The New Wonder Drug?
Since 2001, medical cannabis has been available via doctor’s prescription to treat a variety of symptoms including pain, nausea and lack of appetite associated with conditions such as cancer, AIDS and multiple sclerosis. With the legalization of cannabis for recreational use in Canada in 2018, the substance and its therapeutic effects have seen an explosion of interest, information and scrutiny. Here’s what you need to know.
stories by Marc Huminilowycz
photography by Jessica Crandlemire
In 2013, within one year of retiring from her job at Saunders Book Company, lifetime Collingwood resident Deborah Redman was diagnosed with breast cancer. Following surgery, her oncologist decided that further treatment was not required, and Redman carried on enjoying her life of retirement.
But four years later, Redman began noticing unusual sensations in her ribs, and learned the disturbing news that her cancer had metastasized into her ribs and spine. After consultation with her oncologist, Redman decided to treat her cancer with minimal doses of chemotherapy (in pill form) and seek out complementary alternative treatments to help strengthen her immune system and relieve her pain.
For 15 years, I never slept. Now, I get at least eight hours of sleep every night. Is it possible that sleep is helping my body to heal? I’m feeling really good now. There’s never any pain.
Deborah Redman
“I chose to see a local naturopathic clinic, Be Well Collingwood, to help support my body during my cancer treatment,” says a fit and vibrant-looking Redman. “I have been seeing this clinic regularly to receive a combination of intravenous vitamin C, and I’m taking herbal supplements – primarily mistletoe.”
Redman had heard about the benefits of medical cannabis after her initial breast cancer diagnosis and decided to pursue this treatment option to help her deal with pain. She has been seeing local physician Linda Morel, who practices out of the Mind, Body, Spirit Connection medical cannabis clinic in Collingwood.
“Dr. Morel evaluated my specific cancer and prescribed a combination of CBD oil during the day and a CBD/THC oil blend at nighttime to alleviate my pain and help me sleep better,” says Redman. “I see Dr. Morel for follow-ups every six months, and my dosage is adjusted according to my needs. She sends my prescription to a licensed cannabis supplier, and it’s delivered to my door by courier within days.”
THC (tetrahydrocannabinol) and CBD (cannabidiol) are the primary compounds of cannabis. While THC can affect how users think, act and feel – sometimes making them intoxicated or ‘high’ – CBD is used to lessen pain and other symptoms without the psychoactive effects.
Redman says she had never tried cannabis before her cancer diagnosis. “My kids think it’s funny that I was never into pot, and now I’m a regular user,” she jokes. Asked how her cannabis treatment is going, Redman replies, “For 15 years, I never slept. Now, I get at least eight hours of sleep every night. Is it possible that sleep is helping my body to heal? I’m feeling really good now. There’s never any pain. I just feel a bit more tired because of the chemo. I know it’s not proven, but I really think that cannabis is helping my cancer. My last four CT scans have come back stable.”
Redman’s cannabis physician, Dr. Linda Morel, had been practicing family medicine for more than 40 years until four years ago, when she was approached by Canadian Cannabis Clinics, a licensed provider of medical cannabis and education, to assess local patients and, if warranted, prescribe medical cannabis to treat their symptoms.
“Patients are either referred to me by another physician, or they self-refer,” says Morel, “I will assess them to determine whether or not cannabis treatment will be appropriate for them or if there may be any contraindications. If appropriate, I will write a prescription, usually for a combination of CBD and THC. The patient will see one of our counsellors, who will answer their questions about the product and provide them with guidance on where they can purchase it. They come back to see me for a follow-up three to six months later.”
At her clinic, Morel prescribes medical cannabis for a variety of ailments to patients of all ages. “I treat people with epilepsy, chronic pain, migraines, Parkinson’s, IBS [Irritable Bowel Syndrome], and cancer patients undergoing chemotherapy or radiation. It’s effective, it improves their quality of life, and is an alternative to opioids, which I believe can make them sicker,” she says. “People need to understand that cannabis really does help pain, which can in turn improve a person’s behaviour.”
To reinforce her case for medical cannabis, Morel cites the use of CBD in the successful treatment of Dravet syndrome, a type of epilepsy in very young children characterized by daily seizures, often triggered by hot temperatures or fever. It has traditionally been treated with anticonvulsant medications. According to Dr. Morel, CBD treatment was shown in a recent pharmaceutical study to be effective in reducing the number and frequency of seizures.
Beyond the treatment of pain, seizures, sleep disorders, lack of appetite and side-effects of cancer treatment, cannabis is also showing promise in the treatment of cancer itself, says Morel. While she cautions that the substance is not a cure for the disease, and that more research is needed to study its efficacy, she notes a growing body of evidence, including the work of the Laboratory of Cancer Biology and Cannabis Research at the Israeli Institute of Technology, headed by Dr. David Meiri, which is finding that cannabinoids may boost the body’s immune response against the growth and spread of tumors.
Gloria Andrews, a patient of Morel’s who lives in Thornbury, was diagnosed with stage four ovarian cancer in 2016. Following surgery, she has been on several rounds of chemotherapy. “I was dealing with the typical side-effects of chemo: nausea and joint pain in my knees, ankles and hands. It kills everything,” she says. “I’ve never had a problem with THC, so I started looking into medical cannabis with the help of Dr. Morel.”
