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Thursday, December 14, 2017

Physicians Balking at Prescribing Unresearched Medical Marijuana

"One thing that was quite consistent was adverse events. And the benefits, even if they're real, are much smaller than what people might anticipate."
"I think this gives [doctors] some comfort, saying, 'Look, here's the evidence. It's actually missing in a lot of places, so I can't give it for conditions X, Y and Z'."
"Some of the pain studies go for nothing more ... than five, six hours. And this is for chronic pain."
"It's hard to get a great feel for how someone is going to do long term on a medicine after five, six hours." 
"We would kind of be putting the cart before the horse if we started to prescribe this without the research."
Dr. Mike Allan, professor of family medicine, University of Alberta, Edmonton
Medical marijuana is shown in Toronto on Nov. 5, 2017.   Graeme Roy/THE CANADIAN PRESS
 The Alberta College of Family Physicians edits and distributes 'advisories' which are distributed to over 32,000 clinicians, bringing them up to date on the scientific literature, or in the case of medical marijuana, lack of any such scientific literature attesting to its usefulness, efficacy, and dependability as a drug protocol to ease peoples' pain and discomfort brought on by certain medical conditions. Since a shortage of -- virtually none in fact -- of such research supporting the proposed benefits of medical cannabis exists, there is evidence contrary to popular belief that the use of marijuana as a medical drug may end up being more harmful than useful.

And precisely this, is what family doctors' associations across Canada are now advising their professional members to ensure that they are in receipt of real data, not theoretically-wished-for information, before they think about prescribing the drug, surrendering to their patients' uninformed emphasis on the good using it will purportedly do them. "Tools for Practice" is what the Alberta College publishes as biweekly updates focusing on topical issues, circulated through professional chapters in every province with the exception of Quebec, and Newfoundland and Labrador.

Physicians had indicated they needed professional guidance in the prescribing of medical marijuana. And this need to provide them with what they're concerned with inspired the three most recent updates. The reality is that family doctors are increasingly under pressure from their patients wanting more information about the usefulness and availability of medicinal pot. Searching out reputable and reliable research seemed the best way to go. And after having reviewed all available literature on the subject, Dr. Allan is convinced that medical marijuana represents a high-risk product useful only in specific circumstances and only then where other, safe treatment options have been exhausted.

The number of clients registered with Health Canada for licensed medical marijuana products leaped forward as of June 2017 to over 200,000 individuals, representing a 2.7 increase over the 75,166 people registered last year. A consistent tripling of registrations has occurred in both 2015 and 2016 as Canada moves closer to the legalization of social marijuana use. "The decision to use cannabis for medical purposes is one that is made between patients and their health-care practitioners, and does not involve Health Canada", advised department spokeswoman Tammy Jarbeau.

A document updated in 2013 was published by Health Canada as an information bulletin for the use of medical professionals as a guide to the benefits and harms of medical marijuana. Within the bulletin is a disclaimer that cannabis is not to be considered an approved therapeutic product and Health Canada does not endorse its use. As for the first advisory prepared by Alberta's family physicians college released on November 14, it reports that evidence is "too sparse and poor" to reach any conclusion that marijuana has proven effective in relieving pain.

Two weeks on, a second advisory was circulated which describes  "adverse effects", representing one of the only consistent findings through the existing studies being perused. Those adverse effects included hallucinations, paranoia, dizziness and low-blood pressure. Most studies, it pointed out, involve patients with a history of using cannabis, thus are unlikelier to experience the negative side effects that the average person would experience. Taking that under consideration, it is assumed that research probably underestimates the frequency of adverse outcomes.

Other studies conclude that marijuana use can reduce chemotherapy patients' nausea, and can as well control spastic muscle contractions in patients with multiple sclerosis. No evidence exists, however that there is any positive effect on chronic anxiety or on glaucoma, despite these two conditions often being cited by advocates of the industry. The result is that documents released by both colleges of physicians and surgeons in British Columbia and Alberta emphasize the absence of reliable studies giving evidence of any effectiveness of cannabis as a trustworthy medication.
"I'd be the last person to suggest that cannabis was entirely safe or entirely appropriate for every individual."
"[But the college's apparent bias in highlighting the harms and bypassing the benefits is concerning]."
Philippe Lucas, head, Canadian Medical Cannabis Council
An employee inspects buds at the Tweed plant in Smiths Falls, one of Canada's largest suppliers of medical marijuana. The number of patients signed up with Tweed and other suppliers has tripled in the last year. LARS HAGBERG / AFP/Getty Images

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