Tag Archives: ‘Marijuana

U.S. CDC recommends against using vapes with marijuana ingredient

People should stop using e-cigarettes with the marijuana ingredient tetrahydrocannabinol (THC), U.S. public health officials recommended on Friday as investigation on outbreak of lung illness linked to vaping deepens.

The U.S. Centers for Disease Control and Prevention has previously warned on vaping, but its latest recommendation focused on THC products following U.S. data that pointed to a large number of cases related to the use of the high-inducing component of marijuana.

The CDC and state health officials, along with other health agencies, are investigating 805 confirmed and probable cases and 13 deaths so far from a mysterious respiratory illness tied to vaping, as of the latest update on Thursday.

For the 771 people with basic patient data, 91 per cent were hospitalized. Many need supplemental oxygen and treatment in intensive care units. Most recovered and went home. 

“We do not know yet what exactly is making people sick, for example, whether particular solvents or adulterants are leading to lung injury, or whether cases stem from a single supplier or multiple ones,” Dr. Anne Schuchat, principal deputy director of the CDC, told reporters. 
 
Separate data from Wisconsin and Illinois showed that although no single brand name was reported by all patients, two-thirds of consumers reported using a prefilled-THC cartridge called “Dank Vapes.”

In Canada, a Quebec resident has been diagnosed as the country’s first case of a severe vaping-related breathing illness, federal officials confirmed on Friday.

Last week, officials in Ontario reported a teenager was put on a ventilator after using a vaping device. However, that case has not yet been confirmed under the federal definition. 

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Chocolate in marijuana brownies can throw off potency tests

How much marijuana is really in that pot brownie? Chocolate can throw off potency tests so labels aren’t always accurate, and now scientists are trying to figure out why.

In states where marijuana is legal, pot comes in cookies, mints, gummies, protein bars — even pretzels. These commercial products are labelled with the amount of high-inducing THC. That helps medical marijuana patients get the desired dose and other consumers attune their buzz.

But something about chocolate, chemists say, seems to interfere with potency testing. A chocolate labelled as 10 milligrams of THC could have far more and send someone to the emergency room with hallucinations.

The latest research on chocolate, to be presented at a San Diego meeting this week, is one example of chemistry’s growing role in the marijuana industry. Besides chocolate’s quirks, chemists are working on extending shelf life, mimicking marijuana’s earthy aroma and making products safer.

Chemists working for marijuana companies and testing labs are developing those standards and some are legally protecting their ideas.

Scores of cannabis-related inventions have received U.S. patents, said Boston attorney Vincent Capuano, who holds a doctorate in organic chemistry. Inventors have patented ways of putting cannabis into milk, coffee pods, ice pops and chewing gum.

“There’s a lot of flash and hipness, snake oil and marketing. But there’s still a lot of real chemical advance happening,” Capuano said of the industry. “It’s right in centre field for chemists.”

Marijuana contains hundreds of chemicals, including cannabinoids such as THC and CBD, a trendy ingredient with unproven health claims. Some pose challenges when they’re processed. Chocolate is a good example.

“The chocolate itself is affecting our ability to measure the cannabinoids within it,” said David Dawson, chemist and lead researcher at CW Analytical Laboratories in Oakland, Calif., which tests marijuana.


Cannabis-infused chocolate presents problems for potency testing. (Kevin Kerr)

The more chocolate in the vial, the less accurate the test results, he found. He thinks some of the THC is clinging to the fat in chocolate, effectively hiding from the test.

Dawson’s research is on the agenda at the American Chemical Society meeting in San Diego. The conference includes 20 presentations about marijuana’s technical challenges, said Markus Roggen, a Vancouver, British Columbia-based chemist organizing the program. That’s a big change from a few years ago when presenters didn’t get much beyond the basics such as: “This is THC. This is CBD.”

Some in the marijuana industry hold “a mythical belief in the goddess of cannabis,” Roggen said, but chemists view marijuana more objectively. For its part, the industry is learning to accept the “new guard of scientists with a different approach to the plant,” he said.

Fighting ‘true nature of the THC’

Another focus of research is a group of chemicals called terpenes that give the marijuana plant its pungent aroma. Many terpenes get lost or changed in the process of making a THC or CBD extract. But users want a certain smell and taste, said chemist Jeffrey Raber.

