Open Letter from Dr. Marcia Gillman
The Collège des Médecins du Quebec (CMQ), with its statements issued April 1 regarding medical marijuana (cannabis), insists on disseminating tired old stereotypes and deliberate misinformation which only serves to deter physicians from prescribing to patients who could benefit, as well as stigmatizing medical cannabis users. The CMQ statements fail to provide any basis of truth or reason, nor do they contribute in any meaningful way to the ongoing debate around medical cannabis.
As a palliative care physician specializing in the symptom management of patients living with (and eventually dying from) incurable cancers, I have been prescribing medical cannabis with very good results. In some instances, it has allowed my patients to reduce their need for opioids, thus reducing the potentially serious side effects of narcotic medications. In addition to managing pain, medical marijuana has helped to alleviate other troubling symptoms in my patient population, such as anxiety, insomnia, nausea, and lack of appetite, with the end result often being a reduction in the use of other medications (with their attendant side effects).
Let me examine some of the statements made by Dr. Yves Robert, secretary of the CMQ, in defending its position:
1. “Medical marijuana is not a recognized treatment.” Perhaps not “officially” recognized, but to state that there is no evidence of medical therapeutic benefit is to ignore thousands of published studies over the last few decades (not to mention tens of thousands of compelling anecdotal cases), which have collected a respectable and impressive amount of data attesting to the very promising therapeutic uses as well as highlighting the high safety profile and exceedingly low toxicity of cannabis.
2. “There are no clear indications for medical cannabis.” Wrong. The medical literature (and patient experience) supports an array of indications for a variety of ailments. Spasticity in multiple sclerosis, control of seizures in epilepsy, control of tremor in Parkinson’s disease, pain management in both malignant and chronic non-malignant diseases, chemotherapy-induced nausea and vomiting, appetite stimulation, management of chronic anxiety and post-traumatic stress disorder – to name just a few. The list goes on.
3. “Medical cannabis causes addiction.” This is both misleading and overstated. As suggested by an Institute of Medicine report back in 1999, approximately 9% of general cannabis users may become dependent (as defined by DSM criteria). Compare this to dependency (addiction) risks of 32% for tobacco, 23% for heroin, 17% for cocaine and 15% for alcohol. It strikes me as hypocritical to deny patients easy access to cannabis while tobacco and alcohol are freely available, unquestionably harmful, pose a much greater addiction risk and are of zero medical benefit. The simple truth is that the vast majority of patients can give up their cannabis with no ill effects, other than the return of symptoms for which they were originally taking the drug. Also of note is the fact that medical users are not looking to get high. They would prefer to alleviate their symptoms with a minimum of drug psychoactivity.
4. “The side effects of smoking (marijuana) are still present, just like nicotine and cigarettes.” Once again, the CMQ has not done its homework. Patients need not smoke their cannabis. Other delivery systems are available, such as vaporizing, or ingesting the cannabis extracts in the form of oils, tinctures or edibles.
5. “There are no real scientific data showing safety.” With respect to safety concerns, it’s well supported in the scientific and medical literature that with very few exceptions, cannabis is highly safe and remarkably low in toxicity – much safer, in fact, than aspirin or anti-inflammatories. Apart from those with a history of schizophrenia or unstable heart disease, cannabis can be safely prescribed to the general adult population. There has never been a reported case of death resulting from a lethal overdose of marijuana. I can categorically state that cannabis is without doubt safer and decidedly less toxic than most, if not all, of the medications that I regularly prescribe to my very sick patient population. And yet, the CMQ would have us restrict cannabis prescriptions to a very small, select and specific subset of patients and only as a very last resort (if at all), assuming all else has failed, and even then, with a great deal of caution given the supposedly inherent “dangers” of this plant.
I would very much like to know how the CMQ arrived at its guidelines. Did they bother to consult the many thousands of Canadian patients whose lives have been improved by the use of medical cannabis? Did they bother to avail themselves of the current scientific literature? Did they bother to consult the large data bank of excellent research studies now available? Or did they simply and arbitrarily base their decision on some outdated “Reefer Madness” propaganda?
I am deeply saddened and frustrated on behalf of Quebec patients (as well as Quebec doctors) that the CMQ insists on putting up barriers to a safe, effective and relatively inexpensive medical therapy, despite Canadian court rulings and Health Canada guidelines intended to provide Canadians with easier access to medical cannabis.
In the midst of all the buzz (excuse the pun) surrounding the new “Marihuana for Medical Purposes Regulations” as issued by Health Canada, the CMQ’s stance comes across as deliberately ill-informed and backward-thinking.
Quebec patients deserve better.
Dr. Marcia Gillman
Palliative Care Specialist
April 2, 2014
Montreal, Quebec
An abbreviated version of this letter was posted in the Montreal Gazette on April 4, 2014
