After 20 years of medical cannabis, gaps in product testing leave some Canadians feeling like guinea pigs

Rebecca Zak hoped a prescription for medicinal cannabis would help with her insomnia, but the need to experiment with dosages made her feel like “her own guinea pig”.

“I was lying there just in the middle of the night,” said Zak from Dundas, Ont.

“I didn’t know is this what to look for, does this work? So there was a lot of confusion for me,” she told The Current’s Matt Galloway.

Zak asked her doctor about the recipe for cannabis oil. Her doctor advised her to start with a small dose and gradually increase it. When the first recipe didn’t work, she tried a stronger product, but it brought with it some “nasty side effects” – and still no end to her insomnia.

Rebecca Zak tried medicinal cannabis because of her insomnia, but found it didn’t help her insomnia. (Submitted by Rebecca Zak)

According to Health Canada, 321,539 Canadians had active medical cannabis approvals as of December 2020. Researchers suspect the number could be far higher because not all people who use the drug medicinally apply for medical approval.

Although medical cannabis has been legal in Canada for 20 years, cannabis researcher James MacKillop said that not enough is known about the effectiveness or safety of the many products available.

“There isn’t a lot of guidance from doctors or so-called cannabis professionals because there isn’t good evidence for it,” said MacKillop, director of the Michael G. DeGroote Center for Medical Cannabis Research at McMaster University.

With no definitive research, MacKillop fears that “patients may delay or ultimately fail to access evidence-based treatments when using products that ultimately prove ineffective.”

Last month, he was one of more than 200 scientists and clinicians to sign an open letter calling on Health Canada to remove barriers to this type of research.

“There is an urgent need for randomized controlled trials (RCTs) to evaluate the efficacy and safety of the many medicinal cannabis products currently available to patients in Canada,” the letter said.

In Canada, cannabis products are made to safety standards comparable to food or agricultural products, but not to the same standard as pharmaceuticals. This is the benchmark that products must meet in order to qualify for clinical trials.

“The same products that Health Canada has approved for manufacture and sale do not meet their standards for study in studies,” MacKillop said.

Doctors are cautious about medical cannabis use as many products have not yet been clinically tested, says James MacKillop, director at the Michael G. DeGroote Center for Medical Cannabis Research at McMaster University. (CBC)

In a statement to The Current, Health Canada said it is drafting a response to the open letter but that it contains “clinical trial provisions.” [are] in accordance with international standards “and” to protect the safety of clinical trial participants and the integrity of the data generated “.

As a patient, Zak believes that more research into the effectiveness of medicinal cannabis may have saved her “time, money, and discomfort”.

Since then, she has found an alternative relief from her insomnia – reading in the bathtub.

CBC ARCHIVES | Canadians are given the option of medicinal cannabis in 2001:

Today, Canadians can apply for the right to own and grow marijuana. And soon they may be able to buy it from the government. 2:47

The approval of the court created a gray area.

Canada began approving marijuana for medical purposes in 2001 to alleviate the suffering of people with incurable or chronic conditions.

But the nature of that approval is part of the “separation that is really causing a lot of researchers across the country,” MacKillop said.

“It wasn’t approved by Health Canada as a specific drug for any particular indication or condition. It was approved by the courts for people to have access to,” he told Galloway.

“Now there are dozens of licensed manufacturers who have products that people use for a variety of conditions, not just the conditions that the legal cases were based on.”

MacKillop says a “gray area” is emerging where clinical trial licenses are difficult to obtain from Health Canada, even after researchers have secured funding for peer-reviewed studies.

According to ClinicalTrials.gov, a US government database, there are 218 clinical trials of medicinal cannabis around the world, including 18 in Canada.

MacKillop said there is “moderate” evidence that cannabis can help with pain and some other conditions like multiple sclerosis.

But for conditions like anxiety, depression, and PTSD, he said, “the evidence ranges from nonexistent to actually negative.”

