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Health Canada set to release users’
manual for medical marijuana
DEAN BEEBY
Canadian Press
Sunday, July 20, 2003
(CP) – Health Canada is set to release a user’s manual this week for a drug it has long opposed: marijuana.
The unprecedented move has been triggered by the courts, which compelled Health Canada this month to begin distributing government-certified marijuana to a group of patients who take the substance to alleviate symptoms. The department must also release a manual on how to use its dope – but a draft version of the document shows patients will get little practical advice about ingesting marijuana and lots of warnings against using it at all.
"Administration by smoking is not recommended," says the 59-page document, which is modelled on drug product monographs, standard for approved medicines.
"Marijuana can produce physical and psychological dependence and has the potential for abuse."
The March 30 draft document, obtained under the Access to Information Act, warns that smoking marijuana can be more dangerous to the lungs than tobacco, but provides patients no practical alternatives.
"We’re not recommending, in fact, that marijuana be used," Suzanne Desjardins, a Health Canada scientist who helped produce the manual, said in an interview from Ottawa.
"It’s a drug we don’t recommend. If people want to use it, then we’re saying, well, don’t use it by smoking it. . . . There’s no study that demonstrates (in) what form it should be used."
The manual specifically advises against administering marijuana to children up to 16 years of age or to those 65 years or older because "the potential for harm is likely to outweigh benefits." Nursing and pregnant women are similarly urged to steer clear.
Users who do choose to smoke are warned that "smoking should be gentle and should cease if the patient begins to feel disoriented or agitated … naive smokers should take great care and be supervised."
The document, headlined Information for Health Care Professionals, warns of potential panic attacks, psychosis and convulsions in some cases.
"If disturbing psychiatric symptoms occur at the prescribed dosage, the patient should be closely observed in a quiet environment and supportive measures, including reassurance, should be used."
Users are also advised that traces of marijuana remain in the urine for weeks and may turn up in drug tests carried out by employers or police.
Apart from brief sections citing scientific studies on taking marijuana orally – baked in a chocolate cookie, for example – or rectally as a suppository, the manual offers no techniques to avoid smoking.
Experienced, health-conscious users have long turned to tinctures and vaporizers as alternatives to smoking dope, which delivers the main active ingredient, THC, quickly but can harm the lungs.
A doctor based in Berkeley, Calif., who uses marijuana or cannabis to treat patients, posted his own user’s manual on the Internet last Friday, providing detailed advice on non-smoked forms of ingestion.
"For both efficiency and health reasons, I recommend to all my patients that they set a goal of taking all (or almost all) of their cannabis medicines in non-smoked forms, mostly using edibles and drinkables, ‘topping off’ as necessary with vaporization," Dr. David Hadorn wrote on his Web site (www.davidhadorn.com/cannabis/CM-guideline.htm).
Eric Nash, a Health Canada-approved grower of medical marijuana, provided his only customer with a vaporizer, which heats the substance to release THC for inhaling without any burning.
"Vaporizers are very popular with medical users," he said from his Duncan, B.C., home. Nash is one of 32 growers in Canada each licensed to provide one approved medical user with marijuana.
Tinctures can be produced by soaking marijuana leaves and buds in alcohol, which extracts the active ingredient. Drops of the tincture can then be used in cooking or under the tongue.
Health Canada does not approve the use of marijuana, saying clinical studies are needed first to demonstrate whether it is effective as a medicine. However, court decisions have forced it to allow select patients to use marijuana on a compassionate basis.
Desjardins said the dried marijuana that Health Canada will distribute through doctors to some of the 582 approved medical users will have a standard dose of 10 per cent THC.
The cost will be $5 a gram, much less than on the street. The material, grown under contract by Prairie Plant Systems in Flin Flon, Man., and available in 30-gram bags, was originally intended only for clinical trials.
Direct distribution to patients, however, could be cut off within weeks as the federal government mounts a court challenge of the order requiring it to be a supplier.
The Health Canada user’s manual, which will be sent to doctors and posted on the Internet this week, will be accompanied by a two-page information sheet for patients written in layman’s language, Desjardins said.
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