"We have a situation where we have more than 4,000 people dying of opioid overdose," Dr. Kevin Rod said yesterday at the World Cannabis Congress in Saint John, New Brunswick. "This is a national and international health crisis," added Dr. Rod, who is the medical director of the Toronto Poly Clinic.
Dr. Kevin Rod (left) discusses the opioid crisis with Dr. Mark Ware and Dr. Melanie Kelly
According to the Canadian Institute for Health Information, the number of people requiring hospitalization due to opioid poisoning has gone up 53 percent over the last 10 years. But as cannabis legalization looms on the horizon, some doctors are hoping that increased access to the drug, and increased research will help reduce the number of opioids prescribed across the country.
“As front line fighters in the fight against pain, we’re always looking for new ways to treat or manage chronic pain, and it’s not very often that we have a new solution,” Dr. Rod noted.
That new solution, he believes, is cannabis.
"A lot of stigma"
The biggest obstacle between patients and medicinal cannabis in Canada isn't obstructive laws or a lack of supply. It's the fact that many physicians are still hesitant to prescribe medicinal cannabis because of longstanding biases against cannabis, according to Dr. Mark Ware.
"It's a drug that's got a lot of stigma," Dr. Ware - who served as vice-chair of Canada's cannabis task force - said at the Congress. "There's been a long history of prohibition, so they're still coloured by that impression."
Ware is also the director of clinical research at the Alan Edwards Pain Management Unit at McGill University. He has spent his entire career researching the medicinal properties of cannabis, which was no easy feat at the height of prohibition in 1999. When he was doing his first clinical study, he had to apply to the DEA for a licence to import a cannabis placebo that was only manufactured in one place in the United States. The placebo had no THC, but it still took two years for the licence to be approved.
"Every time I would think, 'Well, this is really hard and I should do something else,' I would meet a patient who would say, 'I just tried a cannabinoid for the first time and it’s been a life-changing experience,' and that would push me to say, ‘Okay, we have to keep going.'"
Now, he says it's becoming easier to access the substance he wants to study, but there still isn’t as much clinical data as there could be.
"The data may not be super strong," Ware said. "But there is some supportive evidence and I think gradually the community will start to understand, but fundamentally, it will only be when clinical trials start to come forward that there will be convincing evidence."
And once physicians start to see the results of cannabis use in some of their patients, those stigmas might start to disappear.
"By providing more education for the population and physicians," Rod said, "there would be a better level of comfort to prescribe [cannabis]."
He says opioids aren’t going to go away completely since they do have a legitimate medicinal purpose, but cannabis research and prescription might help to reduce opioid dependence.
Research and education are key
Over the last 20 years, Ware has conducted clinical trials and countless studies on the various compounds within cannabis, but there is still a lot of research that needs to be done.
There are a few areas of research that are still largely unexplored. Ware has studied the compounds themselves, but the interactions between them are unknown. Also, there has been a lot of research on the effects of cannabis for chronic pain management, but there is preliminary research that shows it can treat a number of other symptoms including anxiety, depression, nausea, and some cancer symptoms. Those need to be more fully investigated as well.
And since so many people are already using it medicinally, Ware suggests a large-scale study that looks at how people are already using cannabis and how effective it has been for them in terms of symptom management.
Finally, with regards to the patients, Ware suggests that physicians stop fighting against the current.
“When it comes to cannabis, physicians have to start to recognize that they can't turn their backs on it anymore,” he said. “It isn't something that they can just pretend will go away. It’s not. It's here to stay.”