PERSONALIZING PRESCRIPTIONS

Most People in the Program Are Allowed to Use Five Grams a Day, But
the Amount Can Soar Depending on Their Needs, Writes Jodie Sinnema

Ian Layfield met a man at this year's medical marijuana conference in
Toronto who was waving around his federal licence to show people he
could legally use 150 grams of pot a day.

He seemed quite proud of the fact, Layfield remembered.

It seemed obvious the man had many chronic ailments that left him in
poor health. Even so, Layfield, who is legally allowed to use nine
grams of medical marijuana a day to fight pain from severe arthritis,
remained skeptical.

"I think the 150 was a (public relations) stunt, that anything over 60
grams a day would be a waste," Layfield said from Victoria, where he
runs a mail-order marijuana company called MedMe. "I don't even know
how you could afford that" - especially given that many people in need
of marijuana for medical purposes are on disability pensions for
severe pain associated with HIV, arthritis, spinal cord injuries or
diseases, cancer or epilepsy.

At $5 a gram from the government's marijuana supply, or $8 to $10 a
gram at compassion clubs, the man would need $750, $1,200 or $1,500 a
day for his weed supply. And that didn't sound possible to Layfield.

He believes one patient could use a maximum of 50 grams a day, then
would likely sell the rest on the black market to generate income.

Health Canada suggests most people use a daily amount of one to three
grams, whether it is inhaled or consumed in brownies, capsules, oils
or other baked goods. Between 2001 and 2007, only 777 medical
marijuana users used between one and three grams daily out of 3,891
users registered with Health Canada.

Most - 1,609 people, or 41 per cent - were granted a licence to use
five grams a day (there was no dosage data for 938 people). One
Kelowna, B.C., man received approval to use 56 grams a day for
multiple conditions related to spinal cord disease and injury.

Given that the government estimates one joint contains 0.5 to one gram
of pot, 56 grams seems like a lot of puffing. But David May, head of
security at the Medical Compassion Clinic in downtown Toronto, said
some patients may need that amount of marijuana because they are
converting it from the dried leaf form into caplets or oils, which
they are better able to ingest.

Janice Cyre, 61, has fibromyalgia and lives on a farm outside
Edmonton. She can legally use 22 grams of marijuana each day. But
she's only allowed to inhale or vaporize three grams a day - the
immediate benefits felt through the blood stream can be offset for
those with lung problems - and then can get one gram in a homemade
cream she applies to her hip and shoulder when the pain is extreme.

The last 18 grams she steeps in tea, making six cups of three grams
each. That, she explains, reduces the level of Delta 9 THC in the pot
- - a cannabinoid that bursts when it's heated in a joint, bringing the
typical high and euphoria - and gives her better access to the
anti-inflammatories and other cannabinoids.

People with HIV, AIDS, hepatitis C and lung cancer can't smoke joints
or pipes because the plant matter burns their lungs, May said. They
may place their dried marijuana into machines that spin and tumble the
leaves and buds and allow the trichome crystals on the plant to fall
into a glass underneath. The crystals hold much of the
Tetrahydrocannabinol or THC, the main active substance in cannabis.
The crystals can then be ingested in capsule form.

But May said 10 to 14 grams of dried marijuana is needed to make one
edible capsule, which can supply pain relief for a long time. So
someone eligible to use 56 grams of pot each day might be using it to
make five or six capsules.

"A lot of people who cannot smoke anymore will only use the
trichomes," May said. "They won't even use the plant anymore and
that's why their numbers (per daily dosage) are so high."

Approximately 28 grams of pot are needed to make one gram of oil, May
said. That can be used for baking. One pinhead of oil - equivalent to
one joint, May said - can be spread on rolling paper or dabbed onto a
metal pad in a pipe.

"It's pure. It's a lot cleaner and it works better," he said. "A lot
of people are getting away from smoking because smoking is bad and
everybody knows it, so everybody is trying to move into different ways
of consuming it without hurting themselves."

But that also puts compassion clubs in a pickle. While individual
users are allowed to convert dried leaves into other forms of
medication for themselves, Canadian law makes it illegal for them to
sell the capsules or oils. Edmonton's compassion club sells only dried
leaves and usually only one or two different strains at a time.

Others, such as the B.C. Compassion Club Society in Vancouver - the
oldest and largest in Canada - sell half cups of butter or jars of
cannabis-infused pesto for $15. Olive oils, baked gingersnap cookies -
three for $7 - and alcohol tinctures or drops for under the tongue or
in tea are available, as well as dozens of leaf strains.

May said most people don't have the chemistry expertise or the money
to convert their marijuana leaves into other forms. Machines such as
vaporizers, which convert the buds into vapours rather than smoke,
cost between $200 and $1,000.

"That's why compassion clinics exist now to teach people how to learn
it better, do it healthier".

Yet Isaac Oommen, communications co-ordinator for the B.C. Compassion
Club, said his club sells a maximum of 15 grams of marijuana a day to
each patient.

Dr. Brian Knight is an anesthetist and pain physician in Edmonton. The
highest daily dosage he has prescribed is 10 grams a day, though he
usually begins at two grams.

People in the industry agree: patients should start with small doses,
and if they are ingesting rather than inhaling, they need to give
themselves more time to feel the effects.

In the end, prescriptions have to be personalized: someone with
chronic epileptic seizures may need 56 grams of marijuana a day to
keep control of their body.

"I've seen this do miracles for people," May said. "I've seen people
come off crack cocaine. I've seen people with Tourette syndrome that
were totally dysfunctional, totally functional now. They actually want
to go to university."

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PROS AND CONS OF MEDICAL MARIJUANA

Pros

- -- May offer pain relief to people suffering from chronic neuropathic
pain - pain caused by accidental or surgical injury to nerves

- -- Effective for HIV-related pain and an appetite stimulant for people
living with AIDS

- -- May provide relief for muscle spasms due to multiple
sclerosis

- -- May reduce opioid dose in treatment of chronic, non-cancer
pain

- -- Cannabis smoking by itself does not appear to be major risk factor
for head, neck or lung cancer

- -- Can improve mood and sleep in patients with chronic
pain

Cons

- -- Can cause drowsiness, dry mouth, headache; can impair psychomotor
skills

- -- Increased risk of heart attack within one hour of
use

- -- May trigger psychosis in those who are vulnerable due to personal
or family history

- -- Can cause changes in lung tissue with long-term use that may lead
to cancer

- -- Possible increased risk of cardiovascular disease

- -- Little known about long-term safety concerns

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