The need for weed

Legal medical marijuana isn’t the miracle fix many chronic-pain sufferers hope it will be  —  I know this from experience.

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medicinal marijuana weed

Illustrations, Shutterstock.

I’m sitting in Dr. B.’s waiting room, bouncing my knee to a jazzy rendition of the Simpsons theme, when a young, anxious-looking man bursts through the clinic door. “I need some weed,” he announces. I wait for the receptionist to usher him out, but instead, she smiles. That’s just the warm, friendly atmosphere you can expect at this Toronto medical-marijuana clinic — which makes it a refreshing change from the inside of my dealer’s car. (I’ve decided not to reveal my identity, or the identity of the doctor or the clinic, in order to protect my confidential relationship with them.)

It’s been 10 years since I was diagnosed with multiple epiphyseal dysplasia, a rare genetic disorder that causes irregular bone and cartilage development and eventually leads to osteoarthritis. At 19, I had to quit my retail job because I couldn’t stand for longer than two hours. I missed out on parties and movie nights to stay home on the couch with a heating pad over my hips. In 2010, when I was 22, I was told I needed a double hip replacement. The surgery gave me some relief but also introduced new problems: During recovery, I experienced a small fracture in my right hip, which meant my legs became different lengths. I felt pain and stiffness almost every day but had a hard time tolerating standard pain meds. Anti-inflammatory pills gave me stomach aches; opiates made me fuzzy. I developed a tolerance for codeine, and only high doses of fast-acting morphine gave me any relief at all — but they also made me feel like an extra from The Walking Dead.

There was one thing, however, I knew I could do to get instant relief. When I was in university, my older brother, who also had his hips replaced at a young age, told me that smoking marijuana helped his pain. I already smoked recreationally (remember, I was in university), but after I weaned myself off all the post-surgery pain meds, I noticed that the first joint I smoked relieved some of the stiffness in my hips. I started Googling and found that plenty of people with joint pain smoked medicinal marijuana, including those with osteoarthritis. I wondered: If my symptoms improved this much from using weed recreationally, how much better wouldI feel if I used it medicinally? And how much easier — and less sketchy — would it be to get prescription pot from a licensed MD than to buy drugs on the street?

Until recently, Health Canada was responsible for the distribution of marijuana and required medical-marijuana users to carry a licence. But under the federal government’s new Marihuana for Medical Purposes Regulations, which went into effect in March 2014, doctors are now responsible for prescribing the drug. After they get a prescription, patients purchase their medicine from one of 16 producers across the country licensed by Health Canada (most of whom are entrepreneurs with no ties to the medical or pharmaceutical industry).

Roughly 40,000 Canadians had medical-marijuana licences around the time the new rules were established — but that number is expected to rise to nearly 400,000 within a decade. In Vancouver, to help meet increasing demand, around 60 dispensaries have popped up, some even offering free samples to customers carrying a prescription. In May 2014, Chuck Varabioff, director of a dispensary called B.C. Pain Society, installed the country’s first medical-marijuana vending machine in his storefront. It was, unsurprisingly, very popular: As of January, the vending machine had grossed more than a million dollars. (Though dispensaries are illegal, police say raiding them isn’t a top priority when people are selling hard drugs on the street.)

My path to a pot prescription started with a visit to my family doctor. When I approached her about getting a referral to a medical-marijuana clinic, she was hesitant. Despite the loosening regulations around medicinal marijuana, Health Canada has not actually approved it for sale as a therapeutic drug, which means there are no official guidelines for dosage and administration.

“The College of Physicians and Surgeons of Ontario doesn’t endorse it,” my doctor told me. In fact, under the current CPSO guidelines, doctors have the right to refuse to prescribe marijuana.

marijuana medical bagWhile medical-marijuana advocates tout the herb’s benefit for everything from fibromyalgia to inflammatory bowel disease and mood disorders like anxiety and depression, their claims are often based on short-term trials that aren’t rigorous enough to qualify as compelling evidence. Medical treatments typically go through many trials and take place over years, rather than weeks or months. As Dr. Anita Srivastava, an assistant professor of family and community medicine at the University of Toronto, puts it, “Most of the research hasn’t met the burden of proof to be considered a suitable treatment.”

That’s not to say there isn’t any credible research out there. A 2014 study of 1,500 Australians found that patients with non-cancer-related chronic pain, such as mig­raines and arthritis, reported that marijuana eased their symptoms better than opioid medications like morphine and oxycodone. And as many as two-thirds of Canadians with medical-marijuana prescriptions maintain that it’s an effective way to manage arthritis pain, which might be why, last September, the Arthritis Society of Canada published a statement calling for more research.

Last year, though, the Canadian Medical Association (CMA) released a statement of its own, declaring that it “will not throw its support behind medical use of the drug until numerous questions about safety, efficacy, dosage and delivery have been answered.” As Srivastava explains, “There are harmful effects [of marijuana use], including increased heart rate, dizziness and psychoactive effects like cognitive alterations and dependence.” But funding to explore those effects and the CMA’s questions is hard to come by, because of the lack of support from the medical community.

