“‘Marijuana Is The New Oxycontin: Should We Be Concerned With How Docs Are Learning About Pot?” – (Global News)

The first reason why I decided to take on this article was obviously, the title. It might just be meant as click bait. But it REALLY rubs me the wrong way. As does a lot of what is contained in the piece. A regular buffet of bothersome thoughts and flat out stupidity from seemingly every angle.

Let us begin.

At the Family Medical Forum in 2017 — the largest family medicine conference in Canada — Dr. Sarah Giles was angry.

The family physician was upset for a few reasons, including that drug reps were lining the pathway to the food area (meaning docs were forced to walk through sales booths to eat), and lunchtime talks sponsored by pharma companies were not clearly labelled as such.

But what really stuck out to Giles was how many cannabis companies had set up shop in the event’s exhibitor hall.

“[Cannabis companies] are coming to these conferences in large numbers,” Giles, who is on the board of Canadian Doctors for Medicare, said. “In 2017, I think there were around 12 different [cannabis] booths, and they were telling the doctors: ‘Oh, use it for this, use it for that,’ but none of it was evidence-based.”

I concur with her feelings of resentment towards big pharma. And I don’t like the idea of marijuana companies more or less following the same lead. As though cutting through the bullshit discourse isn’t difficult enough as it is . . .

But I do have to question the not evidence-based assessment. Not because I don’t consider it a valid concern. More, because I have to question how much research was even possible given the relatively short amount of time the drug was easily accessible, and the extremely long time that it was prohibited for even most medical research purposes. It takes YEARS for most drugs to pass all the required hurdles, and marijuana has been accessible for barely a year.

Not that this surprises me. Everyone in relevant positions in Canada had PLENTY of time to prepare for the upcoming legislative change (whatever the context be), yet still, I see what often seems to amount to little more than excuses for procrastination. While the idiocy of the previous paradigm has indeed set us back (not having as much research data as we ought), this excuse only goes so far.  

But, that is a rant for (and in) another post.

To circle back to Dr. Giles concerns, no, I don’t think that the marijuana industry should be pushing anything that the science does not yet back up. Nor should any other pharmaceutical entity be allowed similarly go off label. And ultimately, none of them should be allowed ANYWHERE NEAR a convention of physicians.  

Seeing a doctor with a desk filled with drug company merchandise is troubling enough. 

Cannabis companies are becoming an increasing presence in the medical industry, touting the drug as a remedy for a variety of ailments, from pain and anxiety to endometriosis and glaucoma — and they do it with little oversight.

The legalization of recreational marijuana in 2018 no doubt helped legitimize cannabis in the eyes of many patients. But some experts say they’re concerned that pot is being pitched as a miracle cure when there is still little research into its benefits.

I do hate when the people in the industry make such bold claims about cannabis. Words like miracle cure are obviously troublesome. And as for harmless, the oh so important contextual issues are often overlooked. For example, bleach is also thought to be generally harmless (as far as chemicals go).  But that doesn’t mean one should be drinking it. 

At the same time, however, this must not become the new GMO foods debate. In a nutshell, “There is no evidence that the substance is NOT harmful!“.
It would have been GREAT if the previous generations weren’t so fearful of weed as to allow it’s usage in research projects. But since that is not the world we live in, we must wait.
Wait, and continue listening to often the SAME PEOPLE spouting on about there being “Not enough research”. Or worse, other nonsensical babble about a substance they never bothered to brush up on even a little.  

They exist in all areas relevant to the legislation, experts and medical officials alike. They are often the go-to interviewees of the media. And their continued place in the spotlight despite arguably not doing their job continues to fucking ANNOY me.

And yes, including in this article.

The College of Family Physicians of Canada (CFPC), which hosts the event, confirmed to Global News that there were 16 cannabis vendors at the last Family Medical Forum in November 2018

“Marijuana is the next OxyContin, where everyone’s like, ‘Oh, it’s not addictive, it’s harmless, it’s good,’ and people are kind of using it willy-nilly because you can get it prescribed and not prescribed,” she said.

“I think we will look back at this time and just be like, ‘What the hell was going on?’”