Raber heads the Werc Shop, a Los Angeles company that mixes terpenes from lavender, oranges, black pepper and other plants to mimic the flavour and scent of cannabis varieties. The mashups are sold to companies who add them to oils, tinctures and foods.

Monica Vialpando, a San Francisco chemist, is working to prevent drinks with CBD and THC oils from separating into unappealing layers while sitting on the shelf. The oils don’t dissolve in water, a problem for companies trying to create new drinks.

“We’re fighting against the true nature of the THC,” Vialpando, who came to cannabis from the pharmaceutical industry.

Chemists solve the problem by increasing the surface area of the oil particles and adding ingredients, called surfactants and emulsifiers, to prevent separation.

She said consumers should be skeptical of outrageous claims for edibles and beverages, including that all the THC or CBD in product will be absorbed. Some potency will always be lost in the digestive system before it hits the bloodstream, she said.

But for now, exactly what happens in the human body with most of these products is unclear, Vialpando said, because there’s been very little safety testing of cannabis emulsions in animals, much less in humans.

In Ottawa, a Canadian government lab is working on a sensor to help police identify stoned drivers. The goal is to detect cannabinoid molecules in saliva or breath droplets, using light and nanoparticles. Still years away from roadside use, the technology might someday also be used by marijuana growers to determine the peak time to harvest, said chemist Li-Lin Tay, who leads the work for National Research Council of Canada.

To do his work with chocolate, Dawson grinds a THC- infused chocolate bar in a commercial food processor, weighs samples, adds solvent to the material (“It starts looking like chocolate milk,” he says), before measuring the THC potency. He’s tested cocoa powder, baking chocolate and white chocolate to try to determine what ingredients are hiding the THC during testing.

This will lead to better testing standards and safer products, he said.

“We need good ‘capital S’ science,” he said.

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How workers compensation is being dragged into the world of medical marijuana

As Melissa Ellsworth drops several grams of dried cannabis into her Magical Butter machine to be ground into oil, she pauses to reflect on how long it took the Workers' Compensation Board of Nova Scotia to start paying for her medical marijuana.

Five years and one tribunal appeal later, she was finally approved in January 2018. The tribunal decision stated there was "sufficient evidence to conclude that the worker is entitled to medical aid in the form of medical marijuana." 

She says that ruling saved her life.

"I can function every day like a normal human being instead of being crippled up in pain," said Ellsworth. "I went from 26 pills a day to cannabis." 

For almost a decade, Ellsworth was on a mixture of opioids, benzodiazepines and sedatives. 

She suffers from chronic pain in her neck, head, jaw and shoulders after being struck in the head with a chair while working as a licensed practical nurse in 2006 at the Nova Scotia Hospital, a psychiatric facility in Dartmouth, N.S. She has been off work since 2010.

Several grams of cannabis are dropped into a Magical Butter machine to make oil. Ellsworth uses the liquid in her food and coffee as well as creams and bath bombs. (Craig Paisley/CBC)

Her tribunal victory comes as workers compensation boards across the country are being forced to revise their restrictive policies around medical cannabis as more patients look for forms of pain relief other than opioids.

Last year, New Brunswick was the first province to introduce cannabis guidelines. It was followed by P.E.I. and Ontario. Nova Scotia is expected to release its guidelines in early April.

Number of claims

But getting cannabis coverage approved through a WCB still isn't an easy process in any province.

Ellsworth is one of 10 workers in Nova Scotia who have qualified. P.E.I. and Alberta have similar numbers. Of the provinces that disclose how many workers are compensated for medical marijuana, New Brunswick has the highest number of claims at 71.

Half of the provincial bodies would not say how many cannabis prescriptions are paid. In all regions, coverage is reviewed on a case-by-case basis. 

In comparison, Veterans Affairs Canada approved more than 7,000 veterans at a cost of $ 50 million in 2017-18. 

Cannabis guidelines

In Nova Scotia, the chief medical officer for the WCB admits the position on cannabis has traditionally been a firm "no." But that has changed in the last year, according to Dr. Manoj Vohra.

"We're starting to see that more evidence is coming, more workers are asking for it and so now we're starting to develop criteria on guidelines," he said.

Vohra said the medical evidence shows that cannabis, especially cannabidiol (CBD) — the non-impairing compound — can help people with chronic illnesses such as cancer and HIV, as well as those suffering from neuropathic pain. 

"If cannabis does help them in those areas where there is evidence, then we're more than open to trying to see how we can do that," he said. "The challenge always comes in with harm. There's not enough clinical trials that actually go through. What are the side-effects?"

