New dosage limits for medical marijuana: But where's the science?

[Alison Myrden]

This is our latest in Canada.

 

Please be aware.

 

 

Alison

xx

 

 

 

NEWS

 

New dosage limits for medical marijuana: But where's the science?

Pauline Comeau

Ottawa, Canada

 

New evidence-based guidelines are urgently needed to help doctors negotiate

Canada's hazy medical marijuana landscape, particularly in light of Health

Canada's efforts to impose new dose limits, say the nation's leading cannabis

researcher and doctors who have been queried about their marijuana

authorizations.

 

Canada should also re-establish a formal process for developing responsible

dosing strategies, says Mark Ware of McGill's University Health Centre, the sole

researcher funded under the now defunct Medical Marijuana Research Program (CMAJ

2006;175:[12]: 1507-8).

 

The 1053 doctors now authorizing marijuana use for 1816 patients need "more

evidence" regarding rational dose levels, he says. And Ware suggests the

Canadian Consortium for the Investigation of Cannabinoid could lead such an

effort.

 

"There is more research, more trials, formulations that could be done," says

Ware. "If we had a couple of days in a room with people and pharmacologists then

we could sit around and say, here is the best we can come up with, here are some

guidelines."

 

Under current medical marijuana rules, doctors authorize the amount of marijuana

they and their patients feel is necessary. However, several who have recommended

above 5 g per day were recently telephoned by a Health Canada medical marijuana

program officer, and advised that the department recommends no more than 1-3 g

per day, irrespective of the medical condition or means of consumption (inhaled,

ingested or both). Health Canada also posted that recommendation on its Web site

in October 2006, after officials noted the number of authorized users prescribed

at more than 5 g per day had increased to 15% in June, 2006 from 10% a year

earlier.

 

 

 

Alison Myrden of Burlington, Ont., is authorized to take 20-28 g of

marijuana per day to alleviate pain from multiple sclerosis and trigeminal

neuralgia. Her physician did not alter her dosage after a Health Canada phone

call, but Myrden says, "I've been prescribed heroin and cocaine, and I've never

had the issues I've had with marijuana." Photo by: Kevin Frayer, Canadian Press

 

 

 

The lower 1-3-g dose recommendation stems from "an examination of current

available evidence on daily amounts," stated unnamed officials in an email

exchange coordinated by Health Canada spokesperson, Renée Bergeron. Asked to

provide the scientific basis for the dose recommendations, the officials cited 3

studies and "preliminary Canadian research findings."

 

In the first study, Medical Cannabis: Rationale Guidelines for Dosing (IDrugs

2004;7:464-70), Health Canada selectively noted that users in Washington and

California consumed 1.42-2.86 g per day. However, the study authors go on to

recommend a dose range of 0.05-7.40 g per day, and that was for a more potent

form of cannabis currently produced by Health Canada's grower (15%

tetrahydrocannabinol content compared to 12%-plus). Moreover, the study

concluded that considering the complexity of marijuana dosing, from tolerance to

mode of ingestion, the guidelines should be viewed only "as a construct to allow

the physician and patient to develop an individual, self-titration dosing

paradigm."

 

The second study surveyed 916 users in the United Kingdom; a third documented

use among 34 multiple sclerosis patients in Nova Scotia. In the latter 2

studies, consumption was less than 1-2 g per day.

 

Ware authored the UK study and coauthored the Nova Scotia one. In both, he says,

nothing more than a range of use was documented. He notes that marijuana

strength and its form of use can alter its therapeutic effectiveness.

 

Susan Russell, acting director for Health Canada's Office of Controlled

Substances, says ordering patterns under the existing medical marijuana program

support the 1-3-g limit as does "preliminary" Canadian information gleaned from

an "unpublished study."

 

Those preliminary research findings are data from a study by Ware, funded by the

Medical Marijuana Research program, which is not complete. "It is therefore

premature to make any public statements about the study data; our estimates

could yet change with further data collection," says Ware.

 

And while 1-3 g seems reasonable, based on the literature, more research is

needed to be definitive, he says.

 

Medicinal marijuana users are frustrated by the latest twist. Tony Adams of

Victoria, BC, is "furious" about the government's failure to respond to his

letters regarding dosage reductions. Adams, 60, who suffers from degenerative

disc disease and severe arthritis, was licensed for 7 g per day. He was seeking

a boost to 10 g to use as tea, but got approval for 5 g.

 

Health Canada's Russell says the goal of the calls to doctors is merely to

"verify or clarify the proposed daily amount." But some physicians say they have

felt challenged, and have either prescribed lower doses or withdrawn from the

program altogether. "You wonder, like with the narcotic control program, if

they're going to flag the doctors that have high [tetrahydrocannabinol

authorization] practices or something; if you're going to be under scrutiny,"

said one physician on condition of anonymity.

 

"In the pain practice, there is enough potential heat on this that I do not want

to stand out too much," says Dr. David Boyd of Victoria Hospital's London Health

Sciences Centre, London, Ont. He has 50-plus patients using marijuana, and no

longer authorizes more than 5 g per day.

 

University of Ottawa Director of Health Services, Dr. Don Kilby is sympathetic

to Health Canada's dilemma in managing a program that can include people seeking

marijuana without true need, and he also sees the difficulty doctors face in

helping patients whose ailments indicate a need for higher marijuana doses.

Guidelines are needed, Kilby says.

 

Russell says Health Canada doesn't plan to develop guidelines, and doesn't have

any "evidence" that doctors are intimidated by the calls. A small, informal

survey of doctors is, however, underway.

 

The CMA received a letter from Health Canada on May 18 indicating that the

department believes scientific evidence supports lower dose recommendations,

that some patients receive considerably more and that the "apparent discrepancy"

is motivating a partial review of the Medical Marijuana Access Regulations.

Health Canada told CMAJ that amendments may be presented for consultation in

2007 or 2008.

 

CMA Director of the Office of Public Health Dr. Sam Shortt says the CMA does not

approve of how medicinal marijuana is regulated considering the lack of studies

correlating outcomes and dosages. Shortt advises doctors to read credible

studies before authorizing marijuana use and to keep detailed clinical notes.

The Canadian Medical Protective Association recommends physicians ask applicants

to sign a release from liability.

[WantDaChronic]

its sad when politics plays a major part in how much medicinal marijuana a person can get

 

everyone on the planet is different and that means people will need different amounts of the same drug to get the same effects and placing a limit of 3g a day for medicinal patients is no where near enough 3g a day should be a starting point for medicinal patients imo and if that isnt enough their dosages should be increased which is exactly what they do with pharmacuticals so i dont see why pot should be any different

[Alison Myrden]

Neither do I see why pot should be any different than any other drug out there.

Doctor's gave me every drug available in Canada for the terrible pain I have in my face twenty four hours a day, including heroin AND cocaine - but cannabis was the only thing that worked along with some morphine. The combination of those two drugs has changed my life!

 

Good point WantDaChronic. EVERYONE should start at at least 5 GRAMS a day the way it originally was for us.

 

What we say as patents is that it is up to US to decide how much cannabis we require and then for our Doctor's to support us and sign for copious amounts of the plant if that is what is required for relief...

 

I received my FIRST prescription for cannabis in 1995 and have stayed around the same level of both cannabis AND dilaudid (morphine) for all of these years and my Doctor's couldn't be happier!

 

Please people - if you use cannabis as medicine - EDUCATE YOUR DOCTOR'S!!!

 

Drop by www.themarijuanamission.com for more information...

 

Love and stuff,

 

 

Alison

xx