Even with a legitimate medical condition, it’s not easy to obtain a prescription through a clinic. My first appointment was exhaustive: I had to do a urine test (to see if I was on any other recreational drugs), go through an hour-long, highly intimate questionnaire with a nurse and then see the doctor for a physical examination. Finally, he prescribed me 1 g of marijuana per day.

What came next was a little surreal. The nurse handed me off to Timothy, an affable medical-marijuana consultant who acts as a broker between clinics and licensed producers (LPs). He showed me how to use the website for CanniMed, one of the country’s 16 LPs, and made recommendations for different varieties — known as strains — based on their ratios of the chemicals THC and CBD. (While THC provides the familiar high of marijuana, CBD is the unsung hero of the plant, containing anti-inflammatory properties that can significantly reduce joint pain.)

Surprisingly, each of the LPs seems to have carved out its own identity. CanniMed, for example, has a clinical website and discreet, vitamin-bottle-like packaging; it seems aimed at the reluctant smoker. On the other hand, Tweed (one of the most popular LPs) has a lively, interactive website and playfully named strains like Bogart and High Lands — I think we can assume it’s geared toward the hipster with a licence to smoke. I gravitated toward Tweed, which Timothy deemed one of the best for quality, and maybe that’s why we discovered it was too busy with orders to take on new clients. So CanniMed it was.

It took a week for CanniMed to confirm my registration, and then I placed an order for a 30-day supply. Three days later, a notice appeared on my door: My medicine was waiting for me at the mail depot. My dad drove me to the warehouse, where I finally got my hands on my first delivery, packaged in a bulky sealed envelope. He was unimpressed. I may have come by my stash honestly, but my dad wasn’t thrilled about driving around the city with 30 g of weed under his passenger seat.

medical marijuana

I was more concerned about the price. The whole process is not cheap: Enrolment in the clinic’s “patient-monitoring program” cost me $200, and a 30-day supply of weed ran upwards of $400. Four months in, I’d spent more than $1,000 on medical marijuana, not including shipping fees and a $150 vaporizer. (The clinic made me sign an agreement that I wouldn’t smoke the drugs I was prescribed, because smoking is harmful to your lungs.) It felt like a lot of cash for pain relief, especially considering that, under my drug plan, I paid only $6 for three months’ worth of Tylenol 3.

The new regulations may have improved access, but they also deregulated pricing. Before last year’s changes, Health Canada priced marijuana at an eminently reasonable $5 a gram. Today, LPs pretty much charge whatever they want, up to $14 a gram. (Opting for the unregulated route — which is to say the street — usually means shelling out $10 a gram.) Patients who were able to pay for their medicine last year suddenly found themselves unable to afford it. Dana Larsen, a marijuana advocate and owner of a Vancouver dispensary, blames Health Canada. “It should really only cost up to $2 a gram,” he says. “There wouldn’t be a need for dispensaries like mine if the government ensured quality access at a good price.”

Experts say the future of medical marijuana depends largely on whether the drug is decriminalized. If that happens (and it might if Justin Trudeau is elected, since he has said that “going the road of legalization is actually a responsible thing to look at”), the profits would be enormous: The medical-marijuana industry is already predicted to gross over $1.3 billion by 2024. Canada’s current licensed producers are poised to take over the marijuana industry the way cigarette companies have capitalized on smokers. That would mean a larger market and more choice for medical-marijuana users.

Economics aside, if medical marijuana is ever going to be perceived as a legitimate, clinically therapeutic drug, it needs a serious image overhaul. “The THC concentrations of medical marijuana are now much higher than [in the strains] you get on the street, which is up to 12 percent,” Srivastava explains. Some strains go up to 22 percent THC, making them far more potent and more likely to lead to dependence. “The producers are marketing it problematically, with names like Green Crack and Amnesia. They’re promoting the psychoactive properties over the medicinal properties.”

As for efficacy, the first time I packed some medical marijuana into a vaporizer and inhaled, I immediately noticed a difference from the stuff my dealer gave me. The taste was much cleaner and the high affected my body more than my mind — I exhaled, and my whole body, from my shoulders to my ankles, felt relaxed. Also, thanks to my vaporizer and the official prescription card I received with my first order, for the first time I felt comfortable vaping inside my tiny apartment. I wasn’t worried about what the neighbours might think.

Three months after my first visit, I went back to the medical clinic for my second appointment to discuss how the marijuana was affecting my pain. The truth was I hadn’t taken a single painkiller since receiving my first 30-g shipment, even after falling on my hip one night. Still, the costs were so high that I debated whether the relief was really worth the investment.

I mentioned this to Timothy when I saw him at the end of my appointment, and he was shocked to hear how high the expenses had been. He checked the Tweed website, where most strains cost between $6 and $9, and found it was now accepting new patients; he then recommended I try mixing three strains for better (and bespoke!) pain relief. My first order, which set me back only $250, arrived last week. At the end of the day, I’m paying about the same as I was for the illegal stuff, but I’m not breaking the law, and I haven’t had to refill my Tylenol 3 prescription for months. But until there is real political will to make therapeutic marijuana truly accessible, the stigma, secrecy and out-of-pocket expense seem like a hefty price to pay for the chance to enjoy a pain-free day.

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