Dr. Manoj Vohra, chief medical officer for the Workers' Compensation Board of Nova Scotia, says there is a reluctance to overprescribe a medication such as cannabis that hasn't been fully researched. He says doctors are especially wary after witnessing the fallout from the ongoing opioid epidemic. (Robert Short/CBC)

Dr. Vohra said there is a collective fear among his colleagues about overprescribing a medication that hasn't been fully researched. He points to the ongoing opioid epidemic as a prime example.

"What's happened 10 to 15 years down the road is we've realized that there's harm that occurs," Vohra said. "And so we want to make sure we don't repeat those mistakes from the past and that we use it and understand what are the risks, what are the contraindications to using it."

In February 2017, 1,543 workers had the cost of their opioid prescriptions covered by the WCB in Nova Scotia. In February 2019, that number dropped to 1,315 workers.

Long overdue

Dr. Mary Lynch, a pain specialist and cannabis researcher in Halifax, said the introduction of cannabis guidelines for injured workers is "long overdue."

"If first- and second-line treatments aren't working, then we will sometimes recommend a medical cannabinoid, depending on the patient's specific presentation," Lynch said. 

"And for those who do benefit, we have run into difficulties with the workers compensation board agreeing to cover the cost."

Lynch is a founding member of the cannabis research startup Panag Pharma Inc., which she and other academic researchers incorporated in 2014 to access research grants.

She hopes Nova Scotia's new guidelines will give weight to a doctor's prescription.

"I'm hoping that the policy will be written in a way that as long as a physician has recommended it, the access will be reasonable, just like it is with any other prescription medication."

As it stands, only Quebec depends on medical advice from the worker's doctor. All other provinces, including ones with guidelines, have their own team of doctors to evaluate claims from injured workers.

Continuous struggle

For Ellsworth, the struggle continues even though she is one of the few who have successfully lobbied for medical marijuana coverage in Nova Scotia.

She was originally prescribed four grams per day. Last August, her family doctor increased her dose to five grams, but that has not been approved by WCB.

"My only job as an injured worker is to take the best care of myself to prevent further injury. I'm trying to do everything I can possible by avoiding addictive medications and everything else. And they're fighting me. They're making it very hard to do," said Ellsworth.

She has appealed her claim to have that extra gram covered, knowing that it will likely lead to another tribunal — a process she has been through eight times for various issues over the years.

"I mean, I've won eight tribunals. How many more do I have to win?" she said.

"Every time I go through a tribunal, I have to live through all that again. And I will be honest, between my employer, workers compensation and everything … it was a nightmare. An absolute nightmare that I would rather not relive again."

Varying doses

Guidelines developed by New Brunswick, P.E.I. and Ontario have set a maximum dose of three grams per day. While Lynch agrees that is an appropriate limit, she also believes some patients may need more.

"You do need to take each of these things on an individual basis, and these days many people are using topical products where you put the agent into a cream, and in that case you do need access to a bit more of the product," the pain specialist said.

The Workers' Compensation Board of Nova Scotia pays for 10 cannabis prescriptions. Of the provinces that disclosed how many workers are compensated for medical marijuana, New Brunswick has the highest number of claims at 71. (Robert Short/CBC)

When it comes to THC levels, the Maritimes set a limit of no higher than one per cent. Ontario allows up to nine per cent. THC is reported to have therapeutic effects but also to be chiefly responsible for the psychotropic effects of cannabis, according to the Workplace Safety and Insurance Board of Ontario.

"I know that each province has to come up with their own answers," Lynch said. 

"One would hope, though, that things will move forward within a reasonable length of time [and] perhaps the wheel doesn't need to be reinvented in every province."

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New guidelines may reduce risk of legal marijuana in youth

Last October, recreational marijuana became legal in Canada. But concerns remain about the impact on the health of young people in particular. Experts say a new set of guidelines published recently in the American Journal of Public Health might help lower the risk. 

Researchers from Canada, the Netherlands and Australia looked at studies that focused on adverse health effects from recreational use of marijuana and came up with recommendations on how to lower the risk. They deliberately excluded studies involving patients on medical marijuana.

The researchers concluded that abstinence is most effective way to avoid health problems. Failing that, the researchers found that daily or near-daily use of marijuana is a strong predictor of mental health problems, heart problems, motor vehicle collisions, and thoughts of suicide. They also found evidence that frequent use is linked to changes in the brain and can impair cognitive abilities like memory and executive function. They said the surest way to avoid these effects is to limit use of cannabis to once a week.

