MEDICAL MARIJUANA - RELIEF IN A BOTTLE

Lalanya Blue McGraw believes cannabis is slowing her cancer while
easing her pain. She's not alone. In B.C., thousands have turned to
the drug for relief, despite murky scientific evidence

Living with incurable cancer, after a third relapse of Hodgkin's
lymphoma, 39-year-old Lalanya Blue McGraw credits the daily use of
medical marijuana for allowing her to make the most of what may be
borrowed time.

"I've been considered terminal for a long time. The cancer is still
there, even after all the chemo and two bone marrow transplants. When
it gets worse, I can go into a clinical trial with a chemo drug that
has not yet been approved in Canada. But until then, I have defied
the odds," says the Vancouver resident, a former jazz singer whose
voice has been affected by the disease.

"I think, I believe, it's the cannabis that is slowing the cancer
down. That's my perspective anyway. It's the only thing I'm on."

When McGraw first asked an oncologist at the BC Cancer Agency in 2002
to prescribe marijuana to treat some of the effects of her cancer, he
was reluctant. He didn't object to her using it, but balked at
dealing with the Health Canada paperwork required when prescribing
any one of four products that can be obtained through the federal
Medical Marijuana Access Regulations, she says.

In 2001, Health Canada delegated the responsibility for prescribing
marijuana to doctors, who must fill out one of two forms attesting to
the fact their patients fit certain criteria. The first form asks
doctors to confirm their patient has a cancer or degenerative
neuromuscular condition that might benefit from marijuana. If doctors
don't feel they can attest to that, they must fill out an alternate,
longer form that can take 20 minutes to complete.

After her last relapse a few years ago, McGraw joined the Compassion
Club, which has a simple form with check boxes. She had a new family
doctor who had moved from Ontario and McGraw said she didn't hesitate
to sign the form.

"I just printed off the Internet form and took it into her. She was
very familiar with it and giggled as she checked off the boxes."

The Compassion Club form takes only a minute to complete and doctors
don't have to do much more than declare that the patient reports
their symptoms are helped by cannabis.

Unlike the federal forms, it does not protect patients from
prosecution for possession but, as an article in the B.C. Medical
Journal said: "Practically .. police are usually reluctant to
prosecute a patient who has a physician endorsement for possession of
marijuana."

McGraw buys marijuana from the club dispensary in various forms -most
often in a $15 tincture vial from which she extracts drops that she
places on her tongue. It calms her mood, alleviates any nausea and
helps her sleep. Although she sometimes smokes it in the dried form,
she says it can make her feel "too goofy."

She also buys an olive oil infused with cannabis, "but that's mostly
when I want to put it in brownies to spoil myself on my birthday," she says.

McGraw was calm throughout the interview, despite facing several
questions about her own mortality. That sense of calm broke, however,
when she was asked about her first experiences with the Compassion
Club. She got teary as she recalled being fast-tracked during her
orientation process because of her incurable form of cancer.

"It is an exceptionally supportive environment at the Compassion
Club. I remember on my first visit, a guy with crutches came over to
me and whispered in my ear to say 'everyone is very friendly in
here.' And they are. It has definitely become a family for me. I
don't have the people I've met there over for dinner or anything, but
in the waiting room there is a passive, friendly vibe. No one tries
to upstage anyone else when it comes to medical problems. Everyone is
respectful and compassionate."

Doctors Respond

Thousands of doctors in B.C. have prescribed marijuana over the past
several years to their patients even though their advocacy and
regulatory bodies aren't convinced on the scientific evidence.

Dr. Pippa Hawley is one of them.

Although she agrees with the College of Physicians and Surgeons of
B.C. and the Canadian Medical Association -which both contend the
lack of credible information makes prescribing marijuana potentially
dangerous because of unknown risks, benefits, complications and drug
interactions -Hawley is one of several specialists at the BC Cancer
Agency who prescribes medicinal marijuana.

"I don't set myself up as a marijuana prescriber. I'm a physician and
if marijuana, or one of its derivatives, is an appropriate management
strategy for a particular patient then I have no problem facilitating
access to it, either by prescribing it or filling in the forms for
them to take to the Compassion Club. But that doesn't make me an
enthusiast," says the internal medicine specialist who started the
Pain and Symptom Management/ Palliative Care program at the BC Cancer Agency.

Hawley was surprised to hear that, according to the most recent
Health Canada information, 1,773 B.C. doctors have helped 3,627
patients get permission to legally possess marijuana.

That figure is the highest in Canada, more even than Ontario where
1,693 doctors signed authorizations for 3,427 patients. Even Quebec,
which like Ontario has a far greater population than B.C., has only
306 doctors prescribing marijuana.

While 1,773 B.C. doctors have filled out the official forms to
authorize patient use of "medicinal" marijuana, the Compassion Club,
the oldest medical marijuana dispensary in Canada, says many more
doctors have signed off on the club's less onerous -albeit quasi-legal -form.

It says 3,400 B.C. doctors, including medical doctors, naturopaths
and traditional Chinese medicine practitioners, have referred
patients there in the past 14 years.

The Compassion Club says it has about 4,000 members for a total of
6,500 since it opened its doors in 1997.