First of all, the OxyCotin quote . . . in this context, it fits. Though it is still annoyingly inaccurate. Oxy is a VERY different beast to marijuana’s THC. If I were to pull a comparison out of my ass, I’d say the difference between caffeine and methamphetamine.

You can not die from overdosing on marijuana. Fact.

OxyCotin overdoses have killed many people. Fact.

If the argument being made here is that all parties ought to be careful with how far they are going with off label recommendations, then I obviously agree. Particularly this early in the game (when it comes to cannabis research).

Of course, the cannabis industry wouldn’t have evolved so far ahead of the research (think of average THC and CBD content) had our trusted leaders not been so ridiculously afraid of a plant. But I suppose it is time to let bygones be bygones.

Well, on one condition. If these people stop using their so-called credentials to score interviews in which they keep beating the drum of the old status quo based on what we don’t know. Or to put it another way, attempt to stand in the way of change on account to their professional procrastination and/or incompetence.

Is medical cannabis effective?

Many cannabis companies have been quick to tout the drug as a pain reliever and a therapeutic product — which has created some pushback.

Well . . . yeah.

On the other hand, anecdote is hard to decipher from the placebo effect without actual scientific methodologies in place to account for all variables. Hence, I must be careful to not play in the same realm as the homeopath or the Acupuncturist.

“If we look at the evidence for marijuana as a therapy or as a medicine, for pain or for anything, frankly, it wouldn’t meet the threshold for what we consider a body of evidence in medicine,” said Dr. Abhimanyu Sud, a pain expert and the academic director of the Safe Opioid Prescribing program at the University of Toronto’s School of Medicine.

Sud points to a recent systematic review of medical marijuana that found the drug wasn’t a very effective treatment for pain (the review says that if cannabinoids do improve pain, it is neuropathic pain and the benefit is likely small). He also says it’s not proven to be effective for anxiety, either. Where there is some evidence for cannabis, he said, is around treating certain kinds of seizure disorders.

But beyond that, there are a lot of legitimate concerns that require further research about using cannabis.

The Safe Opioid Prescribing Center at the U of T School of Medicine?

While I can’t help but spot a potential bias, it’s not financial. The whole point of the program is to help physicians learn how to utilize the tool of opioids without the bias of industry. Which means we just have to assume they don’t have a bias for the drug because that is their focus of research.

No. I really don’t trust anyone.

Based on the linked document provided above, I take this directly from the editors key points.

-Although cannabinoids have been promoted for an array of medical conditions, the evidence base is challenged by bias and a lack of high-level research. Two large evidence synopses suggested that only 3 conditions have an adequate volume of evidence to inform prescribing recommendations: chronic pain, nausea and vomiting after chemotherapy, and spasticity.

-The authors conducted a systematic review of systematic reviews focusing on these conditions, for which medical cannabinoids have the best evidence base and the highest likelihood of having medical advantages, and on adverse events.

-These data were used to inform the development of a simplified primary care medical cannabinoid prescribing guideline

I’ll get a little more into the meat of this.

Systematic reviews focusing on pain reduction in par-ticular populations or conditions generally found incon-sistent or equivocal results. Fitzcharles and colleagues and Walitt and colleagues reported insufficient evi-dence for benefit in rheumatologic pain and fibromyalgia, respectively.20-22 Stevens and Higgins reported on 7 RCTs for acute pain and found a decrease in pain in 1, worse pain in another, and no effect in 5, concluding that can-nabinoids have no role in acute pain.23 In cancer pain, the results of the 2 systematic reviews are unclear: Tateo inconsistently reported outcomes,24 and results of the meta-analysis by Lobos Urbina and Peña Duran did not meet statistical significance (although the effect estimate suggests benefit similar to our meta-analysis results).

The research seems indeed questionable. But the dataset is also fairly small. Thus, even if I am coming at this from a point of bias, I can’t justify the throwing away of this potential new tool in the physician’s toolkit based on this. Particularly when it is a tool which is inherently far less risky than opioids, PERIOD.

