MDS UNEASY ABOUT PRESCRIBING MARIJUANA

The president of the Yukon Medical Association (YMA) won't soon prescribe
medicinal marijuana, even if federal courts have guaranteed that Health Canada
will be a willing supplier.

Advocates for the ready access to medicinal marijuana aren't pleased either
with the last-minute decision made on July 9.

Dr. Wayne MacNicol is the president of the YMA and an obstetrician-gynecologist
at Whitehorse General Hospital. He has been provided with information from
Health Canada on how he should go about prescribing marijuana to his patients.

Currently medical pot will be available to Canadians already registered under
the marihuana (sic) medical access regulations (MMAR), the Health Canada
"mechanism whereby individuals can obtain authorizations to possess or licenses
to produce marihuana for medical purposes and be exempted from criminal
liability under the Controlled Drugs and Substances Act (CDSA)."

Those who aren't a registered member under the MMAR can apply for membership
while applying for pot.

The MMAR, which came into being July 30, 2001, simply doesn't work, says
Philippe Lucas, founder and director of both the Vancouver Island Compassion
Society (VICS) and Canadians for Safe Access, a lobbying organization dedicated
to defending the rights of sick Canadians to have legitimate access and use of
medicinal marijuana.

According to Lucas, no one has ever gained a safe means to access marijuana
through the MMAR.

After undergoing a lengthy application process, the individual receives a piece
of paper, which enables that person to head down to the nearest street corner,
buy dope from a dealer and not get arrested for it.

It cannot guarantee a safe supply nor does it protect the seller from traffi
cking charges. Lucas finds it strange that the department responsible for the
MMAR, Health Canada's Office of Cannabis Medical Access, hasn't provided any
marijuana.

Since July 9, things haven't improved.

"It's just the illusion of a program," Lucas said from Victoria.

As far as Lucas knows, no one has received pot through the two-month-old
program, including Lucas himself, who is part of the 580 or so Canadians in the
MMAR registry. Lucas ordered marijuana over a month ago and it hasn't arrived.

Lucas uses marijuana for pain, nausea and to stimulate an appetite suppressed
by Hepatitis C, which he was diagnosed with in 1995 after a receiving a tainted
blood transfusion in 1982.

Lucas sees the chronically and critically ill in the VICS downtown Victoria
location, from those affected by glaucoma and fibromyalgia to terminally ill
cancer and HIV/AIDS patients.

MacNicol will hesitate to consider the drug for his similarly affected patients
because he lacks the information he's accustomed to having when he deals with
new drugs. What's missing in the package is the literature known as clinical
practice guidelines - information on dosage, duration and frequency of
treatment, proven cases of the drug's effectiveness and in what situations a
patient might benefit from its use.

The reason clinical practice guidelines were not included is because marijuana
has not been federally approved by the Therapeutic Products Directorate, Health
Canada's federal authority that regulates pharmaceutical drugs and medical
devices for human use.

That means the usual testing that precedes a drug's release onto the market
hasn't been done and the information simply isn't available. The circumstances
that might find cannabis in the hands of sick Canadians was a court-induced
process, not one stemming from the Food and Drugs Act.

The package includes a product information sheet, which contains information
like the approximate THC (tetrahydrocannabinol, the crystalline compound that
is the main active ingredient of cannabis) content of the enclosed marijuana
and proper storage instructions.

Also included is a document entitled "Information for the patient" with
instructions on proper use and warnings against smoking the drug, driving under
its influence and consuming while pregnant.

"This document should not be construed as expressing conclusions from Health
Canada about the appropriate use of marihuana for medical purposes," reads a
section intended for doctors.

"It's political," MacNicol said of the drug decision coming from the courts.
"(It's) very odd that the courts would accept that power."

In that regard, he respects Health Minister Anne McLellan for speaking against
the drug, stating how its positive effects have not been scientifically proven.

"As Minister of Health, my first obligation is to ensure the safety and
efficacy of this product," McLellan said in a statement released July 9 from
the federal government. "Marijuana is not a proven therapeutic product.
Therefore I remain committed to the Government of Canada's medical marijuana
research program, which promotes research on the medical value of marihuana
while taking a compassionate approach to Canadians who suffer from serious
medical conditions."

In contrast, Lucas thinks the courts are the ones worth respecting, while
Health Canada and McLellan are acting in "bad faith".

"The courts have been way ahead of the medical organizations and way ahead of
the politicians," he said.

MacNicol, however, is not alone in his hesitation.

"Our unease over use of medical marijuana has been ignored in this (Health
Canada) policy," Canadian Medical Association president Dana Hanson said in a
statement. Hilary Black, founder of the B.C. Compassion Club Society in
Vancouver, doesn't believe the regulations from Health Canada have made things
any easier for Canadians who desire safe access to marijuana.

