UBC Reports | Vol. 50 | No. 1 | Jan. 8, 2004

Dying Patients Don't Want to be Stoned

Most want pain relief, not a marijuana high

By Hilary Thomson

Imagine you are dying a slow, painful death and someone offers you marijuana to relieve your pain. How quickly would you take it?

Not so quickly, according to a study done by palliative care expert Romayne Gallagher. Almost 70 palliative care patients were asked about their attitudes and beliefs surrounding medicinal use of marijuana. Gallagher and fellow researchers from the BC Cancer Agency and Vancouver Coastal Health Authority, VGH site, found the patients had a variety of worries and questions.

"These individuals had some real concerns about using the drug -- concerns that were surprising considering these people were at the end of their life," says Gallagher, a clinical professor in the Faculty of Medicine's division of palliative care.

Marijuana has been available for medical use in Canada since July 2001 when Health Canada implemented the Marijuana Medical Access Regulations. A doctor's recommendation allows patients to obtain and use marijuana without prosecution.

Participants in the study -- conducted at cancer centres and palliative care units in Vancouver and Kelowna -- worried that smoking would result in lung problems, that second-hand smoke would harm their families' health and that they might become addicted to the drug.

Gallagher says both patients and doctors often need to be convinced of the value and safety of readily available pain-relieving drugs such as morphine. Some current attitudes mirror beliefs held decades ago. An article from the 1941 Journal of the American Medical Association states that, "The use of narcotics in terminal cancer is to be condemned if it can possibly be avoided... It is well known that small, regularly administered doses may be counted on to cause and maintain addiction...".

Many study participants believed that marijuana is safer than morphine. In reality, says Gallagher, both drugs are safe if used responsibly. Most participants don't want to smoke the drug and they don't want marijuana's side effects.

"They want pain relief -- they don't want to be stoned," says Gallagher.

Study participants -- whose average age was 56 -- also had social concerns about using marijuana. Some, particularly Asian patients, were afraid of neighbours and police finding out.

"It was disturbing to find that most of these patients were willing to try marijuana despite their concerns and lack of information," she says. "They are a very vulnerable population and eager to use whatever works. The only problem is, we don't have clear evidence about how marijuana does work to treat symptoms in dying people."

In addition to a lack of clinical research information, there are significant obstacles in obtaining the drug. Few dying patients have the energy to start their own grow-op. Buying from suppliers, such as compassion clubs established to distribute marijuana for medical use, can cost up to several hundred dollars per month.

Russell Barth, a 34-year-old who takes marijuana for chronic pain and anxiety, reports it took nine months to get the necessary forms processed so that he could obtain and possess the drug. One of the co-founders of the National Compassion Society in Ottawa, he turned to marijuana because he could not tolerate the pharmaceuticals prescribed to him. His roommate uses the drug to help control epilepsy. Together, they have spent up to $500 per month on medical marijuana.

"It's not an easy drug to use -- it's expensive and there's a lot of bureaucracy involved to get it. Health Canada offers marijuana for slightly less money, but it's poor quality and contains chemicals."

In addition to financial barriers to using the drug, there are medical issues to consider. Marijuana interacts negatively with drugs that slow down the central nervous system, including sleeping pills, some pain medications, antihistamines and seizure medications as well as antiviral drugs used to treat AIDS.

Gallagher points out that there have been no clinical trials of marijuana in Canada, leaving patients pretty much on their own to determine what works for them. She would like to see Canada learn from other countries, such as the U.K., which is conducting large marijuana trials.

In the largest investigation ever done on the treatment of multiple sclerosis, U.K. researchers recently studied marijuana use in more that 600 patients and found that although the drug had no significant effect on muscle spasticity (according to an independent assessment scale) the majority of patients felt it had reduced spasticity symptoms and pain. There was also some evidence that marijuana treatment led to improved mobility.

Gallagher would also like to see regulated prescriptions, a standardized route of administration and dosage, and pharamacare coverage of the marijuana pill as a recognized pain reliever.

Pharmacare covers drugs approved for prescription use by Health Canada. A whole-cannabis preparation called Sativex is currently going through the approval process in the U.K., which may lead to approval in Canada, according to Dr. David Hadorn, who has served as a consultant to the B.C. Pharmacare program.

If Health Canada does approve the drug, Pharmacare would then decide if it should be subsidized and what restrictions, if any, should be placed on the subsidies.

For more information about the medical use of marijuana, visit Health Canada's Web site at www.hc-sc.gc.ca.