“There’s reason to think that marijuana intervention can make [certain] things worse,” Sud said. “It’s not like a sugar pill; it has the potential for harm.”

Giles echoes this and says she’s seen first-hand the harm cannabis can have on certain people.

“I see a lot of people who smoke a lot of pot and end up with marijuana-induced psychosis,” she said.

A recent study published in the medical journal The Lancet found that daily use of high-potency cannabis is “strongly linked to the risk of developing psychosis.”

Health Canada also warns that cannabis use increases the risk of developing mental illnesses such as psychosis or schizophrenia, especially for people who start young, use it frequently or who have a family history of mental illness.

Of course. In every conversation about this drug involving some figure of authority, you will go down the psychosis and mental illness route.

These findings are not unfounded. These things really can happen to people. However, presenting them as a standalone argument (as seems to be the case here) is just lazy. Not that this is anything I don’t expect, given the source.

1.) Daily use of high potency cannabis. Not unlike pretty much any other drug that one could name (including caffeine!), daily use of cannabis (particularly the stronger modern varieties) can have negative effects.

Not everyone uses cannabis daily. Not everyone overindulges in this drug, just as not everyone overindulges in the drink to varying degrees.

I really have to say this?

2.) The status quo laws are what enables teenagers (and possibly even children) to easily access marijuana, to begin with. That oversight is on every single baby boomer and Gen Xer that didn’t bother to fully think through their stance on the war on drugs.

You created this mess. Own it, or shut the fuck up already.

3.)  We come back to the idiocy of the status quo. High potency marijuana bringing on unforeseen consequences in the public at large. 

a.) If this drug were being regulated and inspected like anything else available on the market today, wouldn’t these changes in potency have been easier to track and even account for?

You know, a variety of product ranging from the lesser and relaxing THC level for the beginner or recreational user to the mindblowing and trip-inducing for the Willy Nelson’s among us. Not unlike our options when it comes to pretty much all other drugs.

When the market solely dictates production, profitability trumps everything else. Highly potent is what is profitable. Thus, this is all that is available.

b.) Almost any conversation on this subject matter with someone of authority will have them bring up the irresponsible idiot argument. The deadbeat parent. The relationship wrecker. The person who let pot ruin their life. 

They saw FIRST HAND, what marijuana can do to people. Families. Communities.

They say this whilst seemingly overlooking many of the same results involving other legal AND illegal drugs, such as alcohol. Or for that matter, the case involving the irresponsible jackass that doesn’t drink or do drugs.

President Trump doesn’t drink, nor do drugs. Apparently hasn’t ever done so.

Enough said.

c.) It’s always great when those that were deliberately behind the curve on an ever-present and continually evolving industry resort to fear tactics when the whole thing suddenly runs beyond their ability to predict. When the product has changed so much in their absence that mental health complications that aren’t entirely understood are now the new reality.

So naturally, they do what the oldest generations do best . . . they finger wag. Don’t smoke pot or you may go into a state of PSYCHOSIS!

There is nothing wrong with encouraged moderation. Smoke responsibly!
Change one word, and that word of advice pertaining to another substance translates nicely.

Dr. Lydia Hatcher, an associate clinical professor of family medicine at McMaster University, sits on advisory boards for cannabis companies Canopy Growth and Tilray and says there’s “moderate” research around medical cannabis for pain.

“The National Academy of Science and Medicine, which is a big United States organization, did a very thorough review and found moderate evidence that it helps with chronic pain,” she said.

Even with limited research, the common belief that cannabis is safe and helps treat many health problems stems from the way medical marijuana became legalized and is now marketed, Sud said.

“There was a judicial decision in 2000 that said that it’s unjust to restrict access to marijuana for medical purposes so the federal government was compelled to produce an access-to-marijuana act — but this was not an evidence-based decision; this was a judicial decision,” he said.

“Now we have recreational legislation, and we are working against this idea that marijuana is relatively safe. If it wasn’t medicine, why would it be legalized?”

What a moron. Sud, that is.

Of course, the decision to reverse the prohibition of marijuana was not an evidence-based decision. THERE WAS NO EVIDENCE! BECAUSE OF THE LAW!
SURELY he cannot be that stupid . . .

