André Picard Talks Cannabis with UofTMed Clinicians and Researchers

Sep 18, 2018
Carolyn Morris

 David Juurlink, Anthony Feinstein, André Picard, Courtney Brennan and Alan Bell David Juurlink, Anthony Feinstein, André Picard, Courtney Brennan and Alan Bell

“Prohibition will end in one month,” said The Globe and Mail public health reporter André Picard as he kicked off a recent Faculty of Medicine event called UofTMedTalks, focused on cannabis.

“The one thing everyone agrees with is more research is needed. There are so many unknowns.”

Medical professionals are watching the upcoming legalization of recreational cannabis closely. While it has been legal for medical purposes Canada since 2001, there is still confusion and conflicting opinions around benefits and harms — as UofTMed magazine’s Summer 2018 Cannabis Issue recently explored.

In a lively conversation, family physician and professor Alan Bell, occupational therapist Courtney Brennan, psychiatry professor Anthony Feinstein and clinical pharmacology professor David Juurlink joined Picard to debate the potential impact of cognitive impairment, the difficulty of studying a drug that varies so widely from strain to strain, and the reticence of certain professional medical associations to support medical use.

As a family physician who has integrated cannabis into his practice, Bell worries that if the medical stream were to be replaced by the new recreational market, it could have serious repercussions.

“What worries me is the big market is going to be for a product that gets you really high,” he argued. Without a push from the medical community, producers would likely not prioritize oils or capsules with high levels of cannabidiol (CBD) — the compound associated with most health benefits, but not the high.

Instead of the CBD-heavy oils or capsules used for conditions including pain and chemotherapy-induced nausea and vomiting, Bell believes recreational cannabis will lean towards the most well-known psychoactive ingredient in cannabis: tetrahydrocannabinol (THC) — not ideal for medical purposes.

For Brennan, an occupational therapist based at a mental-health clinic, legalization would ideally encourage more of her clients to open up about their current cannabis use.

“Many of our clients use cannabis — but it’s not medical cannabis as psychiatrists typically won’t authorize it,” she explained.

Some of Brennan’s clients credit cannabis with managing their mental health — including quieting voices. She helps explore whether cannabis is helping, or making things worse. And in cases where quitting is not considered an option, she has been able to encourage clients to use less harmful formats, following Canada’s Lower-Risk Cannabis Use Guidelines, such as using oils instead of smoking.

Feinstein, a psychiatrist who treats patients with multiple sclerosis, sees many people who opt to keep using cannabis despite findings of cognitive harm.

Through a series of studies, Feinstein has found cannabis use among people with multiple sclerosis to be associated with a significant decline in cognitive function — lasting long after intoxication has subsided. In one study, he had patients stop using cannabis, and found their thinking sped up over time.

What he found surprising, however, is that when presented with the results at the end of the study, every single patient wanted to start using cannabis again — despite the cognitive trade-off.

“They found cannabis to be helpful,” he says. “It’s a very complex story.”

While cannabis is not free of harms, Juurlink, who is known for his research in drug safety, insists that clinicians shouldn’t just dismiss its use as medicine. Instead, they should consider potential benefits, as well as side effects associated with alternative options.

“Why is it OK for me to prescribe something like OxyContin for chronic pain, but not OK to prescribe an oral cannabinoid?” he says. “Yes, cannabis has harms, but they don’t hold a candle to those of opioids, especially the way they’ve been prescribed for the past 20 years.”

That said, he does worry about the prevalent misconception that cannabis is harmless. It’s not, he argues. “Anyone who suggests cannabis isn’t accompanied by potential harms either hasn’t reviewed or doesn’t have an objective view of the available evidence.”

“I did not say it would be simple or straightforward,” quipped Faculty of Medicine's Executive Director of Advancement Darina Landa as she wrapped up the event. “I said we would explore and inform complex questions — I certainly did not say we’d resolve them.”


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