BANFF – Nearly six months after recreational cannabis was legalized, the benefits of medicinal uses for the drug remain inconclusive.
That was the message shared by several Bow Valley doctors who were on hand to discuss the issue during an open house at Banff Mineral Springs Hospital last Thursday (March 21).
“There are really only about six randomized controlled trials that have lasted long enough that inform our decision making when it comes to marijuana, which isn’t terribly robust,” said Dr. Dino Smiljic, who is also the medical director of the Bow Valley Primary Care Network.
“That’s why most family physicians and doctors are reluctant to suggest cannabinoids as a modality for pain management.”
He said most doctors will only prescribe medicinal cannabis when other treatment plans don’t seem to be working, however each patient is dealt with on a case-by-case basis.
For example, he said he would be reluctant to prescribe medicinal marijuana if a patient has used tobacco in their past, or it could impact their mental health. He said doctors also need to be cognizant if someone has an addiction, or struggled with addiction in their past.
“The mental health concerns when it comes to cannabinoids are real,” said Smiljic. “There’s a lot of evidence to show that regular heavy marijuana use is very clearly associated with some bad mental health outcomes.”
He said other factors that doctors must consider is how medicinal cannabis could inhibit a person’s memory and cognitive skills, particularly if that person operates heavy machinery, or works with children.
Dr. Peter Baylis, clinical supervisor for Bow Valley Addiction and Mental Health Services, agreed with his colleague.
“Most of the studies were based on concerns with people’s well-being and focused basically on how is this going to create problems for people, so to go from that body of literature to then try and say what are the medical qualities of it, the truth is we don’t know,” said Baylis.
He said part of the challenge is that there are more than 100 cannabinoids and 420 chemical compounds found in cannabis.
“We haven’t done studies where they’ll isolate these different substances as it relates to a particular disorder, so it creates a real problem for anybody to stand up and say, ‘yes, this will mitigate these harms with this particular condition.’ ”
While there is a lack of evidence that medicinal cannabis is effective at treating mental health disorders, both doctors agreed there is a growing body of evidence indicating it could be used to help physical ailments such as spinal cord injuries and multiple sclerosis.
“The College of Family Physicians of Canada, they recommend that we do not use cannabinoids except for spinal cord injury, MS and certainly avoid any depressive, anxious or PTSD symptoms,” said Smiljic, acknowledging the military believes cannabis can be useful for people with PTSD.
He said part of the reason doctors are hesitant to prescribe cannabinoids for pain is because of the ongoing opioid crisis, which is killing thousands of people across North America.
“Oxytocin came on the market in 1997 and I was told this is a wonderful drug because this is an opioid that you don’t get addicted to and we were wrong, we were lied to,” said Smiljic.
Like Oxytocin, he said there is an economic force pushing doctors and regulators to prescribe medicinal marijuana for pain, however there is insufficient evidence that it is effective.
Baylis acknowledged that some people might find cannabis helps them, however medical regulators must always weigh the burden of the intervention against the side effects or harms it has on the general public.
“We make decisions based on laws of probability and averages,” said Baylis. “That’s an important consideration in healthcare otherwise we would be zigzagging all over the landscape with interventions left, right and centre for every condition because one person said it was helpful.”
Dr. Kathryn Cooke, a pediatrician in Canmore, said cannabis can impair neurological development, particularly for young people when their brain is still growing.
“During adolescence, that is the second time in a individual’s life where the brain is growing at a dramatic rate and if that brain is exposed to the THC it will impair its ability to develop properly,” said Cooke.
“It particularly affects the frontal cortex of our brain and that area of our brain is responsible for what we call executive function,” she said, explaining it helps control emotions, attention, impulse control and reasoning.
Cooke said there is also a higher risk of developing psychosis if the use of cannabis begins earlier in life, or before an adolescent turns 15 years old.
“It also increases if you’ve had one psychotic episode of disorientation and mild hallucination that you recovered from and you continue to smoke marijuana you are at a much higher risk for ongoing psychotic episodes,” said Cooke.
She said the use of cannabis has also been proven to show an impact on adolescents’ cognitive ability and a decline in school.
“School performance declines because it affects working memory and it lasts for days,” said Cooke, adding IQs also drop.
When it comes to medicinal marijuana, she said there have been no studies that have properly examined the impact is has on children.
That being said, she acknowledged there is some evidence that cannabis can help with epilepsy that doesn’t respond to other medications as well as chemotherapy and nausea. She aid there is also some evidence that suggests cannabis can help children with severe autism, physical disabilities or cognitive disabilities.
“Each case that arises in my practice and any of our physician practices is analyzed on a case-by-case basis and trying to make the best possible decision based on the family and the child,” said Cooke, adding inhaling cannabis is not an acceptable form of delivery for children.
“There’s no evidence at this point in time that these products are useful for ADHD, anxiety, depression and autism.”
