UBC Reports | Vol.
50 | No. 1 | Jan.
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
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
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
"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
"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
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
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
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.