Toronto Life March 2016: Legal(ish) and Half Baked

Legal(ish)- and half baked.

Toronto Lifes March 2016 edition Legal(ish) captures the insanity; cannabis is both illegal under the Controlled Drugs and Substances Act, and legal under the Marijuana for Medical Purposes Act (MMPR). However, Legal(ish) makes a hash of the difference between medical cannabis and recreational marijuana use.

Choose your Adventure (p.42) is a two page centrefold of medical cannabis buds, along with claims about their effects for a medical user. There is no such determinism in medical cannabis; effects on a given symptom are very subjective. The website maintains a user generated rating system. For chronic pain, patients actually give high ratings for all three varietiesof cannabis. You, as a medical cannabis patient, are an n= 1therapeutic experiment. Medical cannabis doctors attempt to leverage medical cannabiss power to decrease the dosage of more dangerous medications like opiates. Your doctors goal is to achieve symptom control with cannabis, but without unacceptable side effects.

Incredible Edibles ( p.46). Dark chocolate raspberry truffleshave a purported THC content of 330 mg. About half of the cannabis edibles analysed in a Journal of the American Medical Association study failed to meet basic pharmaceutical label accuracy. When inaccurately labelled, more than half contained much less THC than indicated. If the Dark chocolate raspberry truffleactually did contain 330mg of THC, dispensaries are selling the unwitting public an ingested cannabis product that is about 15 times more potent than the dosage required to produce pain relief in surgical patients. This is nothing to snicker about.

Dear Herbal Diplomat(p.49) is headed by a cartoon of a patient trying to convince a very stern looking physician of his legitimate medical need. Yes it is true. An estimated 60% of Canadian Physicians do not feel comfortable to prescribe medical cannabis. When they meet patients who can genuinely benefit from medical cannabis, there are specialised clinics that can be consulted. In US states that have legalized the medical use of cannabis, deaths from prescription opiate overdoses drop. When cannabis eventually does become legal in this country, I will be glad to see the spectre of such deceit gone from my practice. Excellent results for patients with severe symptoms can be achieved with medical cannabis but they take time, skill and mutual trust.

Dr. Andrew B Cooper MD MHSC FRCPC
Assistant Professor, University of Toronto Faculty of Medicine, Department of Anesthesia Caledon Medical Cannabinoid Clinic

JAMA. 2015;313(24):2491-2493. doi:10.1001/jama.2015.6613
JAMA Intern Med. 2014;174(10):1668-1673. doi:10.1001/jamainternmed.2014.4005. Anesthesiology, V 104, No 5, May 2006