And then he proclaims that the medical profession is working against the notion that marijuana is relatively safe . . . BECAUSE IT IS RELATIVELY SAFE!
Opioids may be tricky due to the whole there is no known safe dosage of opioids issue, but not EVERY drug is an opioid.

I’m beginning to think my initial suspicion was correct. This man can’t see past his own niche.

Should docs be getting their cannabis knowledge from pot companies?

Marketing efforts by cannabis companies paired with legislation has pushed pot to the forefront of many patients’ minds.

Though this is the status quo for every drug company (OTC or not) that advertises on any medium, obviously not.

Still, many doctors have expressed discomfort around prescribing cannabis to patients, citing a lack of evidence that it’s an effective treatment for things like pain, sleep disorders and anxiety. There are also concerns around dosing.

But that’s where licensed producers come in.

Jordan Sinclair, the VP of communications at Canopy Growth, said the cannabis company operates “continuing medical education” events that educate “physicians about cannabis science.”

There’s a knowledge gap, he says, as many doctors aren’t educated on the drug.

“Physicians don’t understand this medicine because it’s not included in medical schools,” Sinclair said.

“Patients have a constitutional right to access [cannabis] information, but doctors don’t understand the science because it was never taught so industry is in this odd position where, until medical schools have this in their curriculum, we are, in most instances, one of the primary sources of information.”

This is indeed, problematic. Physicians who are reluctant for the right reasons are justified to be. We just have to close this gap. 

Which leaves us in a bad position for at least a number of years. Longer, unless commonly cited idiotic excuses (like those of Dr. Sud) don’t get tuned out fairly quickly.

These learning workshops or panels are common in the pharmaceutical industry, and drug companies often pay doctors a speaker’s fee or honorarium to present at such events. Sinclair says Canopy Growth, which owns brands including Tweed, Spectrum Cannabis and Tokyo Smoke, gives doctors who present at their cannabis educational sessions an honorarium, too.

While doctors are free to make their own decisions, Sud says paid presentations or informational talks with industry can lead to bias and conflict of interest. Research shows that pharma reps present only selected, usually positive, information about their drugs to doctors and may omit potential risks.

Sud says there’s reason to be concerned that cannabis companies may follow the same route.

“[Conflict of interest] is a big concern, and there’s research around [how] doctors can underplay how much they are influenced by industry so we don’t recognize as much bias that’s actually out there,” he said.

While I don’t disagree with the assessment, ill take it with a grain of salt coming from someone that comes across to me as having their own circumstantial conflict of interest.

Part of leading cannabis education also means producers are investing in their own research.

Canopy Growth recently announced a partnership with the NHL to research if CBD can help treat post-concussion neurological diseases in former hockey players. Tilray has started studying how older adults use cannabis. Aurora Cannabis launched a research project with McGill University to study the effects of CBD “as a therapy for chronic pain and related anxiety and depression.”

There’s a dark history, however, of industries like sugar and tobacco publishing misleading studies or suppressing research that went against their own interests. Sud also points to research that shows industry-sponsored studies are often biased in favour of the sponsor’s products.

And within the medical industry, there’s no greater recent example of lying about the effectiveness of a drug than Purdue Pharma, the manufacturers of OxyContin. Evidence shows that the drug company intentionally misled doctors and patients on the drug’s effectiveness and lied about its addictive nature.

Indeed, a perfect example of an all too familiar problem. When unfettered capitalism meets medicine. Which makes me personally question whether or not it is truly ethical for any aspect of the medical profession be for profit. 

The answer to that is obvious. It’s not. But . . . one thing at a time.

Marijuana is only just barely been legalized.

Sinclair acknowledges that a cannabis company researching and educating on the benefits of cannabis may present as a conflict of interest but insists that as long as there’s disclosure and a third-party literature review process, there’s no need for concern.

He also points to the process of hiring Dr. Mark Ware, who was an associate professor of family medicine and anesthesia at McGill University, as Canopy Growth’s in-house chief medical officer. Sinclair said Ware had to step down from certain academic positions so there was a clear distinction between his role at Canopy Growth and outside work.