The researchers also concluded that the type of marijuana consumed can affect the risk. In general, marijuana products have shown a steady increase in the levels of tetrahydrocannabinol or THC.  In the past, marijuana may have contained five or 10 per cent THC. Now, it's more like 20 to 25 per cent. High THC levels increase the risk of mental health problems and dependence. A study in the United Kingdom found that high levels of THC tripled the risk of psychosis disorder and marijuana-induced psychosis in young people with no psychiatric history. High THC content has been associated with more marked effects on memory.

Stay away from synthetic products

The guidelines recommend that users know the THC content of the marijuana products they use and to choose products that are low in THC. More recently, synthetic marijuana products such as Spice and K2 have become available with concentrations as high as 80 or 90 per cent. Synthetic marijuana has been associated with acute delirium, psychosis, anxiety, strokes, seizures, heart attacks, and even death. The guidelines recommend that users stay away from synthetic products.

Smoking remains the most frequent way of using marijuana. The risks of smoking include coughing, phlegm, wheezing, bronchitis, shortness of breath and impaired respiratory function. These can happen with smoking low-strength marijuana, but the effects go away when you stop smoking. Some studies have suggested an increased risk of emphysema and even lung cancer, but the evidence is weak.

Bongs or water pipes reduce the inhalation of burnt particles but increase other risks. Still, the guidelines say it's generally preferable to avoid smoking combusted marijuana by using vaporizers or edibles. The guidelines also strongly discourage high-risk practices like deep inhalation, breath holding or performing the Valsalva maneuver (bearing down while holding one's breath) when smoking marijuana. These practices disproportionately increase the risk of toxic material getting into the lungs.

Benedikt Fischer, right, speaks in Ottawa last June as they released guidelines aimed at lowering the health risks of cannabis use. Canada needs to move away from what Fischer refers to as "the simplistic binary" that sees marijuana as good or bad. (Sean Kilpatrick/Canadian Press)

The researchers found substantial evidence that driving while impaired from marijuana is associated with an increased risk of motor vehicle collisions. Not surprisingly, the guidelines state that users should categorically refrain from driving or operating other machinery or mobility devices for at least six hours after using marijuana. The guidelines add that depending on the user and the properties of the specific product used, the wait time may need to be longer. The use of both marijuana and alcohol should be avoided because the combination multiplies the risk of impairment. In jurisdictions where driving while impaired laws are stricter than these guidelines, the law takes precedence.

As well, people at higher risk of adverse effects should refrain from using marijuana. They include those with a strong family history of psychosis or substance use. They also recommend that pregnant women avoid using marijuana.

In an email, Benedikt Fischer, the lead author of the guidelines and one of Canada's leading authorities on drug use, said he and his colleagues have been working with the Public Health Agency of Canada and other leading national stakeholder organizations to disseminate the guidelines as broadly as possible. In particular, he said that Canada's Chief Public Health Officer Dr. Theresa Tam has "actively embraced, launched and promoted the guidelines" along with Fischer and his colleagues.

Their view, now that recreational marijuana use is legal, is that Canada needs to move away from what Fischer refers to as "the simplistic binary" that sees marijuana as good or bad and therefore to be used or avoided. He says the guidelines help shift the conversation to "a public health paradigm" in which users know the risks and are given advice on how to  manage them.

The Centre for Addiction and Mental Health has published a summary of the 10 recommendations aimed at the general public.

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Just 1 or 2 experiences with marijuana may alter teen brain

Teens who use pot just one or two times may end up with changes to their brains, a new study finds.
 
There were clear differences on brain scans between teens who said they had tried cannabis a couple of times and those who completely eschewed the drug, researchers reported in the Journal of Neuroscience.
 
There have been hints that even small amounts of pot at a young age might impact the brain, said the study's lead author, Catherine Orr, a lecturer at the Swinburne University of Technology in Melbourne, Australia. "Research using animals to study the effects of cannabis on the brain have shown effects at very low levels, so we had reason to believe that brain changes might occur at even the earliest stages of cannabis use," Orr said in an email.
 
Still, she said, "I was surprised by the extent of the effects."


 
With an estimated 35 percent of U.S. teens using cannabis, the new findings are concerning, the researchers noted.
 
