Since the legalization of cannabinoids—chemical compounds found in cannabis—for medical purposes in 2001, a growing number of Canadian physicians have turned to medicinal marijuana for patients suffering from cancer and other chronic disorders such as multiple sclerosis and arthritis.
Cannabinoid receptors, which bind cannabinoids, influence cognitive and physiological processes and are part of a larger network of receptors that compose the body’s endocannabinoid system. These receptors respond to the two active cannabinoids in cannabis, cannabidiol (CBD) and tetrahydrocannabinol (THC). Positive effects from cannabinoids include pain suppression, enhanced mood, and increased appetite.
Some members of the medical community are eager to use the benefits of cannabinoids to treat their patients. Michael Dworkind, a physician at the Jewish General Hospital, co-founded Santé Cannabis, a Montreal-based medical organization which provides patients with medical cannabis prescriptions, in 2014. Santé Cannabis connects patients to a network of healthcare workers including physicians, educators, and cannabis suppliers.
Specifically, Dworkind is interested in cannabinoids as a potential solution to Canada’s growing opioid crisis, working as a substitute, or at least a complement, for opioid treatment. Currently, 13 per cent of Canadians use prescription opioids, which remains the most frequently-prescribed treatment for chronic illness despite a 5.5 per cent risk of addictive use.
“Opioids and cannabinoids work extremely well together,” Dworkind said. “They are synergistic in their benefit.”
Under Dworkind’s process, following an initial interview process with a doctor, the patient must meet with an educator to learn how to use cannabis responsibly. Only after the patient has completed this process are they put in touch with licenced suppliers. Working with the suppliers to personalize the THC-to-CBD content gives them a newfound degree of involvement in their treatment options.
Despite Dworkind’s optimism, some doctors are not as convinced by the effects of cannabinoids; according to him, only five per cent of doctors in Quebec prescribe cannabinoids. Jeff Blackmer of the Canadian Medical Association emphasized the need for further research, attesting to the fact that eight out of nine physicians in Canada are uncomfortable discussing or providing access to medical cannabis.
“It’s important to recognize that, by and large, that [the] level of evidence [for cannabinoids’ benefits] doesn’t reach the quality that we demand for every other product that physicians prescribe,” Blackmer said in an interview with CBC.
Blackmer’s apprehensions are not unfounded. Like alcoholism and similar psychostimulant abuse disorders, cannabinoids may foster psychological dependence. To combat this effect, doctors who prescribe medical cannabis in Quebec remain in contact with suppliers to ensure that patients are getting the right amount.
“When we see a growth in consumption […], we have to put limits on it, or we ask them to leave the program,” Dworkind said.
Synthetic cannabinoids, such as Nabilone, as well as cannabis-derived medications like Sativex, are commercially available but possess their own set of risks. Similar to cannabis, these options are not covered by provincial health insurance plans.
“Whereas the conventional therapies are covered by the government, non-traditional cannabinoid therapy is not [covered by the government],” Dworkind said. “A bottle of Sativex, which would last two weeks, costs $150.”
Nonetheless, cannabis is a cheaper option for patients on a budget.
“People who have work-related injuries are on a dozen drugs,” Dworkind said. “Total up that amount and compare it $5-$10 a gram, a gram or two a day of cannabis. Cannabis treatment is cost effective.”
The team at Santé Cannabis continues to push forward, educating patients in the hopes that they will embrace cannabinoid treatment for their own sake.
“All of this is about human rights and politics,” Dworkind said. “Quality of life is our bottom line, after all.”