An interesting note here on Canopy Growth. 35% of it is owned by Constellation Brands, a parent company more commonly known for its alcoholic beverage brands (such as Corona and Modelo).

This happened in November of last year, and is bittersweet news, really. On one hand, the billions of dollars should persuade hard-nosed anti-drug conservative-led federal governments to leave the now flourishing legal industry the hell alone. But on the other hand, the corporations now have their claws deep in the industry.

Then again, no gain is without compromise.

“You watch a talking head pundit on TV, and all [they] have to do on the outset is say: ‘Hey, just in the interest of disclosure, I work for this company so people should know that,’” he said.

Given the situation, I would say that we have a good balance. Being that there is currently no alternative to be had than what the marijuana industry is currently producing, this is the best one could hope for. Industry self-policing for the sake of integrity.

It’s certainly not ideal. But it will do until those that spent the past several decades procrastinating finally catch up with the times. Considering the MASSIVE amount of cannabis plant and market evolution just during the span of the war on drugs, and the MASSIVE amount of evolution that legalized growth will bring to the table, we should be caught up by around 2100.

Which will come first . . . marijuana literature and marijuana industry on the same page, or the demise of human civilization VIA climate change?

I’m not a betting man, but I would wager the later on $100 bucks any day.

How are cannabis companies pitching pot?

Outside of educational events and exhibiting at medical conferences, doctors say some cannabis companies are acting unethically when it comes to interacting with health-care professionals.

While health care is provincially legislated, the CFPC — the professional association that certifies doctors in the country — has nationwide policies when it comes to how docs should interact with the drug industry.

These policies say that doctors cannot accept gifts from pharma reps and should disclose if they’re receiving an honorarium or speaker’s fee from a drug company when presenting related material at a conference. In other words, the goal is to be transparent around any potential conflicts of interest.

Research shows that gifts from the pharmaceutical industry — even things as small as pens — can affect a doctor’s prescribing habits. A recent study published in JAMA Network Open found “a strong association” between aggressive marketing of opioids to doctors in the U.S. and increases in prescribing the drug.

Well . . .  yeah. Such is the goal of a good marketing campaign. Spend pennies, and watch the dollars flood in.

Makes me wish there were more teeth to the watchdog organizations than merely demanding disclosures. How about no industry affiliations, PERIOD. Particularly in places like Canada, where some of those market-driven earnings may well be coming out of the pockets of taxpayers.

I am not usually one to voice an ideologically conservative argument, but I’ve gotta say it. When the taxpayers are footing the bill, the prescribed drugs better be the best choice for the ailment. Not the preferred choice of a compromised physician. 

The CFPC says that health-care professionals should adhere to the same code of conduct when it comes to interacting with cannabis companies, but Giles says licensed producers do not play by those rules.

“It used to be that doctors would get concert tickets, they’d get trips skiing, all of this stuff. Then the rules changed to say that basically the only thing doctors can get is food, but the marijuana producers haven’t signed onto that,” said Giles.

“Recently, I was invited to a talk about the benefits of marijuana that was being hosted in a box of an [Ottawa] Sens game. And I was like, ‘Are you kidding me?’ My mind was blown… It actually makes Big Pharma look like the good guys for having some restraint, whereas marijuana is just going crazy.”

Bloody fucking hell.

The rules changed. Cannabis has not signed on. Big pharma looks like the good guys.

No, cannabis growers should not be showering doctors with merch, trips or other integrity compromising incentives. However, big pharma is not the good guys for showing restraint in the face of the cannabis industry currently following a different set of rules. Big pharma is showing restraint because THEY HAVE TO! THEY HAVE TO FOLLOW THE RULES, AS YOU JUST FUCKING SAID!

Is every medical professional interviewed in this piece so far up their own ass that they can’t detect the biased idiocy escaping their own lips?!

Speaking of big pharma . . . HERE IS JUST HOW MUCH RESTRAINT THEY DEMONSTRATE WHEN NO ONE IS WATCHING!

By the time I’m done writing this, I may well need to take a trip to a dispensary.