Orr and her colleagues saw widespread increases in the volume of grey matter in brain regions that are rich with cannabinoid receptors. Grey matter, which is made up of nerve cell bodies, is involved in sensory perception and muscle control.
 
To take a closer look at the impact of mild marijuana use in developing brains, Orr’s team analyzed brain scans gathered as part of the larger IMAGEN study, which was designed to look into adolescent brain development.
 
The researchers analyzed images from 46 14-year-olds who said they had used marijuana once or twice, as well as images from 46 non-cannabis using teens matched “on age, sex, handedness, pubertal status, IQ, socioeconomic status, and use of alcohol and tobacco,” Orr said.

Brain volume

The researchers spotted clear differences between the two groups, which they suspect are due to the low-level pot use. 

They acknowledge that the study didn't actually prove that marijuana led to the differences seen in the scans. It's possible that those who chose to use weed were different to begin with and that the marijuana hadn't played a role in brain development.


 
To try to address this question, the researchers analyzed scans from a third group of teens who had not tried marijuana before they had their brain scans at age 14. By age 16, 69 of these kids said they had used marijuana at least 10 times. But their brain scans at age 14 looked no different than brain scans of other kids who had not taken up cannabis by age 16  which meant there wasn’t any inborn brain difference that would have predicted who would later become a pot user.
 
There may be serious implications to the brain changes noted by the researchers. “In our sample of cannabis users, the greater volumes in the affected parts of the brain were associated with reductions in psychomotor speed and perceptual reasoning and with increased levels of anxiety two years later,” Orr said.
 
The reason for the higher volume of grey matter in cannabinoid-rich regions of the brain may be related to a normal process called “pruning” which may go awry when kids use marijuana, Orr said. As young brains develop, unnecessary or defective neurons are pruned away, she explained. When the system doesn’t work correctly, those cells remain in place.
 
The new findings are a step toward understanding the impact of cannabis on young brains, said Dr. Michael Lynch, a toxicologist and emergency medicine physician and director of the Pittsburgh Poison Center at the University of Pittsburgh Medical Center. “It’s important that there was a change,” Lynch said. “Adolescent brains are going to be more vulnerable to anything drug or environmentally related.”
 
If pruning isn’t working right, “the brain may not work as efficiently as it should,” Lynch said. “But I don’t think we can make a final determination on that from this study.”

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Thailand moves to legalize medical marijuana and another drug

Thailand's legislature has agreed to amend the country's drug laws to allow the licensed medical use of marijuana, as well as kratom, a locally grown plant traditionally used as a stimulant and painkiller.

Thailand on Tuesday became the first country in Southeast Asia to take such action, which is also under consideration in neighbouring Malaysia. New Zealand's government earlier this month enacted a law liberalizing the medical use of marijuana, which had previously been tightly restricted.

The Thai legislation passed its final reading at the National Legislative Assembly by a vote of 166-0 with 13 abstentions.

The changes, which become law when published in the Royal Gazette, legalize the production, import, export, possession and use of marijuana and kratom products for medical purposes.

Purveyors, producers and researchers will need licences to handle the drugs, while end-users will need prescriptions.

Recreational use of the drugs remains illegal and subject to prison terms and fines commensurate with the quantities involved. As with most countries in the region, illicit drug trafficking can be punishable by death. 

Kratom, a coffee-like plant native to Southeast Asia, is sometimes taken by people to treat opioid addiction. (Earth Kratom)

Public hearings showed overwhelming support for legalizing medical cannabis and kratom, a substance produced from the leaves of a tropical tree. Kratom is sometimes taken to treat anxiety, opioid addiction, depression and other conditions, but is also used recreationally for its mild psychotropic effects. 

The bill introducing the legislative changes had noted that recent studies have shown marijuana extract has medicinal benefits, which has prompted "many countries around the world to ease their laws by enacting legal amendments to allow their citizens to legally use kratom and marijuana for medicinal or recreational purposes."

It added that despite being classified as an illegal drug, many patients have used marijuana to treat their diseases.

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Is marijuana really a performance enhancer?

During his lengthy figure skating career, Dylan Moscovitch had to learn how to deal with immense pressure.

He also had to deal with the physical rigours of the sport. He navigated both successfully, retiring earlier this year after a career that included multiple podium finishes, Canadian championships and an Olympic silver medal.

There were lots of things Moscovitch did (all legal) during his career to gain a physical and mental edge.