Under Morel’s care, Andrews is taking a combination of CBD in the daytime and THC at night, and says cannabis gives her complete relief from her nausea and pain. “I can honestly say that I feel better taking cannabis, and my quality of life has improved immensely,” she says. “At one point, I travelled to Australia for a week and a half without my cannabis meds. My left hand had swollen up and the pain in my knees and ankles got unbearable. When I returned, I started taking cannabis again. One week later, my symptoms were gone.”
People need to understand that cannabis really does help pain, which can in turn improve a person’s behaviour. It’s effective, it improves their quality of life, and is an alternative to opioids.
Dr. Linda Morel
At the age of two-and-a-half, Wasaga Beach resident Parker Clost was diagnosed with autism. When he turned 13, he began to experience seizures. As the seizures increased in intensity over the subsequent years, Parker became increasingly frustrated and began to injure himself.
Looking for an alternative to his son’s conventional seizure medication, Parker’s father, Rob Clost, decided to research medical cannabis. “I’m not one to jump into things, and I never gave much thought to cannabis as a treatment for autism, but I decided to learn more about the substance and the cannabinoid system in all of us,” he says.
After educating himself about cannabis, Clost and his spouse consulted with Dr. Morel about the issues his family was facing coping with their son’s illness. She prescribed CBD and THCA (the non-psychoactive form of THC) during the day, and a combination of CBD and THC (for its calming effect) at night and on “tough” days.
“It’ been about two years now, and this combination of cannabis has regulated Parker’s temperament,” says Clost. “Before, he would get frustrated and injure himself, and he would have frequent seizures. To make matters worse, his meds came with a lot of side effects. Now he’s much calmer, his outbreaks are less frequent, and he sleeps better. It takes the edge off and brings him back to a normal day, while allowing him to still function normally. And his seizures are much less intense.”
While he acknowledges that prescribing medical cannabis is not an exact science, Clost has seen a dramatic improvement in his son’s well-being, with more “even” behaviour. “You start slow and let it grow,” he says, adding that treatment with cannabis has resulted in Parker’s prescription seizure medication being reduced by 25 per cent.
CBD or Not CBD
The dangers of buying over-the-counter CBD
Not all product labelled as CBD is the same, cautions Dr. Linda Morel. “You shouldn’t buy CBD over the counter,” she says. “The quality control just isn’t there. About 70 per cent of these products don’t contain the quantity of CBD listed on their labels.”
Morel’s warning is supported by a recent CNN special investigation, “Weed 5,” in which Dr. Sanjay Gupta, a respected American neurosurgeon and medical reporter, states, “It is really discouraging to see the results of a recent study in the medical journal JAMA, where researchers analyzed 84 CBD products from 31 companies and found that 69 per cent were mislabeled. Some of the products had no CBD at all, some had too much CBD, some too much THC. Other studies showed that some CBD products contained dangerous synthetics that have been responsible for outbreaks of illness all over the country.”
Like Morel, Gupta advises that this is just one of many reasons why people should not self-medicate using over-the-counter CBD. Instead, they should see a licensed practitioner and purchase only regulated and licensed product.
“Medical cannabis has been legal since 2001, but then everything changed in 2014, when the government stepped back and gave doctors sole discretion on how to prescribe it; there was a need to quickly educate physicians on the topic,” says Michael Boivin, a clinical pharmacist consultant and owner of CommPharm Consulting in Barrie. In addition to other pharmaceutical topics, Boivin educates health professionals on the subject of medical cannabis.
According to Boivin, the evidence for the benefits of cannabis is strongest for chronic pain, multiple sclerosis (MS), epilepsy in children and the side-effects of chemotherapy. “People use it for pain, sleep and stress anxiety,” he says, noting that people in pain tend to have sleep problems and anxiety.
Boivin calls medical cannabis a “polarizing issue,” but notes, “My goal as a cannabis educator is not to sway anybody. I tell physicians what we know and what we don’t know about it. Cannabis is not a first-line treatment. It doesn’t cure diseases; it helps symptoms. Rather than replacing other medications, cannabis adds to them. Some people do well with cannabis, some don’t. Because cannabis can interact with other medications, it’s important for people to seek professional help.
Since my teens, I have run the gamut of anti-depressant medication, a
Richard Gillman
never-ending cycle of side-effects, more pills, and more conditions. My regular use of medical cannabis has resulted in a remarkable transformation in my life.
Southern Georgian Bay resident Richard Gillman, a cannabis consultant and trainer with CanCann Consulting, works as a counsellor with Dr. Linda Morel at the Mind, Body, Spirit Connection clinic in Collingwood, which he founded. Gillman is also a medical cannabis patient, using the substance to help with his depression, anxiety, and post-traumatic stress disorder (PTSD) for the past three years.
“Since my teens, I have run the gamut of anti-depressant medication, a never-ending cycle of side-effects, more pills, and more conditions,” says Gillman, who is currently taking CBD during the day for pain and anxiety, and THC before bed to help him sleep.
