
Scrimger said he doesn't feel comfortable prescribing medical
marijuana for his cancer patients because doctors are given no
training to understand the different strains, strengths or types of
marijuana they should be prescribing for each ailment. Nor can doctors
control the supply, which could be tainted with other ingredients.

"There's not a lot of good medical data out there to support its use,
evidence that says it's better than all the other medications that we
have available to us for nausea or pain," said Scrimger, the Alberta
Medical Association's section head for oncology. "We don't know how to
prescribe it. There's no real accepted dose. There's no standardized
strength. There's an ignorance, I guess, on the part of most doctors,
to prescribe it even if they wanted to."

The College of Physicians and Surgeons of Alberta recommends
physicians not prescribe medical marijuana because scientific research
hasn't proven its clinical benefits. The Alberta Medical Association
strongly urges doctors to "think twice" before prescribing or
dispensing marijuana, a stance laid out in association president's
letters in 2001 and 2003. Palliative doctors, who may be more likely
to consider medical marijuana as a final option to reduce pain in the
last weeks of life, are also advised against prescribing pot.

Dr. Brian Knight, an anesthetist with expertise in chronic pain
medicine, said he wouldn't call marijuana an important tool, but his
"third-line option," largely prescribed only after his patients have
had little success managing chronic pain through physiotherapy,
psychology, antidepressants, anticonvulsants and opioids, which are
controversial themselves. Knight also prescribes the pharmaceutical
pill or inhaler before trying the leaf variety of cannabis, even
though the synthetic marijuana doesn't usually work for patients, or
brings more side effects than smoking a joint, he said.

The problem, Knight said, is that even though an estimated 30 per cent
of the population suffers from chronic pain, there aren't sufficient
resources such as therapy to help them to the same extent as for those
with other chronic health issues such as diabetes.

"We don't have a lot of tools available to us," he said. And patients
already wait about one year to see him in his pain clinic at the
Misericordia Hospital in Edmonton or at the HealthPointe Medical Centre.

Most of the patients for whom Knight authorizes legal marijuana use
are those he has seen for several years who arrive one day saying they
shared a toke with a friend and felt pain relief. Such personal
stories are what encouraged Knight to try marijuana for patients in
the first place. At the time, he said he worked at a different
Edmonton hospital pain clinic under a director who prohibited
physicians from prescribing the drug.

"After a while, I said, 'These guys found something that works for
them and what am I doing prescribing medications that are making them
sick and not helping them,' " Knight said. Now, he estimates about 20
of his 100 to 200 patients use medical marijuana. He knows at least
two other pain doctors in Edmonton who are open to it.

When Cartwright, 41 and a mother of four, couldn't find a sympathetic
local physician in 2007, she flew to Ontario and paid $100 to a doctor
known for providing authorizations for medical marijuana. Some doctors
in B.C. now do the authorization via Skype, but charge $400 for the service.

Cartwright's Ontario doctor required proof from a medical specialist
that Cartwright had a diagnosis of colitis with debilitating symptoms
untouched by conventional medical therapies.

"I didn't want to be a doctor hopper," Cartwright said. But she had
tried prednisone, codeine and other steroids that are known to soften
teeth and bones over time.

Nothing but marijuana cut down the inflammation of her intestine that
doubled her over in pain, or stimulated her appetite without causing
subsequent terrors she would have "pucker butt," a notso-funny
sensation right before Cartwright started having diarrhea running down her leg.

In her teens, Cartwright's disease wasted her away to 80 pounds. Now,
the 4-foot-9 hairdresser weighs about 103 pounds and lives in a rented
ranch house in east-central Alberta.

Yet even though she's legally allowed to grow 39 plants in her
basement, and use eight grams of pot each day - she has her pink
authorization forms in plain view - Cartwright still worries about
children's services somehow becoming involved.

She has a toddler at home, who isn't allowed downstairs or in
Cartwright's locked bedroom, where she keeps dried marijuana and a
vaporizer, which grinds the leaves, then fills three to four bags full
of vaporized cannabis rather than the burned, toxic smoke from a joint.

Cartwright's son, who turns two on Dec. 12, once thought mommy was
playing with a balloon machine, so Cartwright hides the vaporizer, and
inhales only when her son is napping or busy watching television in a
separate room. Neighbours and friends don't always understand the subtleties.

"That's my medicine," said Cartwright, president of the southern
Alberta Cannabis Club, which advocates on behalf of medical marijuana users.

"It's no different than using insulin for diabetes."