Cannabis was never one of them.

"I don't think I would make it through a program," Moscovitch laughed when asked if he ever contemplated skating high.

"It was talked about — but I don't think athletes in my sport thought marijuana would be a performance-enhancing drug. Alcohol is legal. Alcohol is permitted. I think a lot of people thought it was along the same lines."

Moscovitch has stepped away from competitive skating and moved on to the next chapter of his life. And even though recreational cannabis is now legal in Canada, he still believes acknowledging or promoting its usage can damage an athlete's reputation.

"I think it would taint what I've done and probably change people's view of me as an athlete and a person," he said.

Use not consistent with elite athletics

Moscovitch says he never saw cannabis use being consistent with elite athletics.

"When you compete at a high level, you have to see yourself as a role model and you have to behave accordingly. And for younger generations, it's important to set the tone for them so they understand what it takes to be successful. There is a weight on your shoulders that you have to adhere to those types of views."

Since recreational cannabis became legal in Canada last month, many sectors of society have had to define rules that govern interaction with the substance.

Police forces across Canada, for example, have come up with different directives for how close to a shift an officer is permitted to consume cannabis. The Canadian Forces also had to come up its own set of rules.

Jamie Strashin looks at how pro sports leagues are handling legalized pot in Canada:

CBC Sports' Jamie Strashin discusses how the major sports leagues will handle legalized cannabis in Canada. 4:58

Canada's amateur or high-performance athletes face their own rules. Cannabis is on the World Anti-Doping Agency's list of banned substances. WADA considers it to be performance-enhancing and harmful to an athlete's health, and continues to test for it during competition.

"The professional leagues are looking at it more as a kind of code of conduct thing, a gateway drug to other drugs, a sign of a drug problem if you use marijuana — and we don't take that approach," said Paul Melia, the head of the Canadian Centre for Ethics in Sport, which is the body responsible for drug testing Canadian athletes. 

Canadian Centre for Ethics in Sport president Paul Melia says he doesn't agree with WADA's stance banning cannabis use for high-performance athletes. (Chris Wattie/Reuters)

At the same time, Canada has pushed WADA to remove cannabis from the banned substances list.

Needs a closer look

"There are those who say it inhibits fears. So it allows an athlete to take greater risks in high-risk sports. There are even those who suggest that it adds to an athlete's creativity in sports where creativity may be of some value," Melia said.

"I think a closer look at the scientific literature would suggest it's equivocal when it comes to its performance-enhancing benefit. We've never wanted the Canadian anti-doping program to be used to police recreational drug use by athletes."

In a sport like figure skating, Moscovitch says consuming marijuana would not enhance performance.

"In our sport, there is so much going on: it's very fast-paced, there's lots of balance involved," he said. "Also in pair skating, you have a relationship with another person on the ice that's relying on you. If you are in another place, they will know right away.

"If you lost your focus or you forget a specific thing and change your pattern all of a sudden, you're 10 feet from your partner and it ruins the next element and the set up for the one after. It's potentially dangerous."

The medical evidence — or lack thereof — supports what Moscovitch and Melia are saying about cannabis use.

"If you look at the potential to enhance sport performance, the reality is the evidence just doesn't exist. There's been a couple of older studies, really only two, that I'm aware of," said Dennis Jensen, an associate professor of kinesiology and physical education at McGill University.

While it's unclear whether cannabis acts as a performance enhancer, Jensen said there's a danger in imposing restrictions based on anecdotal evidence. He points out that drugs only make it to market after rigorous testing — and that just hasn't yet happened with cannabis.

"You don't necessarily take something off a list if it also hasn't undergone rigorous testing," he said.

'We don't have the evidence'

Mixed martial arts is an example of where marijuana use could be both an advantage and a disadvantage, Jensen suggests.

"You may have increased confidence, lowering of anxiety that could be potentially performance-enhancing. But if you offset that with slower reaction times, you could argue that you feel better — but you're slower and you're going to get punched more. So I don't really think, in the end of it all, we know. We don't have the evidence."

Jensen and his colleagues at McGill recently published a paper exploring cannabis and athletic performance. He expects an influx of similar studies as academics attempt to fill in the blanks and provide strengthened rationale for rules governing cannabis use across all sectors of society, including sports.

"I think we are in a very prime and timely period to advance this area of research very, very aggressively," he said. "Maybe confirm some of these anecdotal reports or debunk them completely."