“My regular use of medical cannabis has resulted in a remarkable transformation in my life. With my depression and anxiety, getting out of bed and going out the door used to be difficult for me, and I often felt like my insides were going to burst. Mental health issues can overwhelm the mind. Taking cannabis has helped me to cope and enjoy life, without zombifying me. It’s like a shield or a buffer that allows me to step back and gain emotional strength. I’m a better person, a better father and a better husband. Much like a state of remission or insulin for a diabetic, I look at using medical cannabis as a life-long commitment.”
While Gillman and other medical cannabis patients swear by its effectiveness for their mental health issues, the medical community in general is, for the most part, hesitant to condone its use for this purpose. Dr. Kathleen Askland is a psychiatrist at the Outpatient Assessment and Treatment Services of the Waypoint Centre for Mental Health Care, a large, 302-bed psychiatric care centre in Penetanguishene that provides a range of acute and longer-term psychiatric inpatient and outpatient services to Simcoe County, Muskoka, part of Dufferin County and the southern portion of Parry Sound.
“I can honestly say that I feel better taking cannabis, and my quality of life has improved immensely.”
Gloria Andrews
“Having perused the literature and the studies on medical cannabis, I don’t recommend it or prescribe it for psychiatric conditions,” says Askland. She cites several reasons for her decision:
- Cannabis is not an approved, effective or safe treatment for any psychiatric disorder or psychiatric symptom;
- It has not undergone the requisite trials and, unlike approved drugs, does not have a DIN (Drug Identification Number) from Health Canada;
- The evidence of its use and effectiveness is not sufficient – the number of studies supporting its use for mental issues is small;
- There are no documents or reference materials regarding dosage, side-effects or drug interactions;
- The evidence for its potential to cause harm is much more robust than any evidence for its effectiveness in treating psychiatric symptoms or conditions.
“The results of a few studies suggesting positive effects of medical cannabis on mental health have been publicized a lot lately,” she notes. “Cannabis is something of great interest to the public. Patients who either have experience with it or read about it, want it. It’s a bit like the Wild West right now.”
Asked to comment on physicians who are currently prescribing medical cannabis, Askland notes that the federal government has created a mechanism for doctors to prescribe it; however, the major regulatory bodies, such as the Canadian Medical Association, are distancing themselves from medical cannabis, and they don’t currently endorse it.
“I personally don’t prescribe the substance because there is a substantial number of long-term studies of its deleterious effects on anxiety, depression and schizophrenia,” says Askland. “Given the comparative data, there appears to be evidence that cannabis can exacerbate existing psychiatric conditions and promote others.”
I personally don’t prescribe the substance because there is a substantial number of long-term studies of its deleterious effects on anxiety, depression and schizophrenia. There appears to be evidence that cannabis can exacerbate existing psychiatric conditions and promote others.
Dr. Kathleen Askland
Given Askland’s views on medical cannabis and mental health, Dr. Linda Morel, who does prescribe it to patients, was asked to respond. “The first thing that came to mind is that Dr. Askland is addressing people who self-medicate primarily with THC. She is correct that THC can aggravate mental health issues such as anxiety and, if someone has a predisposition to schizophrenia, this can hasten its appearance. That said, research in the Netherlands has been using CBD to mitigate symptoms of schizophrenia.”
Morel continues, “At our clinic, we are very careful in assessing patients relative to their potential for side effects, look at interactions between existing medication and cannabis, and prescribe appropriately for their problems. We rely heavily on CBD. It increases serotonin naturally, which makes it very good for anxiety and depression. CBD also mitigates the negative effects of THC.
“Among medications used as a first-line treatment for your illness, opiates are not a good option. Most patients come to the clinic wanting to get off of them or not take them. They do not work, are more likely to cause addiction than the cannabis we prescribe and have the potential of making pain increase (hyperaesthesia).”
Morel adds that many doctors are still unaware of the medical benefits of cannabis. “I practiced general medicine for over 40 years, but I was never taught about our endocannabinoid system in medical school, and certainly not about prescribing cannabis as an option. I did my reading and research on cannabis, and suddenly I felt as if this might be important. Seeing the benefits in many patients who suffer from chronic disorders, I wish I had medical cannabis available when I was practicing. It gives patients hope. It doesn’t always work, but when it does, it’s life- changing.”
Morel maintains that we are just scratching the surface of medicinal cannabis, and that time will likely reveal more specific treatments for specific disorders. “We are only using THC and CBD, but there are over one hundred other cannabinoids that have been identified and are currently being researched,” she says. “Since legalization, more research is occurring and studies will follow, which is what most physicians want – evidence-based medicine. I expect that the studies will support the research. But studies take time because they require a large number of patients to legitimize them.”
The medical cannabis-prescribing physicians, cannabis consultants, cannabis producers and cannabis patients we spoke to believe in the substance and its potential to treat a variety of physical ailments. Meanwhile, the wider medical community waits for more research and studies to be completed before embracing it. “There’s so much more we’re going to learn about cannabis in the future,” says Morel. “Right now, we’re going slow and low.” ❧
