Health Canada gets the straight dope from patients

Medical marijuana users say, "Ottawa, your pot's totally rank" and the feds agree to weed out the filler. But are docs really so ready to deal?

By Jason Gondziola

For HIV patient Jari Dvorak, a puff of marijuana can mean the difference between maintaining a healthy lifestyle and succumbing to his illness. The Toronto resident uses the drug to keep his appetite up and to handle his nausea � common side effects of many HIV medications.

"Sometimes the pills I'm taking are just overwhelming, other times I just don't feel well," says Mr Dvorak. "I don't smoke that much, actually. I only smoke half a joint to a joint a day."

Last August, he became the first recipient of government-supplied medical marijuana. The moment was a long-awaited victory for Mr Dvorak and other patients, who waged a six-year legal battle to get the feds to decriminalize marijuana for medicinal purposes and provide supply options for patients.

GRASS NOT GREENER
That victory was short-lived. After those heady first days, it became clear that the government's dope didn't make the cut. The main problem was that the quality of the weed wasn't up to snuff. "I cut out three months after I started the supply," says Mr Dvorak, who's still actively involved in the development of Canada's medical marijuana program. "It wasn't very good and the price was too high. I realized I wasn't smoking half a joint anymore, I was smoking two or three joints to get the same effect."

Dr John Goodhew, a Toronto GP and co-chair of the Toronto HIV Primary Care Physicians Group, agrees. He regularly cares for about 400 HIV patients and what they tell him echoes Mr Dvorak's complaints. "I don't have any patients who use the Health Canada product," he says. "It's not just bad, it's really bad. It doesn't smoke like marijuana." The implication seems to be that the government is essentially forcing patients to turn to local drug dealers for a decent stash.

Patients say government-supplied marijuana is poorly prepared � while it's supposed to have the same THC level as street pot (10%), it has fewer THC-carrying buds and is riddled with sticks and leaves, which dilute the potency. The government realizes that it's not winning any kudos from patients. "We've received feedback from users in the medical marijuana program, and because of this feedback Health Canada is examining whether we need to change the preparation of the product," says Catherine Saunders, a spokesperson for Health Canada, but defends their rookie fumblings. "It takes time to perfect a product, if you will."

PRESCRIBING POWER
In addition to looking into the quality of the drug, Health Canada is also reforming the Medical Marijuana Access Regulations. Their most recent meetings involved consultations with patients, doctors, pharmacists, police and support groups. The new policies contain revisions to a number of areas and will be implemented in the fall of 2004.

The current program details three classifications for patients entitled to drug access. The first category is only for the terminally ill with 12 months or less to live and requires the go-ahead from a GP. The other two categories require a specialist's recommendation and cover conditions like severe pain and nausea, MS, epilepsy and cancer-related weight loss, AIDS, and anorexia.

The revisions will see the number of categories reduced to two, and include a diminished requirement for the involvement of specialists in the application process. Dr Goodhew welcomes these changes, saying that the current system creates a two-tier system of physicians where GPs are forced to send their patients to specialists to get access to the drug. "I think the old system was discriminatory in not acknowledging the specialty of primary care," he says. "The current regulations as they're written have shut out GPs. [The new regulations] bring a little more rationality to the system and a little less excess spending on specialized healthcare."

WEEDING OUT LIABILITY
Liability has been an issue for physicians since the program began. Several groups, including the Canadian Medical Protective Association, have warned doctors against hastily prescribing the drug, saying that its medical risks and benefits have not yet been properly assessed.

"One aspect here � and this is one that divides physicians � is whether doctors really feel comfortable in the role of gatekeeper for medical marijuana, because for whatever reason [the government] isn't able to decriminalize it," says Dr Goodhew. "A lot of physicians don't want to have that role, because of the liability. It has to be proven in studies what the negative effects really are, and that hasn't been done."