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Most want pain relief, not a marijuana high

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Imagine you are dying a slow, painful death and someone offers you marijuana to
relieve your pain. How quickly would you take it?

Not so quickly, according to a study done by palliative care expert Romayne
Gallagher. Almost 70 palliative care patients were asked about their attitudes
and beliefs surrounding medicinal use of marijuana. Gallagher and fellow
researchers from the BC Cancer Agency and Vancouver Coastal Health Authority,
VGH site, found the patients had a variety of worries and questions.

"These individuals had some real concerns about using the drug -- concerns that
were surprising considering these people were at the end of their life," says
Gallagher, a clinical professor in the Faculty of Medicine's division of
palliative care.

Marijuana has been available for medical use in Canada since July 2001 when
Health Canada implemented the Marijuana Medical Access Regulations. A doctor's
recommendation allows patients to obtain and use marijuana without

Participants in the study -- conducted at cancer centres and palliative care
units in Vancouver and Kelowna -- worried that smoking would result in lung
problems, that second-hand smoke would harm their families' health and that
might become addicted to the drug.

Gallagher says both patients and doctors often need to be convinced of the
and safety of readily available pain-relieving drugs such as morphine. Some
current attitudes mirror beliefs held decades ago. An article from the 1941
Journal of the American Medical Association states that, "The use of narcotics
in terminal cancer is to be condemned if it can possibly be avoided... It is
well known that small, regularly administered doses may be counted on to cause
and maintain addiction...".

Many study participants believed that marijuana is safer than morphine. In
reality, says Gallagher, both drugs are safe if used responsibly. Most
participants don't want to smoke the drug and they don't want marijuana's side

"They want pain relief -- they don't want to be stoned," says Gallagher.

Study participants -- whose average age was 56 -- also had social concerns
using marijuana. Some, particularly Asian patients, were afraid of neighbours
and police finding out.

"It was disturbing to find that most of these patients were willing to try
marijuana despite their concerns and lack of information," she says. "They
are a
very vulnerable population and eager to use whatever works. The only
problem is,
we don't have clear evidence about how marijuana does work to treat symptoms in
dying people."

In addition to a lack of clinical research information, there are significant
obstacles in obtaining the drug. Few dying patients have the energy to start
their own grow-op. Buying from suppliers, such as compassion clubs established
to distribute marijuana for medical use, can cost up to several hundred dollars
per month.

Russell Barth, a 34-year-old who takes marijuana for chronic pain and anxiety,
reports it took nine months to get the necessary forms processed so that he
could obtain and possess the drug. One of the co-founders of the National
Compassion Society in Ottawa, he turned to marijuana because he could not
tolerate the pharmaceuticals prescribed to him. His roommate uses the drug to
help control epilepsy. Together, they have spent up to $500 per month on

"It's not an easy drug to use -- it's expensive and there's a lot of
involved to get it. Health Canada offers marijuana for slightly less money, but
it's poor quality and contains chemicals."

In addition to financial barriers to using the drug, there are medical
issues to
consider. Marijuana interacts negatively with drugs that slow down the central
nervous system, including sleeping pills, some pain medications, antihistamines
and seizure medications as well as antiviral drugs used to treat AIDS.

Gallagher points out that there have been no clinical trials of marijuana in
Canada, leaving patients pretty much on their own to determine what works for
them. She would like to see Canada learn from other countries, such as the
which is conducting large marijuana trials.

In the largest investigation ever done on the treatment of multiple sclerosis,
U.K. researchers recently studied marijuana use in more that 600 patients and
found that although the drug had no significant effect on muscle spasticity
(according to an independent assessment scale) the majority of patients felt it
had reduced spasticity symptoms and pain. There was also some evidence that
marijuana treatment led to improved mobility.

Gallagher would also like to see regulated prescriptions, a standardized route
of administration and dosage, and pharamacare coverage of the marijuana pill as
a recognized pain reliever.

Pharmacare covers drugs approved for prescription use by Health Canada. A
whole-cannabis preparation called Sativex is currently going through the
approval process in the U.K., which may lead to approval in Canada,
according to
Dr. David Hadorn, who has served as a consultant to the B.C. Pharmacare

If Health Canada does approve the drug, Pharmacare would then decide if it
should be subsidized and what restrictions, if any, should be placed on the

For more information about the medical use of marijuana, visit Health Canada's
Web site at www.hc-sc.gc.ca.

The University of British Columbia
UBC Reports welcomes your feedback.
e-mail: public.affairs@ubc.ca

Source: UBC Reports
Contact public.affairs@ubc.ca
Website: UBC Reports
Address: 310-6251 Cecil Green Park Road, Vancouver, BC Canada V6T 1Z1
Fax: (604) 822-2684
Author: Hilary Thomson
Pubdate: January 8, 2004