POOR QUALITY LEGAL POT DRIVES SUFFERERS TO THE STREETS

Compassion Clubs Filling Void As Government-Grown Crops Have Little
Therapeutic Value for Patients

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
cannabutter.

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 school teacher 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. More multiple sclerosis patients are allowed to
use medical marijuana than any other patient group in Alberta. They
make up 29 per cent of those with government approval. The next
highest group, at 13 per cent of the total, consists of those with
severe arthritis.

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 on 13 different
medications, including one conventional pain killer. 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 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."

Or 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 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
many 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 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. The topic hasn't been revisited since, but
the letters describe the Health Canada 2001 regulations as
unacceptable because they place doctors in an untenable situation. If
patients receive a prescription, then experience dangerous side
effects, can the physicians be held liable?

Palliative doctors, who may be more likely to consider medical
marijuana as a final option to reduce pain in the last weeks of life,
also are advised against prescribing pot.

Cartwright said she isn't looking to get "blazed" or high from
marijuana with lots of THC. Instead, she wants her plants to have high
levels of cannabidiol or CBD, another cannabinoid she said focuses on
pain relief.

But Cartwright, who smoked pot quite regularly through her 20s and
30s, admits she's gone to the streets to sometimes fill her legal
prescription when none of her plants were in the flowering stage. She
doesn't like it, but she's also learned the hard way that patients
aren't allowed to share their stash, even if they have an unexpected
bumper crop.

In August, Cartwright pleaded guilty to trafficking after she mailed a
friend four grams of homegrown marijuana in thanks for a jar of
hemp-based ointment.

She said she had no intent to make money or commit a crime, but viewed
it as if she had sent a bottle of wine or bouquet of flowers as a thank-you.

Cartwright quit drinking when she was 35, but her six-month
conditional sentence prohibits her from drinking alcohol or using
intoxicants, except her daily eight grams.

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