On a mission to change how family doctors view medical marijuana

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From the archives: This article was originally published July 30, 2015

For the past year and a half, David Hepburn has been travelling Canada, educating his fellow family doctors on why and when to prescribe medical marijuana. Speaking at conferences, sometimes sponsored by the commercial growers licensed by Health Canada, Dr. Hepburn runs through the history of cannabis prohibition and the research that has been done on the plant. He says he is trying to change the minds of a medical establishment loath to endorse a drug that has vast amounts of anecdotal evidence, but scant clinical trials, to support its use. He said cannabis can be a suitable medicine for patients suffering migraines, nerve-related pain, neurodegenerative conditions, such as MS, and symptoms such as insomnia or anxiety.

In an interview, he describes his efforts to change how many Canadian doctors – gatekeepers for the federal medical marijuana system – view the drug.

Why did you first become involved in prescribing cannabis about a decade ago?

I was in the group that wanted nothing to do with cannabis, and it actually came from a physician [friend] in Ontario whose mother had cancer. He phoned me up and said, 'My mom is in Victoria, she is an octogenarian, cancer-stricken and her doctor won't help her. My mom would never miss a tax date or jaywalk, and yet the one thing that's helped her with both her pain and her chemo-related symptoms is cannabis.' And would I help her out? Finally I capitulated and said, 'Okay, I will help her apply for the [federal medical marijuana] program.'

I began to explore more into that and I watched this sort of explosion I guess the same way [American neurosurgeon and media personality] Sanjay Gupta would have.

He's made a 180 and I have too.

Why are Canadian doctors are so reluctant to prescribe?

They don't want to be recommending something that we've all been taught is bad for you. The reticence is legitimate, I think that it's normal. 'Hey, listen, I don't know anything about it, I'm not keen on prescribing it.' The standard things that I would hear is, 'We want to see more research into it, etc. etc.' That's a vicious circle – there isn't the research being done because of the fact that the government has made it unresearchable.

So you recommend cannabis for conditions and symptoms without the clinical trials that back up such prescriptions?

There remains a lot of good studies to be done. But because it is safe and tolerable and we know it works for a lot of people for conditions in which the research is lacking, that doesn't mean we neceassarily rob the person of the opportunity to use it now. We sit in our office day after day and year after year and we hear patients who sit down and say, 'Doc, the thing that really works for me, to be honest with you, is cannabis.' We trust these patients and we know them not to be jaywalkers. When you hear it long enough, you begin to realize that it's something that is working for these people.

Is it right for commercial cannabis growers to pay for educating doctors who are the gatekeepers to the clients that buy their products?

That goes on all the time with Big Pharma, they're the ones who sponsor all the big [continuing medical education] events. This is virtually how we do 90 per cent of our education. Routinely on a week-to-week basis, we probably get invitations through the week to two, three, four dinners put on by a specialist and sponsored by a drug company. It's nothing untoward, so to speak. There are other avenues for education – reading journals – but the journals are all supported by pharmaceutical companies, right?

What do you think about clinics specializing in pot prescriptions which say they are charging patients fees because they are helping them navigate the confusing federal medical marijuana regulations?

It's all smoke and mirrors, jiggery-pokery is being done. Personally I think it's unethical, so I charge patients nothing. What I do is I give them the options. I say, 'Here's the list of Health Canada's licensed producers, you can select one based on anything you find interesting on their Web page. Be it the fact that some of [them] offer certain deals with respect to a vaporizer and some require less amount purchased at one time.' Different LPs have different advantages and that is what the patients like.

Are cannabis oils more dangerous than vaporizing the drug?

There are those advantages to it, you can encapsulate them, however there are some disadvantages to them as well. And this is where it's very important to caution people to the appropriate uses of oral or edible or ingestible cannabinoids, and that there is a high variability to absorption rates. One of the things I heard down in Colorado is people were coming in and they were taking more and more derivatives of one sort or another. Next thing you know it all kicks in because it can take an hour or two to really take effect. People ask me the dose and I say, 'Just a little bit. Start low and go slow.'

There has been a lot of talk recently about the dangers of 'edibles.' What happens when someone is sent to hospital with an overdose?

They might give them IV, saline, tell them to go home and they'd be fine. It's not toxic. In fact, it's incredibly nontoxic, however it gives them an unpleasant experience that may sabotage the use of it. I probably would never start people on an oil, but what I like about the vaporizers is that you can titrate the dosage easily. You know in 95 seconds if it's going to work and it doesn't last very long.

You know the actual best form of cannabinoids to me is, believe it or not, suppositories? They are far and away the best delivery mechanism over all.

Why?

They go through a different absorption system, you know within 15 minutes you have it absorbed in there and it's actually done through the intestinal mucosa. You get a longer lasting effect than you would get for the vaporizer, but you also get a quicker response than you would get from the ingestibles.

This interview has been edited and condensed.