Hatcher said she’s heard of cases where cannabis companies act unethically and offer incentives to doctors to prescribe their product.

“There are physicians — and I have no proof positive of this but I hear this through talk and from patients — who are sending all their patients to company ‘X,’ and I have heard there are companies who are paying physicians to do that, which is absolutely non-ethical and shouldn’t be allowed,” she said.

“I know there are also physicians who are seeing patients through Skype and non-recognized methods of telehealth and prescribing that way, which is also not ethical.”

On a smaller scale, Hatcher says pot producers hand out branded merchandise, like pens and notepads.

“They are [also] producing documents and brochures that often have the company name — a lot of which has been disallowed for the pharmaceutical industry,” Hatcher added.

I heard . . . I hear . . . good thing this isn’t a court of law, or that hearsay would be LAUGHED right out of the courtroom.

However, the point being made is noted. Marijuana producers should be held to the same standards as the rest of the drug industry. And more importantly, doctors should be held to the same standard when it comes to resisting such marketing attempts.

Canopy Growth and Aurora Cannabis both said they hand out branded pens and the like but do not give doctors gifts. Despite multiple requests, representatives from Aphria and Tilray did not respond to requests for comment.

Sinclair says that because of the unique space cannabis operates in, it’s up to licensed producers to develop their own approach to industry interaction.

“There are guidelines out there for pharmaceutical sales, and we use those to inform our own approach,” he said. “We’re always in this area where the normal rules don’t apply so we have to chart our own course.”

I’m going to raise the alarm on the final statement of the previous paragraph (made by Sinclair). It’s risky that they interpret this as being a case where the normal rules don’t apply . . . what an idiotic thing to say.

First off, I doubt this unlevel playing field will last. Second, the marijuana industry COULD follow the spirit of the pharma rules if it so chooses. It just, it seems, chooses to make its own interpretations on the fly. Because that is what businesses do. When you have an edge, why let it go to waste.

Once again, medicine meets capitalism.

Differences between Big Pharma and cannabis

Unlike with prescription drugs, it’s up to patients to decide what licensed producer they want to buy from with their medical script.

Hatcher says she doesn’t tell her patients where to get their medical cannabis and says it’s up to them to do their own brand research.

“It’s complicated research because, at least at the present time, there are at least 30-plus companies doing direct-to-consumer selling… and then once the patient has selected their licensed producer, we just do the prescription,” she said.

“That means as long as the physician is using that approach then the bias really is the patient’s bias.”

Giles says there’s a reason cannabis companies are putting themselves in front of doctors, even if it’s up to a patient to decide where they will buy their medical marijuana.

“All of these doctors think they’re immune to having their prescription habits influenced, yet every study shows we are all susceptible to it.”

There are indeed several problems here. But also nothing that can’t relatively easily be remedied. Frankly, a good chunk of this article was making a mountain out of a molehill. And I don’t really lay blame at the feet of author Laura Hensley either. Her chosen experts were just . . . idiotic. Not unlike those likely to be chosen by any other reporter with such an assignment.

Let’s demonstrate how easy this is to tackle.

1.) No cannabis OR pharma industry incentivization is allowed to benefit physicians. Doctors caught accepting such bribes shall be SEVERLY fined, possibly even subject to suspension of their medical licence (if not a full revoke of it after numerous offences).

2.) Purchasing medical marijuana is a headache and an undue burden on the average consumer, so a standardized guidebook (of sorts) should be made to make the choice easier for both consumers and pharmacists. Consumers should be able to access it, but for those who choose, the option of making the purchase through a pharmacist should also be made available.

Of course, this adds yet another middleman to the mix which may well be susceptible to kickbacks. The video linked above showcases this perfectly. However, AGAIN, it’s not something one can’t solve.
Fines. Suspended licencing. And if they STILL don’t conform to the laws of the land, revoke the licence to operate. Whether affiliated with a well-known brand or operating independently, a revoked pharmacy licence should be a penalty to scare most offenders into compliance.

When it comes to marijuana, there is a way. The trick is sticking to the forward journey. Not digging the heels in and looking back.

Particularly if you are an MD.

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