On Thursday, Nova Scotia’s highest court overturned a provincial human rights board decision that said an injured man's legally prescribed medical marijuana must be covered by his union insurance plan, marking a significant setback for medical cannabis advocates.
Is there a double-standard when it comes to off-label pharmaceuticals and medical cannabis?
In Canada, all prescription pharmaceuticals (“drugs”) must be approved for sale by Health Canada. When Health Canada approves a drug for sale the approval stipulates, among other things; the population for whom the drug can be prescribed, the indication(s)
the drug can treat, and the dosage(s) that can be administered. The use of an approved drug beyond the criteria set out in the product’s approval is referred to as “off-label” use.
1 in 9 drugs are used off label: 99.2% of gabapentin is used off label and 75% of pediatric medications are used off label. According to a Health Canada report (below), 79% of off-label prescriptions were not supported by strong scientific evidence. (Strong evidence was described as at least one randomized, controlled clinical trial {RCT}.) Yet, when it comes to medical uses for cannabis, the same rules do not apply and the standards for evidence are so much more rigorous. As a physician seeing the positive impacts of cannabinoid therapy on my patients every day, I really question this double-standard — especially given cannabis’ excellent safety profile.
Check out the Senate of Canada Standing Senate Committee on Social Affairs Science and Technology on Prescription Pharmaceuticals in Canada - Off Label Use.
Research: Opioid use lower in states that eased medical marijuana laws, JAMA (April 2, 2018)
On Monday, the Journal of the American Medical Association published two studies investigating whether access to medical cannabis reduces opiate use and abuse. This article from NPR provides a solid, balanced overview.
NPR reports:
Medical marijuana appears to have put a dent in the opioid abuse epidemic, according to two studies published Monday.
The research suggests that some people turn to marijuana as a way to treat their pain, and by so doing, avoid more dangerous addictive drugs. The findings are the latest to lend support to the idea that some people are willing to substitute marijuana for opioids and other prescription drugs.
Many people end up abusing opioid drugs such as oxycodone and heroin after starting off with a legitimate prescription for pain. The authors argue that people who avoid that first prescription are less likely to end up as part of the opioid epidemic.
"We do know that cannabis is much less risky than opiates, as far as likelihood of dependency," says W. David Bradford, a professor of public policy at the University of Georgia. "And certainly there's no mortality risk" from the drug itself.
Read full article here.
Research: Daily cannabis use could delay at-risk youth from moving to higher drug use, BC Centre on Substance Use (March 2018)
Dr. Blake Pearson to offer virtual appointments to long-term care patients in Ontario
In addition to Dr. Pearson’s medical cannabis clinic, serving individuals across Sarnia-Lambton, he has been focusing on the long-term care community for the last several months and has been seeing great success with these patients. Currently, Dr. Pearson is seeing patients in several Sarnia-area LTC homes and we are delighted to announce that he is now taking virtual appointments on the Ontario Telehealth Network (OTN) platform.
New Jersey Governor, Phil Murphy expands medical marijuana program: NBC
A renaissance is coming to New Jersey’s long embattled medical marijuana program.
Democratic Gov. Phil Murphy announced a long list of reforms this morning, including lowering fees for patients and caregivers, adding five approved medical conditions and proposing legislation to increase monthly product limit for patients.
Patients receiving hospice care would be eligible for an unlimited supply of cannabis. Effective immediately, patients suffering from anxiety, migraines, Tourette’s syndrome, chronic pain related to musculoskeletal disorders, and chronic visceral pain will be eligible for the medical cannabis program.
Murphy added that he would like to eventually see opioid addiction added to the growing list of approved conditions. He called cannabis “an offensive weapon” to the growing crisis.
Medical cannabis shouldn't be subject to tax: Ottawa Citizen
You’ve heard me talk about the cost burden of medical marijuana before; it’s an issue that’s very important to me as a doctor focused on patient and family-centred care.
When the federal government released its 2018 budget, it came as a surprise to many that it was planning to add a new excise tax on medical cannabis. Excise tax is usually reserved for products deemed to have a high social cost, such as tobacco or alcohol. However, a budget branded with the motto, “giving every Canadian a real and fair chance at success,” has seemed to overlook Canadian families already struggling with affordability and access to medical cannabis.
In this article, Jenna Valleriani, does an excellent job exploring why medical cannabis, if authorized by a health-care provider for medical purposes, should be treated any different than most prescription medicines.
If this issue is important to you, I encourage you to reach out to your local government representatives and make your voice heard.
Yours in good health - Blake
Full article here.
Medical cannabis safer for elderly with chronic pain than opioids: European Pharmaceutical Review
Medical cannabis therapy can significantly reduce chronic pain in patients age 65 and older without adverse effects, according to researchers at Ben-Gurion University of the Negev (BGU) and the Cannabis Clinical Research Institute at Soroka University Medical Center.
The new study found that cannabis therapy is safe and efficacious for elderly patients who are seeking to address cancer symptoms, Parkinson’s disease, post-traumatic stress disorder, ulcerative colitis, Crohn’s disease, multiple sclerosis, and other medical issues.
“While older patients represent a large and growing population of medical cannabis users, few studies have addressed how it affects this particular group, which also suffers from dementia, frequent falls, mobility problems, and hearing and visual impairments,” says Victor Novack, a Professor of Medicinein the BGU Faculty of Health Sciences (FOHS), and head of the Soroka Cannabis Clinical Research Institute.
“After monitoring patients 65 and older for six months, we found medical cannabis treatment significantly relieves pain and improves quality of life for seniors with minimal side effects reported.” Read full article here and review research here.
Research: CBD Treatment for Cannabis Users with Psychosis, Schizophrenia Bulletin (2018.44.1)
A major factor associated with poor prognostic outcome after a first psychotic break is cannabis misuse, which is prevalent in schizophrenia and particularly common in individuals with recent-onset psychosis. Behavioral interventions aimed at reducing cannabis use have been unsuccessful in this population. New research published in the Schizophrenia Bulletin, suggests that CBD may improve the disease trajectory of individuals with early psychosis and comorbid cannabis misuse in particular—a population with currently poor prognostic outcome and no specialized effective intervention. Read more.
Medicine or Myth? The Leaf Cannabis News
The College of Family Physicians of Canada drew the ire of Canadian cannabis advocates in February, when it published a set of guidelines meant to help primary-care physicians decide when to prescribe cannabis.
Cannabis and its chemical constituents, concluded the guidelines published in the medical journal Canadian Family Physician, "are not recommended for most patients and conditions by far."
However, as Soloman Israel reports, there is far more to this story. Read on for some interesting perspectives on cannabis as medicine and why large clinical studies are under-funded.