Athletes like Dylan Moscovitch, from his retirement perch, will be watching.

"It's going to be very interesting to see how society adjusts its view, whether there is still the same stigma that comes along with it. Everyone is different but it's very important for athletes to be able to relax and blow off steam," he said.

"Whether that's a couple of drinks with our friends, or meditating, or watching television, or whether that's having some sort of cannabis product. We'll see what happens and I think people having an open mind is super important because everyone has different needs."

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OMA president's comments, apology raise questions about stigma around marijuana

With legalization of recreational marijuana only days away, a leading Ontario doctor is backtracking after she voiced uncertainty around its safety.

Dr. Nadia Alam, president of the Ontario Medical Association, apologized Saturday after suggesting that smoking a joint could act as a gateway to harder drugs in a Thursday CBC Radio interview. 

"What I would say is that I misspoke, I misunderstood," she told CBC Toronto Saturday.

Dr. Nadia Alam, president of the Ontario Medical Association, said she misspoke when she said on CBC Radio's London Morning Thursday that recreational cannabis can cause anxiety, withdrawal symptoms for people who become addicted, and lead to the use of other, more serious drugs like crack cocaine. (CBC)

Alam woke up to a flurry of backlash on social media Saturday morning after a London Morning segment on her stance regarding the side-effects of recreational marijuana aired Thursday.

In addition to saying that marijuana could act as a gateway drug, she said in the interview that recreational use can play a role in causing anxiety and withdrawal symptoms for people who become addicted to it.

Now, she says she is glad her medical colleagues were able to offer their perspectives on the matter and "gently" corrected her.    

"I take my responsibility to provide solid information to my patients, the public, my colleagues, very, very seriously," she said. "I felt a lot of remorse for having made a mistake, so that's why I took corrective action." 


Alam did say, however, that the risks surrounding recreational marijuana need to be taken into account by both the medical community and patients. 

In a Nanos study commissioned by the OMA, 53 per cent of respondents said they believed there is a significant difference between recreational and medicinal marijuana. Moreover, 53 per cent of respondents replied that they would be unlikely to confide in their doctor about their recreational marijuana use.  

Alam went on to cite the dangers and increased reporting of cannabinoid hyperemesis syndrome in emergency rooms. The syndrome involves repeated vomiting, nausea and stomach cramps. Chronic marijuana users, usually those who use it on a daily basis for more than a year, are at the most risk of experiencing the symptoms.  

"That's what I mean about informed decision making," Alam said. "This isn't about making judgments. This isn't about trying to impose my own value system or someone else's value system on a patient."

'There is still a lot of stigma'

Cannabis activist Jodie Emery says misinformation can only harm Canadians. 

Jodie Emery, long-time marijuana activist, holds up a joint while speaking before the House of Commons health committee on the government's legal pot legislation last year. (CBC)

"When doctors spread this kind of fear about cannabis being a gateway drug to harder drugs, they're perpetuating the 'reefer madness' we're supposed to be moving away from."    

Emery says the stigma exists because the government and medical community's attitude toward recreational marijuana focuses on harm. She says after legalization the stigma may change, but it will take time.       

"The stigma will start to break down and that is a net benefit, but people still need to be aware there is still a lot of stigma, still a lot of discrimination."

A second opinion

Dr. Michael Verbora, who has been working in the field of cannabinoid​ medicine for about four years and serves on the Ontario Medical Association as a district delegate, says that Alam was presenting information that was not up to date.

Dr. Michael Verbora, medical director of Aleafia Medical Cannabis Care, says the medical community is resistant to incorporating newer research on marijuana into practice. (Garry Asselstine/CBC) 

"I think she was just circulating information that she thought was to the best of her knowledge, but new information shows that it's not quite the way she presented it." 

Verbora says the medical community is reluctant to engage with newer research about marijuana.   

"Cannabis is so stigmatized and that's just because in the medical community, the way we talk about it, the way we educate on it, we only talk about the harms and we don't talk about the benefits."    

For instance, Verbora says research on the endocannabinoid system has been around for over 20 years but is still not taught in medical schools. It's a system of receptors in the body that has been linked in explaining why cannabinoids help in the treatment of anxiety, depression and insomnia. 

Alam says it is important to recognize when an error has been made. 

"Making mistakes is human, but as soon as you make a mistake you have to correct it no matter your position. Whether you're the president of the Ontario Medical Association or a small-town doc."   

