RESERVATIONS VS. RELIEF

Despite Doctors' Misgivings, Medical Marijuana Users Say the Drug
Dulls Their Pain, Boosts Their Appetites and Curtails Their Nausea.;
and As Jodie Sinnema Writes, They're Not Happy About the Trouble They
Had Finding a Doctor to Prescribe It for Them, and the Quality Of
Health Canada's Offerings

Margaret Marceniuk inhales her medical marijuana through a
pharmaceutical puffer and a headshop 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.

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.

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 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 about 80 kilometres west from Edmonton
to Lake Isle, Alta., has never smoked cigarettes and didn't rebel as a
teenager by getting high on pot.

While working as a school teacher, she refused to try medical
marijuana for her constant pain 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 480
patients 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
different 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 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 to 685 in British Columbia and 939 in Ontario.

Marceniuk only smokes her pipe 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 that 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 six per cent. They
suggest variety in strength and plant types is important for patients
with different medical needs.

Growers say leaves at the top of marijuana plants are naturally
stronger than those at the bottom, so THC levels range from about 15
per cent to 22 per cent in marijuana available at most compassion
clubs. Batches may vary, so clubs try to get to know their suppliers,
who can estimate THC levels, since chemical testing is expensive and
prohibitive.

While the government offers only one strain, compassion clubs offer
more so patients can personalize their prescriptions.

Marceniuk took her licence to a West Coast compassion club where a
list of marijuana types is posted on the wall, including Sativa
strains that infuse a person with energy and Indica strains that tend
to make a person sleepy. Then, Marceniuk said, it was up to her to
figure out how much of what kinds she needed, even relying on basic
advice from her sons, now in their late 20s, since she wasn't so naive
as to believe they had never smoked pot.

She still doesn't know how many grams she uses each day, but likely an
amount that falls inside the Health Canada guidelines of one to three
grams of dried marijuana.

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 multiple sclerosis. 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."

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 not inclined to prescribe it.

"We just don't see the important role for it," said Dr. Robin
Fainsinger, a palliative care doctor and medical director for the
Edmonton zone palliative care program. "We have so many other options
for it that are very effective."

Over the last 20 years, Fainsinger has only prescribed the
pharmaceutical pill form of cannabis called Nabilone for five to six
patients. He has never prescribed it in leaf form.

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 to manage chronic pain through physiotherapy,
psychology, anti-depressants, anti-convulsants 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 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.

"Right off the bat, when we're talking about treating a (pain)
patient, we're really starting behind because we really don't have
access to the multi-disciplinary care that the patients really need."

That becomes a problem when Knight does a thorough history and
examination of patients, gathering background documents and ordering
urine tests that reveal they have cocaine in their blood and suffer
from addictions or a mental illness in addition to chronic pain. When
that's the case, Knight generally doesn't prescribe medical marijuana.

"I don't give a rubber stamp to everyone who comes in the door. I like
to get to know them first," said Knight.

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 use medical marijuana.

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 fear she would have "pucker butt," a
not-sofunny sensation right before diarrhea starting running down her
leg.

In her teens, Cartwright's disease wasted her away to 80 pounds. Now,
the four-footnine hairdresser weighs about 103 pounds and lives in a
rented ranch house in eastcentral Alberta.

Yet even though she's legally allowed to grow 39 plants in her
basement, and use eight grams of pot each day Cartwright still worries
about children's services somehow becoming involved. She has a toddler
at home, who isn't allowed downstairs or into Cartwright's locked
bedroom. Inside is a filing cabinet filled with glass jars of 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 tomorrow, 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."

[sidebar]

ABOUT THIS SERIES

Stories in the series are based on electronic data obtained from
Health Canada through the Access to Information Act.

In 2007, the Citizen requested a full list of applications made for
medical marijuana, with the names and addresses of the patients
removed, including medical conditions, application status and the
first three characters of the applicants' postal codes. No personal
information that could identify the applicant was requested.

Health Canada initially cited privacy concerns and refused to release
the records. The Citizen complained to the Information Commissioner of
Canada. After her office launched an investigation, Health Canada
finally agreed to release the data this fall.

The department provided record-level data that showed applications to
the program from 2001 to 2007.

This week, the department also provided a more recent data set that
spans 2007 to October 2011. It contains information that is similar
but not identical to the previously released data. Where possible, the
most recent data have been used in these stories.

YESTERDAY

The data: What the numbers tell us about who uses the drug and how
accessible it is

The politics: Health Canada's proposed changes to the program have
cast a shadow over its future

Today

The patients: Some experts may be skeptical about marijuana's
effectiveness, but patients who use it have no doubts

Tomorrow

The science: What researchers know about the effectiveness and safety
of medicinal marijuana

The dosage: How much patients use, and how they use
it

Tuesday

The military: The contentious issue of using marijuana to treat
post-traumatic stress disorder

Wednesday

The law: Many municipalities say the program is rife with abuse and
it's time to crack down

Online at http://www.Ottawacitizen.com/medicalmarijuana

Exclusive digital content

To find out more about who is using Canada's medical marijuana
program, go online to use our map and database.

Search by medical condition, province, postal code, dosages and doctor
specialty to find out who is using the drug, and why. Also, see a map
showing where licensees live around the country.

NEIL'S STORY

A mother whose son was diagnosed with cancer in his teens and died
last year talks about the family's experience with medical marijuana.
'I think it was important to him because he was choosing a medication,
a type of relief he needed,' says the woman, who asked to remain anonymous.

IAN'S STORY

Ian Layfield found medical marijuana helped control the pain caused by
an accident that crushed his left foot and ankle five years ago.
Today, he has a mail-in marijuana business called MedMe, which
currently serves more than 500 patients.

TERRY'S STORY

Terry Bremner of Halifax used to hide the fact he used marijuana to
dull the pain associated with fibromyalgia. But he thinks it's time to
speak up against the stigma so prevalent on the East Coast against
marijuana that lumps medical patients with recreational users. 'I want
to set an example,' he says.

JANICE'S STORY

Sixty-one-year-old Janice Cyre is a former nurse who turned to
marijuana to deal with severe pain from fibromyalgia. She and her
husband have since turned their marijuana expertise into the only
above board compassion club operating in Alberta.