Barriers to research jeopardize the potential benefits Canada could derive from legalizing cannabis over many other countries, says George Smitherman, president and CEO of the Cannabis Council of Canada. (Submitted by George Smitherman)

Barriers harm Canada’s industry, research

Cannabis producers are “wholeheartedly focused on researchers” who call for further study, said George Smitherman, president and CEO of the Cannabis Council of Canada (C3), a national industry association.

He believes the research would ultimately benefit consumers.

“I think this is really … driven by the desire to make medical cannabis more effective at targeting people’s ailments,” he told The Current.

Smitherman, who previously served as Ontario’s liberal health minister, said obstacles to cannabis research jeopardize the potential benefits Canada could derive from legalization over many other countries.

“We are really sitting back and missing out on tremendous opportunities to better educate about good and appropriate cannabis use,” he said.

Smitherman said his organization, which accounts for roughly half of the cannabis produced and sold in Canada, has been campaigning for change in Health Canada for months. He said the regulator responded with incremental changes.

We’re really sitting back and missing out on tremendous opportunities to better educate good and fair cannabis use – George Smitherman

In September, Health Canada published clarifications regarding the requirements for conducting clinical research on cannabis. In its statement to The Current, the regulator said it later “heard from stakeholders that more flexibility is needed to facilitate cannabis research in Canada,” and is working to update the clarification.

Smitherman said it would take more than “a few words to clear up” the problem.

“It is really important to convince Health Canada that Canadian medical cannabis research should be recognized as a government priority and that Canada should have the ambition to re-establish itself as a world leader,” he said.

BC woman used cannabis in surgical recovery

Aly Benson has been using cannabis as a medical treatment for six years. She believes that her everyday life would be “very, very painful” without him.

Abbotsford, BC resident initially started using CBD bath bombs to help with nerve damage related to a shoulder injury. When numbness restricted her mobility, she said the baths reduced inflammation.

“Not being able to walk resulted in, ‘Hey, let’s go for a little six-mile walk,'” said Benson, who works for a Toronto-based cannabis e-commerce company. She also volunteers on the Patient Advisory Board of Medical Cannabis Canada, a non-profit patient advocacy organization.

Aly Benson has been using medicinal cannabis for six years. (Submitted by Aly Benson)

Benson says she uses a variety of products – in topical, edible, and inhalable forms – to help with old injuries, as well as anxiety and depression. She also recently had spinal surgery and stopped using opioids. She made her recovery with medicinal cannabis instead, and researched the dosage and treatment regimen herself. It included some physical therapy and massage therapy.

While her recovery has gone well, she said better dosing instructions would be helpful, as well as clearer information about the effects of different products and how to compare them.

In 2019, McMaster University researchers published a review of nearly three decades of data on the use of cannabis to manage pain and whether it was linked to decreased opioid use. No consensus on the research was found.

MacKillop said Benson’s story shows why “people believe it is so promising and why we actually believe that medical cannabis needs further study”.

Worried about addiction problems, MacKillop says that “cannabis use disorders aren’t all that common, but they are a real thing”. (Jack Guez / AFP / Getty Images)

Addiction risk

He fears that people could rely on medicinal cannabis products without evidence that they are effective. And habitual use could pose new problems.

Neuroscientist Sarah Konefal says it’s important to know that people can become addicted to cannabis. She recently told CBC’s The Dose that cannabis use disorders, while uncommon, are one of the greatest risks associated with marijuana use.

Signs of a cannabis use disorder can include using more cannabis than intended and trying unsuccessfully to control cannabis use and the cannabis use that is affecting other areas of your life, said Konefal, a research and policy analyst with the Canadian Center for Substance Use and addiction.

MacKillop is also particularly concerned about the mental health effects.

“I fear that vulnerable people with mental illness see this as a possible miracle cure,” he said.

“And unfortunately the evidence may ultimately not support that.”

Written by Padraig Moran with files from CBC Radio. Produced by Ryan Chatterjee.

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