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Medical marijuana system will continue after legalization, says Health Canada

Health Canada will continue operating the medical marijuana system after recreational use of cannabis is legalized next month, but it will be reviewed within five years. 

The announcement came in response to a call last month from the Canadian Medical Association — which represents doctors in this country — asking that the medical marijuana system be phased out post-legalization.

Dr. Jeff Blackmer, vice-president of medical professionalism for the CMA, said at the time that many physicians are uncomfortable prescribing marijuana, citing the lack of research and evidence of its effectiveness, along with a general lack of knowledge around dosing.

Once legalization happens, Blackmer argued there will be no reason for physicians to be involved if people want to access cannabis.

Dr. Jeff Blackmer with the Canadian Medical Association says doctors want medical marijuana phased out after legalization. 5:21

"Health Canada recognizes the concerns of the Canadian Medical Association regarding the level of evidence on the risks and benefits of cannabis for medical purposes, as well as on dosage and potential interactions with other medications," read a statement issued this week by Health Canada.

"Measures under the Cannabis Act aim to facilitate research with the goal of improving our knowledge of the risks and benefits of cannabis."

The statement adds that legalization — which comes into effect Oct. 17 — will "provide for a new research licence and permit research activities under cultivation and processing licences."

"The aim of these provisions is to facilitate research and development by streamlining the process and requirements for cannabis-based research," read the statement.

"This additional flexibility will support pre-clinical and clinical research on the use of cannabis and cannabinoids for medical purposes. Such research could lead to new drug submissions of cannabis-based products for market authorization as drugs."

Health Canada will also work to evaluate the drug review and approval process for health products containing cannabis "so Canadians in need have better access to an array of medicinal options.‎"

In a statement issued Wednesday, CMA officials said they will continue to press for increased research. 

"We will continue to urge the government to invest resources and funding in independent research to assess the impact of cannabis in health and health care," it read.

"As more scientific evidence becomes available, we will work with Health Canada and other governmental agencies as well as stakeholders in the medical profession to better understand how this might fit into current medical practice. In the meantime, physicians will continue to work with their patients directly to provide the best care possible."

A review of the medical marijuana system will be done by Health Canada within five years after legalization, "to determine whether the system is meeting its objectives," according to a framework for legalization issued by the federal government in 2016

Researchers and patient advocates have expressed support for continuing the medical system after legalization. 

"It is simply a reality now that cannabis is part of the medical landscape," James MacKillop, director of the Peter Boris Centre for Addictions Research, told CBC News in an interview last month.

"I think we need to address that reality head-on as opposed to sort of walking away from the reality at this point," said MacKillop, who is also the co-director of the Michael G. DeGroote Centre for Medicinal Cannabis Research at McMaster University in Hamilton.

The Canadian Nurses Association — which represents 139,000 members — has also said it is in favour of continuing a separate system for medical marijuana, in part because officials worry that dismantling it could encourage producers to focus their efforts on recreational products.

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Girl, 4, sent to hospital after eating marijuana chocolate bar

Halifax RCMP are investigating whether any charges should be laid after a four-year-old girl was sent to hospital by a marijuana edible.

Police began the investigation after the girl, who is from East Petpeswick on Nova Scotia's Eastern Shore, ate what she thought was a regular chocolate bar Saturday.

"On Saturday afternoon, as we understand it, a gentleman was having his kids helping him to clean out his vehicle," said Cpl. Jennifer Clarke. 

"There were three young children, the four-year-old being the youngest. And I understand the four-year-old found what she thought was just a chocolate bar in the console of the vehicle. She ate 15 squares of the chocolate bar. Now the chocolate bar turned out to be an edible marijuana product."

The recommended dose of the edible was one square per day for an adult.

Cpl. Jennifer Clarke is a spokesperson for the Nova Scotia RCMP. (CBC)

The girl was treated and released from hospital. The RCMP said the chocolate bar appeared to be commercially packaged, not homemade. 

"We do know that some edibles do look very, very tempting and look a lot like a regular candy or treat that a person might see," Clarke said.

The RCMP are reminding people that recreational marijuana is still illegal to possess and that even after legalization on Oct. 17, it will still be illegal to sell edibles. People who do possess edibles should keep them locked up away from children.

Clarke said it's difficult to predict whether there will be more cases of children accidentally ingesting cannabis following legalization. Some in the industry have said they expect the demand for edibles will spike after Oct. 17.

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