http://www.nationalpost.com/commentary/story.html?f=/stories/20010808/638941.html

August 8, 2001
David Gratzer
National Post

Canada is now the first Western nation to legalize marijuana for medical uses. The new regulations allow the prescribing of marijuana for the terminally ill, those with specific medical conditions (such as multiple sclerosis patients with severe pain) and seriously ill patients who have failed "conventional treatments."

The decision to allow the weed is monumental -- and irrelevant.

That marijuana was illegal in the first place makes sense to the casual observer. After all, pot is a street drug that is both addictive and, with sustained use, harmful.

It's a compelling argument -- and one borne of ignorance. The reality is that many street drugs (often illegal for recreation) are allowed for medical use. Consider that possessing cocaine is a crime. But, in a health care setting, cocaine is an anesthetic; I have never seen an emergency room that didn't have liquid cocaine.

Morphine, codeine and heroin are used for pain relief. In fact, morphine is one of the most basic and effective drugs used to treat pain. Several years ago, two prominent physicians wrote a book titled the ABCs of Palliative Care. They had harsh words for doctors reluctant to prescribe morphine for the dying, going so far as to suggest these colleagues were "part of the problem."

Why the ban on marijuana? "It's all politics," explains a pharmacist friend.

Contrast marijuana and codeine. Marijuana is a relatively innocuous drug. Codeine is a modified morphine chemical. It takes an estimated 1,500 pounds of marijuana to achieve a lethal dose -- smoked in under 15 minutes. Codeine overdoses may require just a bottle or two of pills. Marijuana is banned. Codeine is not only widely available in prescription drugs (like Tylenol 3), but can be purchased over the counter in low doses.

Indeed, marijuana should never have been blacklisted. That decision reflects bad politics, not good medicine.

Not everyone sees it that way. A former president of the Canadian Medical Association criticized the federal government's action, suggesting that allowing marijuana for medical purposes was a first step toward decriminalization. In medical circles, it's a commonly argued point -- but is it convincing? After all, we have always allowed morphine for end stage renal cancer and cocaine for nose bleeds, but has this bolstered in any way the efforts to decriminalize street drugs? Would medical marijuana?

Last week, the federal government corrected a past wrong. The self-congratulations have already begun. Speaking at the July announcement of the regulatory changes, Allan Rock, the Minister of Health, declared: "Today's announcement [of the revised rules] is a landmark in our ongoing effort to give Canadians suffering from grave and debilitating illnesses access to marijuana for medical purposes. This compassionate measure will improve the quality of life of sick Canadians, particularly those who are terminally ill."

I have no philosophical objections to lifting the ban, but will it really result in better, more compassionate medical care?

Anecdotal evidence appears plentiful -- and photogenic. TV news reports often portray patients who offer amazing testimonials to the power of pot. Proponents of legalization frequently tout two uses for medical marijuana: in the management of pain and as an anti-nausea medication.

The reality is that marijuana probably doesn't have much use in either capacity.

In a review of all randomized controlled trials comparing the efficacy of cannabinoids with conventional drugs published in the British Medical Journal, marijuana proved to be no more effective than codeine at pain relief -- but had several undesirable side effects. As well, most of these studies were done in the 1970s, before the development and better utilization of several pain killers (such as NSAIDs) in use today.

In a review of 30 studies involving cannabinoids as a treatment for chemotherapy-induced nausea and vomiting, marijuana was reported to be effective for moderate nausea, but not for severe symptoms. Since the bulk of these studies were done, newer medications have been developed that unquestionably have better ability to control the side effects of chemotherapy.

Not surprisingly, then, in a recent editorial of the British Medical Journal, Professor Eija Kalso suggests: "The current information is that the adverse effects of cannabinoids outweigh their effectiveness."

Make no mistake: alleviating the pain and suffering of patients is a noble and vital pursuit. What remains unclear is that medical marijuana will contribute anything to the arsenal physicians already have at their disposal. Of course, there is always the potential for marijuana to have unforeseen applications. Perhaps a future Nobel laureate will one day cite Allan Rock in his acceptance speech.

More likely, however, the practical implications of legalized pot will be more smoke than fire.

Dr. David Gratzer is the author of Code Blue: Reviving Canada's Health Care System, which was awarded last year's Donner Prize.
 

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