Medicinal and recreational cannabis should be separate, say researchers

Two Halifax researchers are urging the federal government to keep medicinal and recreational marijuana streams separate once the plant is legalized in Canada.

The op-ed, published in the latest issue of the Canadian Medical Association Journal, was co-authored by Dr. Melanie Kelly, a professor of pharmacology and ophthalmology at Dalhousie University, and Elizabeth Cairns, a PhD candidate studying pharmacology and neuroscience.

Cairns and Kelly support a recommendation, initially proposed by the Liberal government's task force on cannabis legalization and regulation, to keep the two so-called "streams" medicinal and recreational separate.

"[Patients] are potentially looking for a totally different product and there's no guarantee with a market that's recreationally driven that that product will be maintained and sold," said Cairns.

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CMA recommends 1 stream

Unlike the task force, the Canadian Medical Association (CMA) recommends just one stream once marijuana is legalized, arguing that more research must be conducted on cannabis before it should be approved for widespread medical use.

"We accept that [people] say they have benefited from using cannabis, but there's no or very little research behind that," said Dr. Granger Avery, president of the CMA.

"Until we have research and the real information behind it, we're not in favour of endorsing it for medical intervention."

There are still many regulations being hashed out as Canada prepares to legalize marijuana for recreational use before July 1 of next year.

"With recreational cannabis, what you're looking for is intoxication that is not necessarily the case for medicinal cannabis," said Cairns, who points out that cannabis is the preferred, clinical term which includes not only the dried marijuana plant but also any extracts derived from the plant, such as cannabis oil.

Decrease the stigma for patients

The piece from Cairns and Kelly argues that a dual-stream approach would not only decrease the stigma surrounding medical cannabis, but would benefit patients in other ways including:

• Protecting the supply of strains of medical cannabis that have desirable effects for patients, such as lower THC strains sometimes used to treat children who suffer from seizures.
• Driving clinical research into therapeutic uses for cannabis.
• Giving health-care providers the incentive to be up to date on the latest research involving therapeutic benefits of cannabis.

Child's seizures reduced 90%

Before Mandy McKnight's nine-year-old son Liam started taking cannabis oil to treat Dravet syndrome, he was having upwards of 80 seizures a day. Since starting treatment, his seizures have reduced by about 90 per cent.

"Sometimes he can go a week, two weeks, without having any seizures at all," said McKnight, whose family lives in Constance Bay, Ont.

She has many concerns if legalization means there is no distinction between medical and recreational cannabis, not the least of which is where it will be sold.

"I'm not going into an LCBO [liquor store] to buy medicine for my kid," she said.

The task force has recommended that marijuana not be sold alongside liquor, but ultimately distribution plans will be up to individual provinces, the federal government has said.

"Most patients want to have different venues for delivery. They want to have it looking more like a medicine, they're using it for a specific [medical] purpose," said Kelly.

Out-of-pocket costs for patients

Another problem, said McKnight, is the cost. Since cannabis does not have a Drug Identification Number, it can be difficult to get insurance companies to pay for the medication.

McKnight said her family spends $700 or $800 a month on cannabis oil, out of pocket. Previously, they were spending about $2,500 per month on pharmaceuticals that Liam no longer needs because of his cannabis treatment. She said the cost of ambulance fees and hospital stays is also way down.

I'm not going into an LCBO to get medicine for my kid.- MandyMcKnight

"I know parents who are getting loans and falling behind on their payments, their bill payments because they need to buy this and there's no coverage, whatsoever, there's nothing," said McKnight.

Kelly said this situation underlines the importance of keeping medicinal cannabis separate, so there are more clinical trials into therapeutic cannabis benefits that may make providing a DIN more palatable to those in the pharmaceutical industry.

"We're already seeing a revolution in terms of the industry. I hear quite a lot and I'm seeing very innovative devices to dose-standardize even dried cannabis, recommending different ways of ingesting like vaporization," said Kelly.

A lot to work out

For its part, the Nova Scotia government recognizes the legalization of marijuana is complicated.

"We'll be looking at both models of delivery and a lot of complexities as we speak, but working through those. We have a short timeline, July of 2018, so a lot of work to do," said Justice MinisterMark Furey, speaking for the province.

The government saidthough decisions are still being made at the provincial level, physicians will still have the ultimate say over their patients' care.

"Decisions regarding medicinal marijuana for patients, of any age, are made by physicians and that will continue. This is federally regulated and will be ongoing,"said Sarah Gillis, speaking for the Nova Scotia Department of Justice.

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