The B.C. Compassion Club provides high-quality, low-cost cannabis to 2,500
people across Canada, most of whom live in the Vancouver area.

To gain membership to the registered non-profit organization, individuals bring
a package provided by the club to their family doctor, naturopath or
practitioner of Chinese medicine.

If the doctor supports the patient's desire for medicinal pot, she faxes the
information back to the club and finalizes the registration process.

In some cases, where a doctor is hesitant to approve the application because of
legal reasons, the club might authorize membership anyway, if need for the herb
is evident. VICS operates on the same principles. Among their 330-strong
membership, there are a few American clients.

Neither club has any Yukon members but interested Yukon individuals, who have
the support of their health practitioners, can enroll.

Once registered, members have access to organic cannabis, be that marijuana or
hash, tinctures, mouth-sprays and even baked goods.

Black believes that general practitioners (GPs) across Canada shouldn't have
been granted the role of gatekeepers for Health Canada's Flin Flon, Man.-made
pot.

"It's an incredibly onerous process to get through," Black said in an interview
of the steps patients must take to access marijuana from their family doctors.
"They're required to get a recommendation from their GP and two specialists."

The above regulations apply to individuals with non-terminal conditions, such
as epilepsy or multiple sclerosis. If a patient is dying, a recommendation from
one doctor is sufficient to gain access to the drug.

In Lucas' case, therefore, three of his doctors must sign off on the
application. In Victoria, it takes Lucas eight months to get in to to see one
specialist, his gastroenterologist.

The paperwork provided to Canadian doctors is substantial: a 10-page
application form, said Black.

Black doesn't blame the prescribing doctors resisting the process. "They are
not trained in dealing with herbal medicines," said Black.

According to Black, the problem is that Health Canada has approached marijuana
as a pharmaceutical drug, which it isn't. Similar to St. John's Wort, hailed
for its anti-depressant medicinal qualities, and tobacco, marijuana is a plant.

The Canadian Pharmacists Association (CPhA) has taken a similar stance on
marijuana as Health Canada.

"CPhA agrees with the (Health) Minister that marijuana should be subject to the
same standards as other prescription drugs," Jeff Poston, executive director of
the association, said in a statement.

"We fully appreciate doctors' reluctance to prescribe it without proper
scientific evidence that it provides more benefit than harm ... In the
meantime, we're pleased that it is still available to patients on compassionate
grounds."

Black's vision of the best method to dispense marijuana begins with this
prescription process.

Black and fellow advocates believe that naturopathic doctors should also be
able to authorize a patient's request for pot. The responsibility sitting only
in the hands of family doctors is too limiting, said Black.

In addition, Black disagrees wholeheartedly with the centralized supply Health
Canada has set up in an underground mine in Manitoba.

"I believe that cannabis should be distributed through community non-profit
organizations," said Black. "The supply should be coming from a number of
local, high-quality, organic (farms)."

Finally, Black disagrees with reports stemming from Health Canada and
provincial medical associations that state there is no evidence to support
marijuana's medicinal properties.

"I say that it's simply not true," she said. "There's a plethora of research
and they're simply not looking at it."

Canadians for Safe Access has provided a section on their Web site to deal
specifically with this issue. Included are reports and studies on the efficacy,
safety, importance of high-THC content for safer, improved results and
standards for proper cultivation, use and distribution of marijuana.

VICS is currently involved in joint research projects with the University of
California, San Francisco and the University of British Columbia. In addition,
they will soon be launching a month-long comprehensive study researching the
effects of four different strains of cannabis on relieving chronic pain.

VICS funds their own studies as do most other organizations interested in this
research.

"No one else is handling or dealing with this," said Lucas, who finds Health
Canada's ignorance of the published studies frustrating.

He believes one reason Health Canada and doctors are far from eager to pursue
pot stems from the fact that no high-rolling pharmaceutical company is backing
the herb. "Health Canada is well-aware of the evidence," he said.

He supports this by referring to the latest drug information monograph provided
to physicians, which cites close to 100 studies outlining marijuana 's
benefits.

"There's a real discrepancy between what they're saying and what they know."
Lucas fears Health Canada and the CMA are bending to the rule of their
insurance providers and plain old-fashioned bad facts.

"In a modern liberal democracy, we absolutely cannot have laws that are based
on fear and misinformation," he said. "We have to have laws that are based on
logic, science and reason."

In the meantime, the 580 or so Canadians registered under the MMAR will
continue to fill out the paperwork and attempt to access marijuana as easily as
possible.

"Health Canada ... is really playing catch up to compassion clubs," said Lucas.

For the approximately 5,000 compassion club members across Canada, it appears
there's a better way to go about accessing the relief they so desperately
crave.

Said Lucas: "If Health Canada announced today that they were going to license
compassion clubs, today ... I think that there'd be maybe three days of outcry
(from opponents) and then they'd be swept away."