- While medical cannabis has been legal in Canada for 19 years, doctors still feel uncertain authorizing its use to patients.
- Shoppers Drug Mart, Canada’s largest drugstore chain, is partnering with product quality and verification testing company TruTrace to create an online database to track cannabis quality.
- The goal is to collect data on cannabis products from seed to sale, including a detailed chemistry and genetics of the plant and its metabolomic signatures, to understand what types help which patients.
- “There was this idea that it was going to fix everything from Parkinson’s to Alzheimer’s to osteoarthritis to multiple sclerosis, but where’s the evidence?” said Dr. Hance Clark, who’s been working with Shoppers for the past four years. “The answer is, there isn’t much. It’s all anecdotal. So then the question is, how could we do this better, how could we change the system?”
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Medical cannabis has been legal in Canada since July 30, 2001. Despite this, only a small number of doctors — around 5%, according to one source at the University Health Network of Toronto — will authorize cannabis use for medical purposes to patients.
“I’m not surprised that it’s at that level,” said Dr. Jill Osborn, an anesthesiologist at St. Paul’s hospital in Vancouver, British Columbia, who specializes in pain management. “There isn’t good literature out there with regard to the use of cannabis and pain.”
Osborn said that while there was some literature that was “optimistically supportive,” there was a dearth of interest from both the government and from Big Pharma in financially supporting more research.
Doctors describe an industry that, despite being 19 years old, is still chaotic and largely unregulated. Issues with black market seeds, or illegal products still on the market, make it hard to confirm that the cannabis is coming from legitimate sources. This means doctors are hesitant to authorize, or even suggest, cannabis use for patients.
They also can’t vouch for what’s actually in the drugs.
“We don’t know right now what the dose is, what strain to use, for how long the patient should be taking it,” Osborn said.
Any doctor would be cautious in this situation, said Mitchell Shannon, the publisher of the Canadian Journal of Medical Cannabis. According to him, there just isn’t enough literature out there right now to draw definitive conclusions about the perceived benefits of cannabis.
“The medical evidence supporting cannabinoids for most disorders is scant,” he said. Shannon added that most of what his journal publishes will be, for example, small studies that were conducted on only a few people by one doctor in Israel, or historical looks at how medical cannabis was used around the world. But both Shannon and Osborn said there are few, if any, large empirical studies on cannabis being medically beneficial.
Inching toward a solution
Shoppers Drug Mart, Canada’s largest drugstore chain, is attempting to mitigate confusing guidelines and information around cannabis use with a new partnership with the California-based TruTrace, which does product quality and verification testing. The two are creating a new online portal, called Medical Cannabis By Shoppers Drug Mart, accessible to both patients and doctors that will track exactly what strains of flower, how many milligrams of THC, and what kinds of chemicals are in the products.
Shoppers has been a licensed provider of medical marijuana since 2018, according to the Toronto Star. It doesn’t produce the drug itself or sell it in stores, but a Shoppers spokesperson said that it’s available on their website.
Dr. Hance Clark, the director of pain services at Toronto General Hospital, has been working with Shoppers on this project for the past four years. Using the Shoppers database, he’s now leading a study to look into chronic pain management using cannabis. The study, in part, will allow patients to track what cannabis products they take from seed to sale.
Clark said that at the time when legalization went en vogue, the media was painting a picture of a weed utopia where cannabis could cure everything.
“There was this idea that it was going to fix everything from Parkinson’s to Alzheimer’s to osteoarthritis to multiple sclerosis, but where’s the evidence?” Clark said. “The answer is, there isn’t much. It’s all anecdotal. So then the question is, how could we do this better, how could we change the system?”
The idea of the database is to create a standardized system with traceable data for each batch of cannabis flower in order to better understand what strains of cannabis work for which patients.
The information is rendered such that a doctor can see that, for example, one oil has 250 milligrams of THC, while another strain has a certain percentage of CBD. According to Robert Galarza, the CEO of TruTrace, the database will have “all data points” relevant to the cannabis strain in question, including a detailed chemistry and genetics of the plant and its metabolomic signatures.
“This is about an industry going from being illegal to trying to be legitimate,” said Ken Weisbrod, the vice president of business development for Shoppers, who’s been spearheading the effort to get Medical Cannabis By Shoppers Drug Mart up and running. “This is about getting doctors to a confidence level that they see this as being on par with other medicines.”
Clark said he’s had patients in the past who’ve found cannabis products that were somewhat useful to them, but then four to five months later the effect wore off. “With batch to batch variation, the substitution of products, you’re never really sure what’s arriving at your door,” Clark said. “Doctors don’t have the randomized control trials and don’t know what people are consuming enough to gauge the outcome. Why would a doctor step into this game without any evidence or knowledge?”
“The foundations of getting robust information starts with collecting consistent data,” Weisbrod said. “We’re all about getting that foundation. We want to start getting material and get a robust look and how this can help patients.”
An alternative to opioids
Hanging over all of this is the shadow of the opioid epidemic and the undue number of deaths and pain it has caused. According to the Canadian health ministry, in 2017 alone, 11 people died every day of opioid overdoses, and the fastest growing population of opioid users are 15 to 24 year olds.
“I think we’re a very conservative bunch,” said Dr. Catherine McCauig, a dermatologist in Québec. “We’re not very comfortable with something we don’t know. Every now and then I run across a patient that has pain, and I think it would be nice for them to have an alternative [to an opioid]. But, we’re afraid.”
The fact is that cannabis is still a controlled substance in many places. In the US, marijuana is still a Schedule I narcotic, according to the Drug Enforcement Administration.
“We have a strong association with cannabis being weed, and all the stigma that goes with that,” said Clark. “And doctors do live with that stigma.”
“You have no idea what this stuff means or what the implications are for a patient’s health,” Shannon added. “You might be inviting some catastrophe.”
That doesn’t mean this won’t change. Osborn compared the evolution of weed as a medicine to similar progressions that the medical community has seen in the past.
“If we jump back centuries, where did morphine come from? It was opium. It was used in multiple different tinctures, and it was studied and became understood,” she said. “Aspirin came from willow bark. They used to just chew on it, and now we know correct dosages and there’s a pill. Digoxin [a drug used to treat heart failure] came from foxglove.”
But as with all of these medicines, figuring out their dosages, the most effective delivery method, and their side effects took time, research, and money to develop. With this new database, Clark, Weisbrod, and Galaraza hope they can at least get a jump on the research side.