While patients and marijuana advocates have complained over the years
about the lack of enthusiasm on the part of doctors, Hawley says she
knows of no colleagues withholding access to medicinal marijuana.

"Not that I think they are fantastic products. There may be doctors
who aren't keen on marijuana, but I don't think anyone would deny a
patient access if it was medically justifiable," she says.

"With all symptom control there is a degree of trial and error
because everyone is different, but particular pain syndromes that can
respond well to marijuana are the ones where there is neuropathic
nerve pain or if there are a lot of muscle spasms.

"And it is not well documented, but people who have difficulty with
anxiety, especially if they have been recreational users of marijuana
in the past, may be those ones who tend to do well," she says.

Since marijuana is known to sometimes carry side effects, Hawley says
doctors have to be aware of that.

"It can make people paranoid. That's why we have to be careful about
being too liberal with it. People who have already been recreational
users tend to know their threshold."

The oral (pill) form is good for treating nausea and poor appetite,
but when pain and anxiety are the main complaints, then a spray
inside the mouth can be prescribed.

The Health Canada form allows patients to possess dried marijuana for
smoking; they also can grow it themselves or buy it from authorized
growers. Hawley said some patients prefer she fill out the Health
Canada form instead of the Compassion Club form, but she has to warn
them that it can take weeks or months for processing by the
government so "forget it for people at the end of their life; they
are better off going to the Compassion Club or some other dispensary."

Those who favour - about one in three patients - going the Health
Canada route are patients who tell her they feel more secure knowing
they have the full legal, Health Canada designation, especially if
they have a history of any drug infractions, she says.

Hawley says she wouldn't be surprised to hear that family doctors
sometimes encounter patients who ask for the authorizations just
because the marijuana is so much cheaper when bought from the
Compassion Club rather than from dealers on the street.

"There may be some patients who are faking something. But if someone
has a genuine pain problem and they are reasonable people who have
not behaved dysfunctionally, have not been aggressive or abused
previous prescriptions, have been polite and pleasant, then I think
very few doctors would have problems filling out the forms."

She says a third to a half of cancer patients report that medical
marijuana provides symptom relief.

"I give people fairly low expectations when I first prescribe and I
am more receptive to prescribing if they have tried other stuff [like
methadone] but not responded."

Some patients hate the "spacey" side-effect of marijuana because they
don't like feeling different, while others find it to be a pleasurable effect.

Opinion Divided

Getting any kind of agreement on the pros, cons, risks and benefits
of marijuana is seemingly impossible.

The Canadian Medical Association's position statement on medical
marijuana has evolved over time.

Initially, it "vigorously" opposed making physicians part of the
supply chain because of the lack of evidence. More recently, it has
stated it accepts that physicians who feel qualified to recommend
medical marijuana to their patients do so in accordance with Health
Canada regulations, which ask doctors to attest to a diagnosis and
the failure of conventional therapies.

It has encouraged government to fund research on safety, dosing and
delivery systems.

And it has endorsed compulsory education and licensing programs for
doctors who do prescribe.

The doctors' legal defence agency, the Canadian Medical Protective
Association, has told its members that anyone who is uncomfortable
with the Health Canada regulations should refrain from prescribing
the drug to patients.

In B.C., the College of Physicians and Surgeons has a position
statement that says the lack of good evidence on smoked marijuana's
medicinal use makes it "difficult and possibly dangerous for
physicians to prescribe," especially because of uncertainty about
interactions with other drugs.

Doctors could be "the subject of accusations or suggestions of
negligence, including liability if a prescribed drug [like marijuana]
produces unforeseen or unidentified negative effects."

Like the CMA, the college says only doctors who are familiar with the
pharmacology of marijuana should prescribe it.

A medical literature search on marijuana will turn up anywhere from
12,000 to 15,000 articles and studies. But Dr. Robbert Vroom, senior
deputy registrar of the college, says there is a "minuscule" number
with "real science" methodology.

If the evidence was clear, then doctors across Canada would be
uniformly prescribing, he says.

Instead, B.C. now has the highest number of doctors prescribing -
"seven times more per capita than Quebec" - a situation he attributes
to the "lack of robust evidence-based guidelines as well as a
spillover of the highly prevalent use of recreational marijuana in B.C."

Vroom, a former emergency room doctor at Surrey Memorial Hospital,
said he doesn't doubt that some patients experience benefits when
they use marijuana.

He said they may well be the same kinds of people who turn to "the
comfort and pleasure of a substance they enjoyed in the past, be it
tobacco, wine or Scotch."

"I maintain that medical marijuana is a substance of unknown
composition, potency, or dose administered by smoke inhalation,
foisted on the medical profession for us to gate-keep," said Vroom,
in a recent letter in the BC Medical Journal.

He was rebutting a letter from Philippe Lucas and Rielle Capler,
co-founders of the advocacy organization Canadians for Safe Access,
who contend that "the fact that cannabis has an excellent reputation
as a recreational drug in no way negates the evidence of the efficacy
and relative safety of its medical use."

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MEDICAL MARIJUANA

A Four-Part Series

FRIDAY: Health vs. safety: Municipalities raise concerns over grow-ops

TODAY: The human case for medical marijuana

TUESDAY: The law

WEDNESDAY: Criminal concerns